Arthritis, Bones And Joints Chronic Arthritis
( Originally Published 1936 )
FOR the past five years it has been particularly evident that physicians, especially American physicians, have been concentrating their attention on the difficult problem of chronic arthritis or chronic inflammation of the joints.
These crippling and deforming changes which occur in so many people affect usually a large number of the joints of the body. It is on this account that they present so serious a disease problem. If only one joint or one extremity were affected, the individual could make shift to compensate for this defect and perform a good measure of useful work. But added to the pain itself, the widespread limitation of movement and crippling usually makes complete invalids out of these people, unable to be self-supportive in any way. In fact, they are worse than that, as they usually require considerable attendance from others.
The same fact, however, leads us to believe that the disease is not local, due to change in one locality of the body, but has a general central cause to which the joint system is particularly responsive.
What this central cause is has been the battle-ground of conflicting opinions in the studies above referred to. In general, the two dominant theories may be called "the theory of infection" and "the theory of nutritional change."
The infectious theory of the cause of chronic arthritis supposes that certain germs enter the body, become localized in such places as the crypts of the tonsils, the gallbladder, or the roots of teeth, and from these foci wander out into the blood stream. Having an affinity for joint structures they light upon these and set up the chronic inflammation.
The nutritional theory supposes that the changes are due to pro-found and probably complicated changes in the nutrition of the body, particularly affecting those chemicals which enter into the nutritional exchange in the joint structure. This theory supposes that diet will exert considerable influence in changing the deranged nutrition and hence improving the arthritis.
It is probable that in most cases both elements have something to do—that there is nutritional change, and upon this local spot of lowered resistance infection has an easy time implanting itself. The process is carried further in the course of the disease when the deranged nutrition allows and even helps the infection to progress.
Nor is this alone a complete statement of the situation. There are different forms of arthritis, some of them more certainly due to infection than others. This is true especially of the so-called hypertrophic arthritis, in which bony deposits form around the joints. Such cases, however, are neither as frequent nor as crippling as the other forms of rheumatoid arthritis in which chalky deposits take the place of the bone, and great crippling and limitation of movement result. It is these latter cases which have engaged the attention of the research workers the most.