The clinical features are characteristic.  There is a sudden onset of excruciating pain, usually during the early hours of the morning, the joint becomes swollen, red, and glistening, with engorgement of the veins and some fever and disturbance of health and temper.  In the course of a week or ten days there is a gradual return to the normal.  Such attacks may recur only once a year or they may be more frequent; the successive attacks tend to become less acute but last longer, and the local phenomena persist, the joint remaining permanently swollen and stiff.  Masses of chalk form in and around the joint, and those in the subcutaneous tissue may break through the skin, forming indolent ulcers with exposure of the chalky masses (tophi).  The hands may become seriously crippled, especially when the tendon sheaths and bursae also are affected; the crippling resembles that resulting from arthritis deformans but it differs in not being symmetrical.

The local treatment consists in employing soothing applications and a Bier’s bandage for two or three hours twice daily while the symptoms are acute; later, hot-air baths, massage, and exercises are indicated.  It is remarkable how completely even the most deformed joints may recover their function.  Dietetic and medicinal treatment must also be employed.

#Chronic Rheumatism.#—­This term is applied to a condition which sometimes follows upon acute articular rheumatism in persons presenting a family tendency to acute rheumatism or to inflammations of serous membranes, and manifesting other evidence of the rheumatic taint, such as chorea or rheumatic nodules.

The changes in the joints involve almost exclusively the synovial membrane and the ligaments; they consist in cellular infiltration and exudation, resulting in the formation of new connective tissue which encroaches on the cavity of the joint and gives rise to adhesions, and by contracting causes stiffness and deformity.  The articular cartilages may subsequently be transformed into connective tissue, with consequent fibrous ankylosis and obliteration of the joint.  The bones are affected only in so far as they undergo fatty atrophy from disuse of the limb, or alteration in their configuration as a result of partial dislocation.  Osseous ankylosis may occur, especially in the small joints of the hand and foot.

The disease is generally poly-articular and may be met with in childhood and youth as well as in adult life.  In some cases pain is so severe that the patient resists the least attempt at movement.  In others, the joints, although stiff, can be moved but exhibit pronounced crackings.  When there is much connective tissue formed in relation to the synovial membrane, the joint is swollen, and as the muscles waste above and below, the swelling is spindle-shaped.  Subacute exacerbations occur from time to time, with fever and aggravation of the local symptoms and implication of other joints.  After repeated recurrences, there is ankylosis with deformity, the patient becoming a helpless cripple.  On account of the tendency to visceral complications, the tenure of life is uncertain.