Inflammatory disease and its control in rheumatic disorders.

Inflammation is a central and essential component in most forms of arthritis-for instance, rheumatoid arthritis, acute gout, Reiter's disease, and even osteoarthrosis.The inflammatory changes are different in these various disorders.The underlying pathological processes produce entirely different changes in the body and the resulting clinical syndromes are entirely dissimilar.It follows that attempts to control the inflamnmatory changes have different effects on the different rheumatic disorders.Let us take four different rheumatic disorders-gout, ankylosing spondylitis, rheumatoid arthritis, and polymyalgia arteritica-and discuss what part inflammation plays in their symptomatology.In none does inflammation seem to have any useful function.With all due respect to mother nature the inflammatory process she puts there, presumably to perform some useful function initially, is now the disease itself in greater or lesser degree.It is inflammation that causes the local joint pain, tenderness, swelling, and stiffness and also the systemic illness that goes with it.In attempting to suppress this inflamma- tion we are doing nothing but good unless bacteria are present in the tissues.So had we a perfect non-toxic and highly effective anti-inflammatory agent, by suppressing inflammatory change we would eliminate much of the pain, swelling, stiffness, tenderness, and disability in many rheumatic disorders, even if we did not cure the disease. GoutThere is general agreement today that the intense discomfort of acute gout is due to deposition of crystals of monosodium urate in the tissues, which sets up an intense and acute inflammatory reaction.Seegmiller and Howell' suggested that three requirements were necessary for an acute attack of gout: (a) deposition in the tissues of crystals of monosodium urate; (b) development of an inflammatory *Based on the Bradshaw lecture delivered at the Warwickshire Postgraduate Medical Centre on