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. I
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.