Note 41 — Chapter XXII · CLINICAL DIAGNOSIS (continued)

In support of this contention, I would note that Charcot, while he gives us an inimitable account of the tophaceous variety of gout, introduces also another variant, as he deems it, of chronic articular gout. The joint changes in this latter are marked by what he terms “a thorough atrophy,” including the superjacent skin, which “is pale, shining and polished.” With this are associated ankyloses, angular deflections, and partial dislocations. The joints, he states, “may be absolutely free from swelling, for example when the extra-articular urate deposits either do not exist at all, or only mere traces of them, or when only the articular cartilages are invaded by the urate of soda.” It cannot, we think, be doubted that the clinical content of this group is largely made up of rheumatoid or atrophic arthritis. The evidence that these examples, quâ uratic deposits, are of “gouty” nature, is obviously very slender.

Reverting to Sir Dyce Duckworth, this authority also recognises two varieties of chronic articular gout: (a) tophaceous gout; (b) chronic deforming gout, with as its synonym arthritis deformans uratica. As to the clinical content of this latter group he writes: “The fingers, hands, and wrists show various deformities depending on over-growth of articulating ends of bone, cartilage, ligaments, and bursæ. These may be complicated with visible or invisible tophaceous deposits.” As to these anatomical alterations, Duckworth regards them as “similar to, but not the same as, those induced by rheumatic disease.” But he adds: “It is very rare for the deformities of true gout to attain the gross characters peculiar to chronic rheumatic arthritis; they are altogether of lesser degree in the majority of the worst instances.” From a careful study of their anatomical characters, I cannot avoid the conclusion that they were in the main examples of the hypertrophic variety of arthritis deformans, viz., osteoarthritis.