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Arthritis Deformans

Arthritis deformans has unfortunately been called by several names
besides the descriptive term which, in the present state of our
knowledge, is the most suitable for it. We do not know its cause. We
do not well understand even the predisposing factors in its causation.
Hence, the term arthritis deformans, which declares simply that it is
an inflammatory condition of the joints producing deformities, exactly
fits it. It has often been spoken of by such names as "rheumatic
arthritis," or "rheumatoid arthritis," and, above all, by the
unfortunate term "rheumatic gout." Many of the worst suggestions that
attach to the word rheumatism are founded on these ill-chosen
designations. Arthritis deformans was supposed to be connected with
rheumatism or with gout, or perhaps to be due to a combination of the
two. In a majority of the cases there is no history of either true
gout or rheumatism to be obtained from the patient, and where a
rheumatic or gouty history does occur, it is either quite indefinite
or it is clear that arthritis deformans developed in a gouty or
rheumatic subject, that is, following genuine gout or rheumatism, just
as it might develop in any other individual without any causal
connection between it and the other affections.

Supposed under the old theory to be a constitutional, probably a
blood disease, patients who saw the ugly, crippling deformities
produced by it and then heard the word rheumatism used in
connection with it were prone to think of this as the terminal stage
of all the severe rheumatic conditions. As a matter of fact no
evidence that we have shows that the disease has any connection with
chemical modifications of nutrition or metabolism; nor, above all, has
the so-called uric acid diathesis or any other superacidity of the
blood any etiological connection with it. It has always seemed to me
to be clearly a nervous arthropathy, as the lesions are almost without
exception more or less symmetrically distributed. The joints that
suffer are commonly the smaller ones in corresponding positions on
opposite sides of the body, and they run a definite atrophic course
sometimes with the preceding phase of hypertrophy that is so
characteristic of the trophic lesions of an affection produced by a
disease or defect of the nervous system. This symmetrical distribution
constitutes the best possible evidence that arthritis deformans is not
a nutritional disease and, above all, is not due to chemical changes
in the blood.

The affection exists in at least three forms and there is a growing
persuasion that there are even more varieties of it that will have to
be separated by clinical observation.

There is a good study of the three types of the disease in Guy's
Hospital Reports, Vols. 56-57, London, 1902. The article is entitled
"Acute Rheumatoid Arthritis," but there seems no reason for applying
the word rheumatoid to the group, especially since there is no proved
connection with rheumatism and no similarity, except in the case of
acute deforming arthritis in which at the beginning it may be
difficult to differentiate the two affections.

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