Progress in Arthritis

Knowledge about arthritis has increased so fast in the last eight years that last week the A.M.A. Journal published a lengthy report by twelve specialists to bring U.S. doctors up to date on the nation's No. 1 chronic disease.

Arthritis is one of the oldest diseases on earth--fossil remains show that even dinosaurs suffered from it 200,000,000 years ago. Arthritis has always bedeviled the human race. The great thermal baths built by the Romans are monuments to the aching bones of the middle-aged Romans who had it. Today, in the U.S., the 6,850,000 people with swollen arthritic joints far outnumber the sufferers from any other chronic disease (including heart disease, hardening of the arteries, high blood pressure). Arthritis causes more days lost from work than industrial accidents, or any disease except nervous and mental ailments.

Yet eight years ago most U.S. doctors paid little attention to arthritis. Typical treatments included injection of streptococcic and typhoid vaccines, dietary fads, bee venom serum, manipulation of gnarled hands and joints. Such treatments have now been largely discarded. More important, several different forms of arthritis have been clearly distinguished, each with its special therapy. Three recently developed blood tests also indicate what sort of arthritis a patient has.

Three-fourths of all arthritis cases are now known to fall into two main classes:

> Rheumatoid arthritis, which usually affects people between the ages of 20 and 40. The cause is still unknown. Some of its symptoms (e.g., slight fever) suggest it may be infectious though no microorganism has so far been incriminated. Another possible cause: metabolic disorders.

> Osteoarthritis--grandfather's back-breaking "rheumatism"--which is a degenerative ailment of old age, rarely appears before 40. The cause is the normal wear & tear on the joints. Yet osteoarthritis afflicts some people who have never done a lick of work in their lives, while lifelong toilers often escape it. So doctors suspect a hereditary tendency--i.e., some folk are born with tough joints, others with weak ones.

Rheumatoid arthritis usually begins at the extremities, often moves joint by joint from the fingers toward the shoulder. Its pains often migrate at random. Osteoarthritis affects the weight-bearing joints in the spine, hips, knees, and the first joints of the fingers. Its pains are always localized. Rheumatoid sufferers, unlike the osteoarthritics, are usually undernourished, anemic and slightly feverish.

Gold in the Veins. The main advance is in the treatment of rheumatoid arthritis. The whole body, not just the swollen joints, is treated. The principal idea is rest. "Many patients state that all they do is rest [but] examination . . . will frequently show that they are tense and that their muscles are in more or less constant spasm." Rest relaxes this spasm.

A very promising new treatment (not yet completely endorsed) is the injection of gold compounds into veins or muscles. This relieves from 48 to 80% of rheumatoid arthritis sufferers, of whom 10% are wholly cured. Drawback: gold is somewhat poisonous to about 17% of all cases, and several people have died from it. Yet most of New York City's 25 arthritis clinics are now using gold--with medical caution and skill.

Arthritic deformities--hopelessly gnarled hands or clumsily stiffened joints where two bones have calcified together--"are too often due to neglect" and can largely be avoided. Treatment: simple exercises and a simple splint worn for part of each day. Warm dips, as in old-age rheumatism, are helpful. Curious fact: pregnancy usually brings temporary relief to arthritic women.

Gonococcic Arthritis (a frequent product of gonorrhea) is the easiest form to cure. It usually settles in the knee, ankle or shoulder and cripples about one-fourth of its victims. But early dosing with sulfa drugs brings "striking improvement" within three days. Gouty arthritis--from which more & more U.S. men are suffering--is not curable, but colchicine (a drug from a European lilylike plant) relieves it "spectacularly," although colchicine is of no use in treating any other form of arthritis.

"The biggest single medical undertaking in history" was projected last fortnight by the American Red Cross: in the next twelvemonth the organization will collect 2,500,000 pints of blood from U.S. citizens for their armed forces. This quota is about 50% higher than for the last twelvemonth, will require some 50,000 donors every week.

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