The Treatment of Infective Arthritis With Special Reference to Hyperthermia

Abstract

The term, infective arthritis, is applied to a group of diseases in which there are inflammatory changes in one or more joints of the body, known to be, or believed to be, due to a systemic infecting agent. In some of these the specific infecting agent is known; in others it is unknown or of a doubtful nature.The material presented in this study is not a representative cross-section of such joint infections as they occur in the ordinary population or even among the personnel of the Armed Forces. Our work is concerned with the diagnosis and. treatment of the venereal diseases and, as might be expected, patients with arthritis who are sent to us for treatment or who are found by us in the routine of ordinary practice, are those with gonorrhoea, those who have a history of past gonorrhoea or those who present evidence of some other infection of the genitourinary tract. Yet there were cases in our series in which the evidence of genital infection was obtained only by specialized examination, and which in other hands might certainly have received the diagnostic label, " rheumatoid arthritis ". In undertaking the treatment of such patients, we were fortunate in that many of them came under our care earlier in the course of the. disease than might be expected in civil life, in which the premium on absolute physical fitness is less and force of economic circumstances may delay the application of in-patient treatment. Rheumatoid arthritisThe subject of the disease, or group of diseases, which is known as rheumatoid arthritis and by other names, is not one upon which we can claim expert knowledge, and is therefore uncertain ground upon which we are unwilling to linger. It is, however, a subject which touches the fringe of venereology, leaving a " no man's land " of some doubt and difficulty. Study of some of the recent literature of the subject does little to clarify the problem. Sclater has analysed the case records of 388 cases of rheumatoid arthritis which occurred in Scotland. He gives the criteria on which the diagnosis was made as follows.(1) The presence of persistent swelling of the periarticular tissues in the region of more than one joint.(2) The involvement, either primarily or subsequently, of the wrist, metacarpophalangeal joints, or interphalangea1 joints.(3) The presence of muscular wasting.(4) Radiological evidence compatible with a diagnosis of rheumatoid arthritis.

Incidence of Chronic Genital Infection in Male Patients with Uveitis: A PRELIMINARY REPORT

“…Much less attention has been devoted to its association with "non-specific" genital infection. King, Williams, Nicol, and Loudon (1946) and Harkness (1950) describe iritis as one of the complications of non-gonococcal urethritis. Ford (1953) found six of his 21 patients with Reiter's disease to have relapsing iritis.…”

Reiter's disease in three boys.

“…A persistently monarticular arthritis has been seen in adult cases of both venereal and dysenteric types (Postma, 1937;King, Williams, Nicol and Loudon, 1946;Paronen, 1948;Harkness, 1950;Guck and Wolf, 1952;Csonka, 1958) and also in childhood cases (Florman and Goldstein, 1948;Jacobs, 1961;Davies and others, 1969). Probably the most common causes of monarticular arthritis in children are trauma (including osteochondritis), Still's disease, and tuberculosis (Bywaters and Ansell, 1965).…”

Value if Treatment in Reiter'S Disease

“…Successful claims are more difficult to assess, as few cases seem to have been given this treatment until other measures had failed, and generally no mention is made of the time which elapsed between treatment and complete recovery. Thus Harkness (1945) attributes recovery in manycases to induced fever although the average duration of the illness in these cases would appear to be about 2 months, while King, Williams, Nicol, and Loudon (1946) give no indication of the duration of the illness. King and his colleagues found that fever induced with TAB vaccine cured 25 out of 32 cases, but that only 41 patients recovered out of a total of 79 treated by mechanically induced hyperthermia.…”