[Footnote 253: _Archives Générales de Méd._, Nov., 1872, pp. 512-542.]
[Footnote 254: _Archives of Med._, Oct., 1880.]
The articular affection of locomotor ataxia sometimes closely resembles monoarticular rheumatoid arthritis,[255] but may be distinguished by its sudden invasion, often without pain or fever; the prompt development of a general and often enormous tumefaction of the entire member, with copious effusion into the joint; the early destruction of the articular cartilages, the rapid wearing away of the heads of the bones, and the proneness to spontaneous fracture of their brittle shafts; the prompt absorption of the articular effusion, followed by a relaxed state of the ligaments and a facility of dislocation; the early occurrence of the articular affection, when motor inco-ordination is scarcely developed, and its frequent association with the crises of ataxia or the presence of some of the other symptoms of that disease. The importance of these facts will be especially evident in those examples of ataxic articular disease in which, at an advanced stage, eburnation and deformity of the articular surfaces, with the formation of loose bodies and osteophytes, are observed, just as they are in arthritis deformans.
[Footnote 255: Charcot's _Lectures on Diseases of the Nervous System_, Syd. Soc., 1877; _Archives de Physiologie_, t. i., p. 161, 1868; _ibid._, xi., 1869.]
Articular disease closely allied to what occurs in locomotor ataxia is now and then observed in the early stages of progressive muscular atrophy,[256] but while the large joints, more particularly the knee and the shoulder, suffer in the former affection, the phalangeal chiefly and the larger articulations more rarely are attacked in the latter. Of course the peculiar symptoms of progressive muscular atrophy coexisting with those of the articular affection would serve to distinguish the latter from rheumatoid arthritis.
[Footnote 256: Remak, _Allgem. Med. Central. Zeitung_, March, 1862; Rosenthal, _Clinical Treatise on Diseases of the Nervous System_, translated by L. Putzel, M.D., 1879, p. 286.]
It is often very difficult to say whether a given case is one of chronic rheumatoid arthritis or of chronic gout; and there is no doubt that in England, where gout prevails, it is not unfrequently associated with rheumatoid arthritis, sometimes preceding and even causing it, much more often following it, for the one does not exclude the other.