Medicine: Those Aching Joints

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For all nonarticular rheumatism: no neat cures, but plenty of opportunities for substantial relief.

Rheumatoid Arthritis. Commonest and most crippling of the acute forms of rheumatism. Cause unknown, although some researchers suspect that (like rheumatic fever) it is the after effect of a streptococcal infection. May occur in childhood (when it is known as Still's disease) or late in life, but is commonest in the 305, when it strikes three times as many women as men. (Possibly related is rheumatoid spondylitis, or arthritis of the spine, which singles out young men.) Usually attacks virtually all joints in the limbs. Difficult to diagnose, but in 1930 Dr. Russell L. Cecil, now medical director of the Arthritis and Rheumatism Foundation, discovered a clumping factor in the blood serum of patients that has led to a promising test.

Physicians used to treat rheumatoid arthritis by guess and by God, gave aspirin by the carload to ease the pain of inflamed, swollen and exquisitely tender joints. In the 19305 it was found that, for no known reason, injections of certain gold salts brought the disease under control. Treatment was fraught with danger of damage to liver and kidneys. But the net effect was beneficial in perhaps 40% of cases.

Miracles & Disappointments. In 1949 came the dramatized announcement (with before-and-after movies) from the Mayo Clinic of wondrous results with two hormones: ACTH and cortisone. Hopes for miracle cures soared, along with sales of the hormones. Gradually it has become clear that the hormones do not cure rheumatoid arthritis; they suppress its worst symptoms until—as is the way with this baffling disease—it may subside spontaneously after a few months. Victims of other forms of rheumatism, some of whom thought rheumatism was all one disease, were disappointed when the hormones proved of little use to them. In some patients they produced swift and undesirable side effects (high blood pressure, moon face, beards on women).

Today, treatment has settled down to three patterns, the choice depending on local option. In one hospital in any major U.S. city, an acute case will be dosed heavily with aspirin and nothing else at first; in another, he will get aspirin and gold salts, and in a third, one of the hormones. In any good medical center doctors will switch from one regimen to another if they are not satisfied with results.

New Joints for Old. In the past, there was little doctors could do to restore useful movement of frozen joints and wasted muscles after the disease had done its gnarling and crippling work. Lately there have been major advances, largely through new and daring surgical techniques. Typical is the case of Angelina Ferrara, who was severely crippled by Still's disease at the age. of nine. Her knees were bent and could not be straightened; her elbows were straight and could not be bent; her hips were bent and frozen. Last year, aged 25, Angelina was taken to the arthritis clinic at Manhattan's superbly equipped Hospital for Special Surgery. There she scored near zero on the ADL (activities of daily living) test: she could not walk, dress or feed herself, comb her hair, or go to the bathroom alone.