Observations on rheumatoid arthritis, Heberden's nodes, Dupuytren's contraction, and some other arthritic conditions / by Sir Dyce Duckworth.
- Dyce Duckworth
- Date:
- [1899?]
Licence: Public Domain Mark
Credit: Observations on rheumatoid arthritis, Heberden's nodes, Dupuytren's contraction, and some other arthritic conditions / by Sir Dyce Duckworth. Source: Wellcome Collection.
Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.
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![M. Lancereaux has directed attention to a slowly progressive variety of arthritis, which he connects with chronic interstitial nephritis, arising from, or occurring as part of, the condition of arterio-capillary fibrosis. He notes the absence of uratic deposit, the destruction of articular cartilage, and the forma- tion of ecchondroses and bony outgrowths. The joints chiefly involved are the nietacarpo-phalangeal of the thumb and the knees. He regards the disorder as independent of gout and saturnine impregnation, and presenting the characters of rheu- matoid arthritis, and due to a neuro-trophic defect.^ I do not think these observations have been much noticed or confirmed by other observers, and I am disposed to regard these changes, which I have myself observed, as dependent upon a gouty habit, and to represent some of the incomplete forms of gouty arthritis. I may allude here to Dr. Archibald Garrod's views respecting what he regards as examples of secondary rheu- matoid arthritis. He believes that joints which have been involved by rheumatism, gonorrhoeal arthritis, or gout may sometimes undergo the peculiar dystrophic change of rheu- matoid arthritis, the original specific irritant having in each case determined the onset of the new form of degeneration. From the point of morbid anatomy, regard should be had to the specific differences which are to be found in the out- growths respectively of gouty and rheumatoid arthritis. Those of the former are of the nature of exostoses, and those of the latter are ecchondroses, as shown by Dr. Wynne.^ Lancereaux's variety of dry arthritis is perhaps somewhat allied to the condi- tion of Heberden's nodes, of which I will next treat. As the result of many observations, I have come to regard these as more often significant of a truly gouty tendency than a result of any rheumatic condition. They are met with in certain families, many members of which may be overtly gouty, and they are distinctly hereditary. They appear sometimes to be little more than a senile change, and are regarded by some authorities as indications whereon to prognosticate longevity. A node may be the result of a local injury to a solitary joint in a gouty subject. In some persons these nodes are rendered active and ])ainful by any gout-provoking food or conditions. Charcot noted the frequency of cancer in women who manifested them. Heberden's remarks about them have been, I think, somewliat misunderstood. What he meant to infer was that they were not ordinary examples of gouty arthritis, and that they oc- curred in persons in whom gout was unknown. But we have \ m''^** I*^err)nt. MpcI. OoiisfresH; vol. ii. p. T93. Loudon, 1881. ' Trciitise on Gout, Duckwoitli, p. 77, 1B89.](https://iiif.wellcomecollection.org/image/b2146117x_0009.jp2/full/800%2C/0/default.jpg)
