At all events muscle atrophy, sometimes with pseudo-ankylosis, sometimes with actual ankylosis, will characterize most of these cases, and muscles naturally disappear as they functionate less and less.
Pain is an irregular feature, some of the lesions being quite painful, others almost free from it. The lesions are essentially progressive in their character, unless the whole body condition and environment can be changed for the better. Consequently individuals become more and more crippled. Muscle spasm is rarely present, but when such changes occur in the intervertebral joints the individual becomes gradually bent over or deformed, partly because the muscles no longer have strength to maintain the erect posture, and partly from actual changes in the bones and joints. Most of the instances, however, are characterized by tenderness, while a general myalgia or malaise is a frequent complaint. There are sometimes exacerbations, during which both severe neuralgic pains and mild fever are quite pronounced. Not infrequently on handling the affected joint pseudocrepitus or actual crepitus will be obtained. Sometimes the joint surfaces are roughened, and then this sensation is most pronounced. When the synovial membrane is proliferated, in pannus form, over the cartilages, its enlarged fringes will give a soft crepitus which is quite distinctive. Fragments of these fringes, as well as of cartilage, may become detached, and loose objects of this kind in the joint may be recognized by the sense of touch.
Fig. 195
General osteo-arthritis, with multiple synostoses (“ossified man”).
While this is going on within the joint, adjoining tendon sheaths and bursæ become more or less involved, and even the periosteum will undergo considerable thickening.
The monarticular type is more frequent in men than in women, and occurs more often in a large joint or in the spine, in which latter case it is hardly to be considered monarticular. The changes that may occur in the spine are distinctive, varying from trifling stiffness and limitation of motion to pronounced deformity, by which, for instance, not only the kyphosis of acute spondylitis may be imitated, but the body flexed to an angle with the axis of the pelvis and fixed there, so that the individual is bent to nearly a right angle. Some of the other deformities of this condition are more or less characteristic. In the hands the fingers are bent toward the ulnar side, and often strongly flexed, perhaps even overlapped, thus giving the hand a peculiar claw-like appearance. The feet are extended completely, the joints rigid, the toes turned outward, and also overlapping. By such changes in the hip and knee the legs and thighs may be flexed and the hips perhaps so ankylosed as to prevent separation of the knees. While these changes are, as stated, most common in the later years of life, children are not exempt, girls being more frequently affected than boys, the condition coming on at first with more or less acute symptoms. These children will often be found to have enlarged spleens and lymph nodes, to show malnutrition, while some of them will display certain symptoms of exophthalmic goitre. In other words, they are in that condition included under the term status lymphaticus, to which subject the reader is referred. (See [p. 163].)
It would appear, then, that we can expunge the term chronic articular rheumatism, since by it is not meant the ultimate result of an acute rheumatic affection, but rather one of the vague conditions described above.
[Fig. 195], taken from a skeleton in the author’s possession, illustrates an extreme condition of this kind, characterized by multiple synostoses, nearly all of the principal joints being involved.
As between the terms osteo-arthritis and arthritis deformans it is not practicable to make such accurate distinctions as shall be acceptable to all. In a general way the more the bone participates the more we may use the former designation, whereas when other joint structures are chiefly involved we may resort to the latter.