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research teams to this problem in recent years seems, at long last,
likely to yield results. There is evidence to support the view that
the disease is initiated by an exogenous antigen but that its continuance is the result of a secondary induced auto-immune response. If this is substantiated then there are grounds for anticipating more effective methods of treatment and a reduction in
the alarming disability rate occasioned by these diseases.
Osteoarthritis, the most common of the rheumatic complaints
though accompanied by recurrent problems of pain and disability
especially in the elderly, seems to be tolerated surprisingly well
even when there is gross involvement of major joints. Perhaps
this is because, more often than not, the onset is insidious and
occurs later in life. It is estimated that the incidence ranges from
20% in all men and 30% in all women over the age of 15 years
but radiological evidence indicates that, over the age of 65 years
few people, if any, are free from intervertebral disc degeneration. In these cases much can be achieved by reducing or abolishing excessive physical stresses and strains in industry by increased
mechanisation, the application of anthropometry and the education of workers in the correct methods of handling and lifting of
heavy loads. An increasing number of patients are benefiting
from the replacement of joints by modern techniques which, in
many instances, results in a return to a useful degree of function.
Due to its internal geometry, the hip joint appears always to
be under strain and it would seem that 13% of the adult population over 45 years have degenerative changes in their hips. Some
orthopaedic surgeons and radiologists believe that the tilt deformity of the head and neck of the femur is a hazard of the keen
athlete. In a recent examination in a London hospital the rate in
highly athletic patients was estimated to be double that of a random sample and that in the juveniles examined there was a statistically significant increase in "growing pains" in those developing
a tilt deformity.
Clinical gout may antedate arthritis by a number of years and,
preventively, any person with hyperuricaemia, even though asymptomatic, must be considered a potential victim. However, of
the rheumatic diseases, gout is one of the most satisfactory for
the physicians to treat for they now have in their armoury an
impressive range of sophisticated drugs with which to control
inflammation and subsequent arthritis.
Improvement in the treatment and rehabilitation of the rheumatic groups is of great concern to local authorities for it becomes their responsibility to sustain individuals and their families
when they become registered as disabled. It should be the