Arthritis deformans : comprising rheumatoid arthritis, osteo-arthritis, and spondylitis deformans / by R. Llewellyn Jones.

  • Jones, R. Llewellyn.
Date:
1909
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Licence: In copyright

Credit: Arthritis deformans : comprising rheumatoid arthritis, osteo-arthritis, and spondylitis deformans / by R. Llewellyn Jones. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

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    main sub-divisions, rheumatoid arthritis and osteo-arthritis, were described and differentiated by Charcot; indeed, as will be seen later, it is easy to discern in his and Vidal's writings a foreshadowing even of the pathological division recently advocated by Goldthwait into atrophic and hypertrophic arthritis. One of the main obstacles to progress in the past undoubtedly arose out of our tacit adherence to this illustrious physician's conception of the essential pathological unity of all forms of the affection. As evidence of this do we not frequently see it inferred that osteo-arthritis is merely the later or more advanced stage of rheumatoid arthritis ? What actual evidence have we that the atrophic or rheumatoid type does at any stage of its life history take on the characteristics of the hypertrophic or osteo-arthritic variety ? Assuredly we have no pathological basis for this assumption ; indeed, such as we have points to the fact that new bony formations, so specific a characteristic in osteo-arthritis, are invariably absent in rheumatoid arthritis, at all events in its early stages, and such as may develop later are inconsiderable, and not comparable either in size or character with those of osteo-arthritis, in which disease bony outgrowths appear early and are constantly present. It is true, as McCrae and others, including myself, have noted, that in any given case, while some of the joints may be of a rheumatoid type, other articulations in the same individual may be of an osteo-arthritic character, but such instances of the overlapping of the two varieties are comparatively rare, and as Goldthwait, who also admits this occasional co-existence, remarks, the articular lesions can usually be distinguished by their onset at different periods of the patient's life, as well as by their distinctive and widely differing characters. This existence side by side of rheumatoid and osteo-arthritic lesions cannot, however, be construed as a proof of their identity, or that one form may gradate into the other. We have an analogy afforded us by those instances in which the arthritic lesions of gout and osteo-arthritis are present in different joints of the same individual. We do not presume, therefore, that gout and osteo-arthritis are identical, or that one passes into the other, because of their occasional co-existence