Medicine: Those Aching Joints

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Arthritis Due to Injury. Caused either by a single severe injury or by endless repetition of minor, unnoticed injuries. Commonest examples: tennis elbow and housemaid's knee. Treatment: draining away water on the knee, heat, massage, X rays, Novocain injections and, in severe cases, surgery. Now usually curable.

Arthritis of Rheumatic Fever. Now readily dealt with, in most cases, by prompt treatment of the rheumatic fever with aspirin and hormones of the cortisone family, and the use of penicillin to prevent recurrences. For all practical purposes: under control.

Osteoarthritis (degenerative joint disease). No known cause except advancing years, but there are probably other causes, especially in premature severe cases; 97% of persons over 60 have it, though most in such mild form that they have few symptoms. Occurs when bearing surfaces in joints lose their smooth mobility. Resulting handicap may be negligible or severe; it is rarely disabling. Aspirin helps to ease pain, as does heat (hot baths or heating pads); injection of hydrocortisone into a particular joint may give relief for months. A well-balanced, vitamin-rich diet is good for an oldster's general wellbeing, but has no direct relationship to the disease. Still incurable, but can often be relieved.

Arthritis Due to Gout. The one rheumatic disease for which the cause is known, up to a point (the body's inability to dispose of purines without creating an excess of uric acid), and the only one for which diet is important. About 95% of victims are males. The disease smolders indefinitely, but is marked by acute flare-ups with excruciating pain in swollen, inflamed joints. In rare cases, it can threaten life by depositing uric acid crystals in the kidneys or heart. Sufferers must avoid foods rich in purines—yeast, herring roe, sardines, asparagus, and many organ meats such as sweetbreads, liver, heart and kidneys. Other treatment: colchicine (an ancient remedy extracted from the autumn crocus), ACTH, phenylbutazone (a powerful but potentially dangerous drug). Another drug, probenecid, is no good for acute attacks and may actually aggravate them, but paradoxically is the best long-term treatment to keep the disease quiescent. Not yet curable, but now usually controllable.

Nonarticular Rheumatism. A grab-bag category. Includes bursitis (inflammation of the sac that helps reduce friction around a joint), myositis (inflammation of muscle tissues), fibrositis (muscle inflammation extending to connective tissues), tenosynovitis (inflammation of a tendon sheath), and such oddities as psychogenic rheumatism. Treatment: aspirin, possibly combined with hormones such as cortisone, prednisone and prednisolone. Codeine helps kill the pain, and heat is helpful. In bursitis, surgery is sometimes used to scrape calcified deposits from the inside of a bursa. In psychogenic rheumatism no physical cause can be found for the patient's undeniable physical ills. Symptoms most often resemble those of fibrositis and the two are often confused. (Adding to the confusion, some experts hold that the disorders are really one and the same.) Exceptionally common in the armed forces under stress of battle. Only treatment : psychotherapy—an understanding general practitioner can handle mild cases, but stubborn ones may need the analyst's couch.