Polyenthesitis.

We described the clinical symptoms and signs of 11 cases of polyenthesitis, confirmed by the presence of inflammation in biopsies and increased activity in scintigraphy. All cases are negative for HLA-B27, and there is no presence of systemic inflammatory reaction, radiographic sacroiliitis, or chronic arthritis. The enthesitis is not ossifying and follows a rather benign clinical course. In one case, herpes virus-like particles were detected in the fibroblast debris of the tissue removed from Achilles tendon insertion. This fact suggests that polyenthesitis may be a clinical manifestation due to a reaction to an infectious agent.

Effect of hypercarbia and hypertension on spinal cord tissue oxygen in experimental cervical myelopathy.

Tissue oxygen tension of the cervical cord was measured by the polarographic technique described in the preceding paper on dogs whose cervical cords had sustained combined compression and ischemia. Both hypercarbia and systemic hypertension elevated the tissue oxygen of the cord effectively even at the compressed and ischemic segments, and their effects were additive. Clinical applicability of combined hypercarbia and hypertension to the treatment of ischemia of the human cord was suggested.

Rheumatoid nodules at the cement-bone interface in revision arthroplasty of rheumatoid patients.

We studied the histology of the cement-bone interface and the regenerated synovium in ten aseptically loosened arthroplasties in rheumatoid patients. In two patients we found rheumatoid nodules at the cement-bone interface and marked lymphoplasmacytic infiltration in another three. Failed joints in osteoarthritic patients did not show these changes, and it seems likely that the presence of abundant immunocompetent cells was due to the background disease. We speculate that rheumatoid inflammation contributed to the process of loosening.

Operations for cervical spondylotic myelopathy. A comparison of the results of anterior and posterior procedures.

Over the past 19 years we have operated on 269 patients with myelopathy associated with cervical spondylosis. We report our results in 191 cases which we have followed up for 1 to 12 years (average 31 months). The clinical state before and after operation was recorded using the criteria of the Japanese Orthopaedic Association. Posterior operations gave better results than anterior for the more advanced myelopathies such as transverse lesions, the Brown-Séquard syndrome and the motor syndromes, but the brachialgia and cord syndrome and the central cord syndrome were satisfactorily treated by anterior operations. Of the three anterior and three posterior techniques used, no single one showed an overall superiority. A short duration of symptoms before operation was associated with better results, but these were not influenced by the age of the patients.

Variant type of congenital stomatocytosis.

A 52-year-old female with congenital stomatocytosis showed hemolytic anemia, an increased mean corpuscular volume (MCV), and mean corpuscular hemoglobin concentration (MCHC), reticulocytosis and an increased osmotic fragility. Lipid and protein content of membranes, the activities of membrane-associated enzymes in erythrocytes and the elution pattern of hemoglobin were normal. Erythrocyte Na+ influx was moderately increased and Na+ efflux, particularly ouabain-insensitive Na+ "leak-out" was also increased. K+ concentration of erythrocytes was abnormally low with a slightly increased Na+ content. These phenotypes are very rare, and should be classified as a variant type.

Double-blind study with liposteroid in rheumatoid arthritis.

A multicentre double-blind comparative trial was performed in 138 patients with rheumatoid arthritis (RA) after biweekly intravenous or intramuscular injections of liposteroid (containing 2.5 mg of dexamethasone), which had been developed as a drug for targeting therapy of RA, and Decadron (containing 3.3 mg of dexamethasone) as a reference drug. The results showed a tendency to a significantly higher rate of improvement with lower frequency of side-effects in the liposteroid group than in the Decadron group. This study indicates that liposteroid is more useful for RA and that the separation of the efficacy and side-effects of steroids could be clinically confirmed to some extent.

Interim results of a multicenter open study with auranofin in Japan.

We report the results of 47 of 116 rheumatoid patients, who took auranofin (AF) for more than 6 months. After 8-12 weeks of treatment with AF 3 mg bid, a remarkable improvement was observed especially in numbers of tender and swollen joints and duration of morning stiffness. The mean activity index before AF was 70.1% and the index decreased linearly for 6 months to 53.5%. AF was particularly effective in patients with high rheumatoid activity, as well as in those of short duration of disease and Stages I and II. Radiographic examination showed a possible prevention by AF of progression of bone destruction in the joints. A total of 86 side effects were reported in 50 cases: 36 gastrointestinal; 34 mucocutaneous and 16 others. Most side effects cleared during the treatment and no serious side effects were reported. Drug administration was discontinued in only 11 cases (9.5%). Blood gold level reached a plateau after 9 weeks (mean level was 0.67 micrograms/ml). Urinary excretion rate was parallel with the blood gold level.

Autoimmunity and chondrolysis of the hip. A report of two cases.

