_Startings at night_ are to be regarded as an indication that there is
progressive disease involving the articular surfaces.
_The formation of extra-articular abscess_ may take place early, or it
may not occur till long after the disease has subsided. The abscess may
develop so insidiously that it does not attract attention until it has
attained considerable size, especially when associated with disease of
the spine, pelvis, or hip. The position of the abscess in relation to
different joints is fairly constant and is determined by the anatomical
relationships of the capsule and synovial membrane to the surrounding
tissues. The bursae and tendon sheaths in the vicinity may influence the
direction of spread of the abscess and the situation of resulting
sinuses. When the abscess is allowed to burst, or is opened and becomes
infected with pyogenic bacteria, there is not only the risk of
aggravation of the disease and persistent suppuration, but there is a
greater liability to general tuberculosis.
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