. Physical diagnosis . e ). (Jj) The primary polyartic-ular form usually begins inthe fingers, and is very apt tooccur symmetrically, , incorresponding joints of bothhands at the same time (seeFig. 224). The joints are en-larged, boggy, spindle shaped(owing to the rapid atrophyof the interossei), often abnor-mally white, apparently fluct-uant, and show trophic skinlesions (glossy skin, sweat-ing, mottling) (see Fig. 225).The terminal finger-joints arerarely swollen. Late in thecourse of the disease a ring of constriction often marks the line ofarticulation (see Fig. 226). Pain is no
. Physical diagnosis . e ). (Jj) The primary polyartic-ular form usually begins inthe fingers, and is very apt tooccur symmetrically, , incorresponding joints of bothhands at the same time (seeFig. 224). The joints are en-larged, boggy, spindle shaped(owing to the rapid atrophyof the interossei), often abnor-mally white, apparently fluct-uant, and show trophic skinlesions (glossy skin, sweat-ing, mottling) (see Fig. 225).The terminal finger-joints arerarely swollen. Late in thecourse of the disease a ring of constriction often marks the line ofarticulation (see Fig. 226). Pain is not severe until motion is at-tempted or unless the joint is jarred and stirred up by some trau-matism. The changes progress slowly and attack new and larger joints,moving centrally from the periphery. At any stage the processmay become arrested, but usually not until ankylosis or contractureshave occurred in one or many joints. Some of the ossified menof dime museums are in the ankylosed stage of this terrible Fig. Arthritis. (Goldthwaite.) 498 PHYSICAL DIAGNOSIS. Flexion of fingers with hyperextension of the terminal joints anddeflection to the ulnar side are common deformities. IV. Hypertrophic Arthritis.—Bony enlargement and osteophyticspurs are the distinguishing feature. The new bone is oftenest de-posited round the edges of the articular cartilage, forming an irreg-ular fungoid ring (ring bone in horses) or lip near the joint.
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