Note 31 — Chapter XXXI · SURGICAL DISEASES OF THE JOINTS AND JOINT STRUCTURES.

The following types of arthritis bear little, if any, relation to true rheumatic disease, though often spoken of as rheumatoid:

The chronic villous form, most common in the knee, purely local, without effusion, and giving dry crepitus or creaking. The joint fringes are numerous, and sometimes vascular. If the crepitus be marked and the fringes too extensive the latter may be relieved by operation. Otherwise this form is to be treated by early local stimulation, with some support, at least with a bandage.

The atrophic form, of unknown etiology, causing progressive and finally crippling swelling, with later atrophy. There is little if any fluid present. Here the changes occur in both bone and cartilage, with a tendency to abnormal calcification. In this form rest and hypernutrition, especially with normal proteids, are called for, and every possible stimulus to elimination through all the emunctories.

The hypertrophic arthritis, by which cartilages are first thickened and then ossified, interfering with motion and with contour. This form causes great limitation of motion and sometimes pressure on nerves, with referred pains. It seems to have some relation to cold, exposure, and injury. Detachment of pieces of cartilage is not uncommon, so that there are loose bodies in the joint cavity. Treatment here consists of fixation, with improvement of nutrition and elimination. This form may subside under proper treatment.

The chronic, gouty arthritis, with deposits of sodium urate in and around the joint tissues, with perhaps some bone absorption beneath them, which are not connected with the bone. In the digits entire phalanges may disappear by absorption. The treatment here is essentially constitutional and directed toward the gouty diathesis.