Gout, with a section on ocular disease in the goutyLlewellyn, Llewellyn J. (Llewellyn Jones)
Science
Gout, with a section on ocular disease in the gouty
Llewellyn, Llewellyn J. (Llewellyn Jones)
Eye -- Diseases; Gout
In Hutchinson’s list of eye diseases which occur in association with
rheumatism and gout there is a history of gonorrhœa in twenty-six cases,
syphilis in seventeen, of both gonorrhœa and syphilis in six. Herpes
occurred in two, pustular acne in one, eczema in one, albuminuria in
one, ague in one. Bad teeth are reported in two. In all the total was
fifty-seven cases out of 117 (48·7 per cent.) in which there was a
possible source of infection. It is probable that this percentage would
have been materially increased if at that time it had been recognised how
great is the influence of pyorrhœa and other sources of infection in the
etiology of irido-cyclitis.
With regard to all infections it is only in the present day that full
advantage is taken of bio-chemical and bacteriological methods of
differentiation. How frequently the true origin of disease must have been
overlooked when the pallid spirochæte was unknown, when the Wassermann
test was not applied, and when the complement fixation test for gonorrhœa
was not recognised.
With regard to a combined cause it has been maintained that gonorrhœa
is always more severe in the gouty than in other people, and it may
be that the more intense the gonorrhœa the more likely may it be to
produce constitutional symptoms, of which iritis is one. In all such the
combination of gout and iritis would indelibly impress upon the mind
of the surgeon the intimate association of joint and eye. It was long
ago recognised that many forms of joint disorder were associated with
iritis, and, as the cause of the arthritis was not always gout, Mackenzie
introduced the generalisation “arthritic iritis.” “Not being able,”
he tells us,[50] “to determine the diathesis which predisposes to this
ophthalmia” (iritis), “I use _arthritic_ as a conventional term, without
adopting it in the strict sense of gouty.” The expression is well worthy
of retention for the reason that it warns us to be prepared for an attack
of iritis in many forms of arthritis and arthralgia.
In the following articular diseases the triad joint, muscle and nerve
disorders is not uncommonly linked with iritis:—
Tuberculous arthritis;
Syphilitic arthritis;
Gonococcal arthritis;
Certain forms of specific arthritis: malarial, dysenteric, etc.;
Infective arthritis of undifferentiated type, as yet unaffiliated to
specific germs.
In the following forms of arthritis iritis is less common:—
Acute articular rheumatism;
Acute gout;
Osteoarthritis (hypertrophic);
Rheumatoid arthritis (atrophic).
Iritis occurring in these last suggests the possibility of error in the
diagnosis of the putative parent disease. Especially is the clinical
similarity of gonorrhœal (polyarticular) rheumatism to rheumatoid
arthritis to be borne in mind.
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