Definition.—A specific septic arthritis, or synovitis, due to the poison of gonorrheal virus, and resembling rheumatism, though the latter term is a misnomer. While it may occur during the acute stage, it usually follows or accompanies the gleet.
Etiology.—This disease is entirely distinct from rheumatism, therefore to designate it as gonorrheal rheumatism is a misnomer. It is due to the virus or toxins developed from gonorrheal infection, poisoning the articulations, giving rise to a septic synovitis or arthritis.
Pathology.—The evidence of synovitis is not different from that of ordinary inflammation of the joints. In some cases there is but little if any effusion, and the membrane presents a dry appearance, and the inflammation extends along the sheaths of the tendons for quite a distance. There may be effusion into the joints, and in rare cases this may become purulent. In the more chronic form the effusion is quite marked.
One peculiarity of the arthritis is in the virus selecting, for a display of its power, joints not usually involved in rheumatic arthritis, such as the sterno-clavicular, sacro-iliac, intro-vertebral and the temporo-maxillary. There is more apt to be stiffness of the joint following this lesion than in rheumatic arthritis, due to fibrous adhesions and a thickening of the membrane. Endocarditis is not an uncommon complication, which may assume an ulcerative form.
Symptoms.—Usually the joint symptoms develop upon the subsidence of the flow from the urethra. The symptoms vary, usually being of a milder type in the acute than in the chronic. In the acute form, there may be but little swelling of the joint, though the pain is severe and more persistent than in ordinary arthritis. There may be, however, all the symptoms of an acute fibrous inflammation of a joint, with swelling and great pain on motion; the pain is often aggravated at night; the inflammation, extending along the sheaths of the tendon, may pass to the periosteum, giving rise to edema, which persists for weeks or months.
In the chronic form, there is more effusion into the joint, consequently more swelling, and less tendency on the part of the patient to move the injured member. Pain is the chief feature in both the acute and chronic forms.
Diagnosis.—The history will greatly aid in the diagnosis, and should the patient deny a venereal infection, the persistent pain and absence of a general or systemic trouble, and the unusual selection of joints, will render the diagnosis easy.
Prognosis.—This is favorable, though the course of the disease is slow, and more or less stiffness remains for a long time after recovery.
Treatment.—Berberis aquifolium promises some relief, and should be used freely. In the use of local measures fixation will give the best results. Where the pain is very severe, the patient had better undergo anesthesia and the injured member firmly bandaged or even placed in a plaster pans cast. In the chronic form, free incision and thorough irrigation is highly extolled, and no doubt good results attend this procedure.
The Eclectic Practice of Medicine, 1907, was written by Rolla L. Thomas, M. S., M. D.