Exciting cause may be: Exposure to cold and wet, improper food, unhygienic surroundings, worry, blows and acute infections.
Conditions.—Several joints are usually involved symmetrically. At the edge of the joints there is formation of new bone covered with cartilage, causing the enlargement of the bone and often partial loss of motion in that joint.
Symptoms.—Several distinct types exist. 1. General progressive types which may be acute or chronic.
Acute.—This occurs usually in women from twenty to thirty and at the change of life. It comes on like acute joint rheumatism, many joints being affected, permanent enlargement appearing early, redness of the joints rarely existing, the pain being very severe, some fever, feel very tired, with anemia, loss of flesh and strength. The first and later attacks are often associated with pregnancy, confinement or nursing.
[CONSTITUTIONAL DISEASES 315]
Chronic Type.—There is a gradual onset of pain or stiffness in one or more joints, usually of the fingers, then of the corresponding joints of the other side and then other joints. The swelling at first may be in the soft parts of the joints with effusion in the joints and tenderness. The pain varies from slight to severe. Periods of improvement and getting worse alternate; the joints becoming enlarged and deformed, often nearly stiff in partial bending on account of the thickened bone and soft tissues. The muscles that move the joint dwindle and there may be changes in the skin and nails of the parts affected due to the want of proper nourishment. Disturbances of the stomach and anemia are common. The heart is not affected. There may be only a few joints affected, or many, with great deformity, before the disease reaches the period of inactivity.
2. Monarticular or one joint type.—This usually occurs in males over fifty; one joint or a few large joints may be affected, generally with shrinking of the corresponding muscles. If it occurs in the hip it is called Morbus Coxae Senilis,—Hip joint disease in the aged.
Recovery.—The disease usually goes on with intervals of improvement and often results in great crippling and disability. In some cases it becomes permanent.
General Treatment.—The climate should be warm and dry. The patient should avoid exposing himself; lead a general hygienic life, with as nourishing food as his digestion will permit. The chief line of treatment should be to improve the general health and relieve the pain. The stomach, bowels, and kidneys should be kept working well. Nourishing food should be taken, but its effect must be watched. Cod-liver oil to build up the system, iron and arsenic may be of value. Sometimes iodide of potash is good. Early and thorough treatment at Hot Springs offers the best hope of arresting its progress, the Hot Springs in Bath County, Va., and in Arkansas. Much can be done at home by hot air baths, hot baths, and compresses at night to the tender joints.
Local.—Massage carefully given is helpful. The hot air treatment is good.
Baking the joints is now frequently done.