Volume 1

A system of medicine / edited by J. Russell Reynolds.

Date:
1866-1879
Catalogue details

Licence: Public Domain Mark

Credit: A system of medicine / edited by J. Russell Reynolds. Source: Wellcome Collection.

    905/976 (page 885)
    886 degree capable of being inherited; whereas gout is distinctly hereditary. , _ ,, • The sex of the patient does not aid us much. Both sexes are liable to the disease, and the difference in their liability is too slight to enable us to give it much weight in diagnosis. Nor does the age of the patient argue much, as it has been shown that Rheumatoid Arthritis attacks both children and very aged persons. In many instances Rheumatoid Arthritis is preceded by a condition of ill health; there are evidences of bad nutrition and exhaustion of the nervous system. Rheumatoid Arthritis usually begins as a subacute disease, and the joint affection gradually increases; but occasionally it commences in an acute form. These latter cases may be mistaken for acute gout or rheumatic fever. There are, however, peculiarities in its course by which it can generally be distinguished from either of these diseases ; the most marked being its progressive character, which has been fully described above. From acute gout it may be distinguished by the length of the paroxysm, the absence of periodicity, by the large and small joints being equally attacked at the outset, and the great toes not being specially involved. From rheumatic fever or acute rheumatism by the comparative freedom from constitutional disturbance, the longer duration of the paroxysm, and the absence of acute cardiac inflammation. From chronic rheumatism it can be distinguished by the com- parative absence of structural alteration in the former disease. The most frequent difficulty which occurs is to separate chronic Rheumatoid Arthritis from chronic gout, and, on referring to the article “ Gout,” in the present volume, a case illustrative of this diffi- culty wiR be seen. There should be always a careful search made for evidences of urate deposits on the ear and at the tips of the fingers, and in the bursae over the olecranon process of the elbows; but from mere inspection it is difficult to make a diagnosis, especially if the affection has become chronic. When the diagnosis is very obscure, notwithstanding that the above rules have been followed, it may be at once cleared up by an exami- nation of the blood : in Rheumatoid Arthritis there is no uric acid present; there is also, in most cases, the absence of any material alteration in the urine. One disease is with difficulty separated from the acute forms of Rheumatoid Arthritis—namely, the joint affection arising from urethral suppuration; the history of the case will of course enable us to clear up the diagnosis. Prognosis on Rheumatoid Arthritis.—Rheumatoid Arthritis is un- questionably a very intractable disease, and this is not to be wondered at, if we consider its ordinary antecedents. Its most common pre- disposing cause is a thoroughly impaired condition of the system,