. Diseases of children. ctor in this diseaseis obscure, but it is believed to be chronic sepsis. Girls are affectedin greater numbers than boys. Most cases occur before the eruptionof the primary teeth. Symptoms.—Acute exacerbations are accompanied by fever and bytenderness in the affected joints; but the most marked featm-es ofthe disease are a gradually developing ankylosis of the joints andswelling due to pathological thickening of the soft structures. Thereare no exostoses and no degenerative bone changes; but muscularwasting is often extreme. The lymphatic glands about the jomts and RHEUM
. Diseases of children. ctor in this diseaseis obscure, but it is believed to be chronic sepsis. Girls are affectedin greater numbers than boys. Most cases occur before the eruptionof the primary teeth. Symptoms.—Acute exacerbations are accompanied by fever and bytenderness in the affected joints; but the most marked featm-es ofthe disease are a gradually developing ankylosis of the joints andswelling due to pathological thickening of the soft structures. Thereare no exostoses and no degenerative bone changes; but muscularwasting is often extreme. The lymphatic glands about the jomts and RHEUMATOID ARTHRITIS—ARTHRITIS DEFORMANS 759 throughout the entire body may be greatly enlarged, the liver andspleen hypertrophied, and the blood picture is that of severe of the pleiu-a and the pericardium are occasionally —Since there are no destructive changes in the joints,the prognosis is somewhat more favorable than in other chronicjoint diseases; but complete recovery is Fig. 74.—Stills disease. RHEUMATOID ARTHRITIS--ARTHRITIS DEFORMANS. Rheumatoid arthritis is extremely rare in children, and is at firstusually mistaken for clironic rheumatism. It is marked by thickenmgof the synovial membrane, by enlargement of the articulatmg surfacesof the bones, and, occasionally, by effusions into the joints. Etiology.—^This disease is now believed to be infectious in origin,and the earlier theory that it originated in the nervous system has-^been largely discredited. It is usually the result of exposure to damp-ness and cold, and the infection is supposed to have its origin indecayed teeth, diseased tonsils, or other suppurating foci. 760 RHEUMATISM Symptoms.—In exceptional cases the onset of rheumatoid arthritismay be sudden, but, as a rule, it is slow. There is usually no fever,but the joints are painful and swollen, and gradually become the pain increases, motion becomes limited, and in protractedcases marked ankylosis
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