Hypertrophied fringes and pedunculated or loose bodies often co-exist with hydrops, and give rise to characteristic clinical features, particularly in the knee.  The fringes, especially when they assume the type of the arborescent lipoma, project into the cavity of the joint, filling up its recesses and distending its capsule so that the joint is swollen and slightly flexed.  Pain is not a prominent feature, and the patient may walk fairly well.  On grasping the joint while it is being actively flexed and extended, the fringes may be felt moving under the fingers.  Symptoms from impaction of a loose body are exceptional.

[Illustration:  FIG. 160.—­Arthritis Deformans of Hands, showing symmetry of lesions, ulnar deviation of fingers, and nodular thickening at inter-phalangeal joints.]

The dry form of arthritis deformans, although specially common in the knee, is met with in other joints, either as a mon-articular or poly-articular disease; and it is also met with in the joints of the spine and of the fingers as well as in the temporo-mandibular joint.  In the joints of the fingers the disease is remarkably symmetrical, and tends to assume a nodular type (Heberden’s nodes) (Fig. 160); in younger subjects it assumes a more painful and progressive fusiform type (Fig. 161).  In the larger joints the subjective symptoms usually precede any palpable evidence of disease, the patient complaining of stiffness, crackings, and aching, aggravated by changes in the weather.  The roughness due to fibrillation of the articular cartilages causes coarse friction on moving the joint, or, in the knee, on moving the patella on the condyles of the femur.  It may be months or even years before the lipping and other hypertrophic changes in the ends of the bones are recognisable, and before the joint assumes the deformed features which the name of the disease suggests.

The capsular ligament, except in hydrops, is the seat of connective-tissue overgrowth, and tends to become contracted and rigid.  Intra-articular ligaments, such as the ligamentum teres in the hip, are usually worn away and disappear.  The surrounding muscles undergo atrophy, tendons become adherent to their sheaths and may be ossified, and the sheaths of nerves may be involved by the cicatricial changes in the surrounding tissues.

The X-ray appearances of arthritis deformans necessarily vary with the type of the disease and the joint affected; in the joints of the fingers there is a narrowing of the spaces between the articular ends of the bones as a result of absorption of the articular cartilage, and rarefaction of the cancellous tissue in the vicinity of the joints; in the larger joints there is “lipping” of the articular margins, osteophytes, and other evidence of abnormal ossification in and around the joint.  Eburnation of the articular surfaces is shown by increase in the density of the shadow of the bone in the areas affected.