Types and Treatment of Chronic Rheumatism
The use of the term “rheumatism” by clinicians has caused a great deal of confusion among physicians. It is not synonymous with arthritis, which includes all the inflammations of the joint, or with arthropathy, which comprises all joint diseases. It does not include gout, which is a disorder of metabolism accompanied by joint symptoms which are usually acute but may become chronic, nor does it include the chronic joint disturbances occurring in hemophilia and certain diseases of the nervous system. Likewise, those disorders are excluded which are the result of the localization in the joints of certain bacteria such as the tubercle bacillus, the gonococcus, the staphylococcus and other bacteria of specific type. In the latter group the lesion is a septic process best designated as specific infective arthritis, which is usually primarily an acute infection but may become chronic. The joint lesions are metastatic expressions of a blood-borne infection and the joints, at least during the acute stage, harbor the specific bacteria which incite typically a purulent effusion. It is evident also that joint disorders resulting from trauma alone, in which the lesion is local, should not be called rheumatism.
If one excludes gout, the arthropathies secondary to lesions of the central nervous system and similar disturbances, specific infective arthritis, and traumatic arthritis, there remains a great group of chronic joint diseases which are designated “chronic rheumatism.” This is a constitutional or generalized disease accompanied by joint manifestations. The word “constitutional” should be stressed. It is defined by. . .