=Osteopathic Etiology= and =Pathology=.—This disorder should be studied
in connection with arthritis deformans owing to similar sources of
infection and various common factors. It usually develops slowly and
follows an acute or subacute attack and is common among the poor,
especially those exposed to damp and cold. Heredity, advanced years,
although the disease may appear at any age, and constant exposure to
cold and wet are predisposing causes. Chronic lesions to the spinal
column corresponding to the affected area are found. Too much stress
from an osteopathic point of view cannot be placed upon the importance
of lesions to both the digestive organs and to the joints especially
involved. Then, in addition, particular attention should be given
osteopathically or surgically, or both, to sites of focal infection.
=Pathologically=, the capsules and ligaments of the joints are
thickened also, the sheaths of the tendons around the joint, so that
in long standing cases the movements are impaired. In severe cases the
cartilages may be eroded. Atrophy of the muscles covering the joints
sometimes occurs, especially when there is neuritis; thus producing
marked deformity. This muscular atrophy is particularly marked when
the shoulders or hips are involved. The atrophy is caused partly from
disease; in cases where the joint is distended with effusion, the
wasting may be due to pressure upon the muscles or blood-vessels.
=Symptoms.=—Several joints are usually affected; but it may be limited
to one joint, particularly the knee, hip or shoulder. Pain and
stiffness are the most common symptoms. The pain is increased upon
motion, while the stiffness is often lessened by using the limbs. The
joints are slightly swollen, but seldom reddened and are usually tender
upon pressure. All the symptoms are aggravated on the approach of
stormy weather. There is fever but the general health is not greatly
impaired. There may be distortion of the joints and ankylosis may
occur. Arterial degeneration and chronic endocarditis may develop as
complications.
=Prognosis.=—This should be guarded so far as a complete cure is
concerned; although most cases are greatly benefited.
=Treatment.=—The treatment of chronic articular rheumatism is largely
correcting lesions of the spinal column, which affect the diseased
tissues as well as the digestive organs, local treatment of the joints,
and removal of focal infections. A certain percentage will respond to
osteopathic measures alone, though surgery has a definite place in
others. The joints and limbs should be thoroughly treated so as to
restore a better circulation and relieve the inflamed tissues. Wrapping
the affected joint with cold cloths and then covering the cloths with
flannel and oiled silk is often helpful. Due attention should be given
the general health, such as nourishing food, free elimination and
outdoor exercise.
Probably in some cases where the primary infection has been eliminated
secondary foci are present and a general treatment will arouse
sufficient reaction to cope with the condition.