The joint lesions which accompany #acute rheumatism# or “rheumatic fever” are believed to be due to a diplococcus.  In the course of a general illness in which there is moderate pyrexia and profuse sweating, some of the larger joints, and not infrequently the smaller ones also, become swollen and extremely sensitive, so that the sufferer lies in bed helpless, dreading the slightest movement.  From day to day fresh joints are attacked, while those first affected subside, often with great rapidity.  Affections of the heart-valves and of the pericardium are commonly present.  On recovery from the acute illness, it may be found that the joints have entirely recovered, but in a small proportion of cases certain of them remain stiff and pass into the crippled condition described under chronic rheumatism.  There is no call for operative interference.

#Gonococcal Affections of Joints.#—­These include all forms of joint lesion occurring in association with gonorrhoeal urethritis, vulvo-vaginitis, or gonorrhoeal ophthalmia.  They may develop at any stage of the urethritis, but are most frequently met with from the eighteenth to the twenty-second day after the primary infection, when the organisms have reached the posterior urethra; they have been observed, however, after the discharge has ceased.  There is no connection between the severity of the gonorrhoea and the incidence of joint disease.  In women, the gonorrhoeal nature of the discharge must be established by bacteriological examination.

As a complication of ophthalmia, the joint lesions are met with in infants, and occur more commonly towards the end of the second or during the third week.

The gonococcus is carried to the joint in the blood-stream and is first deposited in the synovial membrane, in the tissues of which it can usually be found; it may be impossible to find it in the exudate within the joint.  The joint lesions may be the only evidence of metastasis, or they may be part of a general infection involving the endocardium, pleura, and tendon sheaths.

The joints most frequently affected are the knee, elbow, ankle, wrist, and fingers.  Usually two or more joints are affected.

Several clinical types are differentiated. (1) A dry poly-arthritis met with in the joints and tendon sheaths of the wrist and hand, formerly described as gonorrhoeal rheumatism, which in some cases is trifling and evanescent, and in others is persistent and progressive, and results in stiffness of the affected joints and permanent crippling of the hand and fingers.

(2) The commonest type is a chronic synovitis or hydrops, in which the joint—­very often the knee—­becomes filled with a serous or sero-fibrinous exudate.  There are no reactive changes in the synovial membrane, cellular tissue, or skin, nor is there any fever or disturbance of health.  The movements are free except in so far as they are restricted by the amount of fluid in the joint.  It usually subsides in two or three weeks under rest, but tends to relapse.