Two patients with rapidly progressive chondrolysis of the hip are reported. Immunofluorescent staining showed deposits of immunoglobulins and complement components in the synovium and the remaining femoral head cartilage. Seven patients with osteoarthritis of the hip and knee, or femoral neck fractures, were used as controls and all had a negative immunofluorescent staining reaction in the synovium. We suggest that an autoimmune reaction against articular cartilage antigens may play a role in the development of chondrolysis.

[Arthritis and polyenthesitis after viral pleuro-pneumopathy due to Coxsackie virus]. / Arthrites et polyenthésites après pleuro-pneumopathie virale à virus Cocksakie.

A sixty-one year-old male developed subacute polyenthesitis one month after the onset on pleuropulmonary disease. This last manifestation resolved completely six months later, whereas the enthesopathy ran a subacute course, improving over time. Three years after onset, the patient had monoarthritis of the left elbow and tendinitis of both Achilles tendons. During the course of the disease, neutralizing antibodies against Coxsackie virus A9 rose significantly then returned to normal when clinical manifestations improved. This finding suggests that viral infections may cause enthesopathy.

Older age onset rheumatoid arthritis with or without osteoarthritis.

The clinical features of a group of 79 patients with older age onset rheumatoid arthritis (ORA) were compared with those of a group of 414 patients with younger age onset rheumatoid arthritis. The ORA group contained approximately equal numbers of men and women, were less rheumatoid factor positive, had a raised erythrocyte sedimentation rate, lower HLA-DR4 positivity, and a tendency towards larger joint involvement at the onset of the disease. These features have been reported by many authors except for the lower DR4 positivity. Of these features, the lower prevalence of rheumatoid factor positivity and the tendency towards larger joint involvement at the onset were characteristic of a subset of patients with ORA who had had osteoarthritis before the onset of rheumatoid arthritis. It is suggested that osteoarthritic large joints may be susceptible to the occurrence of rheumatoid synovitis at the onset of the disease, but that the osteoarthritis inducing factor may be negatively related to the progression of rheumatoid arthritis.

The pattern of spinal and extraspinal hyperostosis in patients with ossification of the posterior longitudinal ligament and the ligamentum flavum causing myelopathy.

Thirty one patients suffering from myelopathy associated with ossification of the posterior longitudinal ligament and ligamentum flavum of the spine have been investigated. The pattern of spinal and peripheral hyperostosis was recorded in each case. Flowing anterior vertebral hyperostosis and ligamentous ossification at the enthesis around the pelvis and hips were the most frequent associations, occurring in approximately 86% of patients. The distribution and incidence of the spinal and extraspinal hyperostosis in this series corresponds closely to the findings in diffuse idiopathic skeletal hyperostosis (DISH). The present findings indicate that patients suffering from cervical myelopathy and ossification of the posterior longitudinal ligament should be regarded as manifesting focal features of a more generalised disorder producing skeletal hyperostosis.

Nerve supply to the posterior longitudinal ligament and the intervertebral disc of the rat vertebral column as studied by acetylcholinesterase histochemistry. I. Distribution in the lumbar region.

The nerve supply to the posterior longitudinal ligament (PLL) and the intervertebral disc (IVD) of the lumbar vertebra was investigated by acetylcholinesterase (AchE) enzyme histochemistry in the rat. The meningeal branch of the spinal nerve (the sinuvertebral nerve) enters the vertebral canal and divides into ascending and descending branches which fuse with those from adjacent vertebrae. They give off transverse branches, connecting with those from the opposite side to form the superficial nerve fibre network in the intervertebral segment, which spreads to the vertebral segment of the PLL. Apart from this superficial nervous network, many nerve fibres enter through the posterolateral portion of the annulus fibrosus (AF) and form a dense, fine nerve fibre network in the deep layer of the intervertebral portion of the PLL and the superficial layer of the AF. Nerve fibres and terminals cannot be found in the deep layer of the AF or the nucleus pulposus. In the central part of the deeper nerve network there are few nerve terminals whereas there are abundant free nerve endings in the peripheral zones. It is suggested that these abundant nerve fibres may be correlated with various functions characteristic of this region and that they may be important in the regulation of movement and posture in the vertebral column.

Nerve supply to the posterior longitudinal ligament and the intervertebral disc of the rat vertebral column as studied by acetylcholinesterase histochemistry. II. Regional differences in the distribution of the nerve fibres and their origins.

Regional differences of the distribution and the origin of the nerve fibres of the posterior longitudinal ligament (PLL) and the intervertebral disc (IVD) were investigated by acetylcholinesterase (AchE) enzyme histochemistry in the rat. The deeper nerve network was well-developed at the lower thoracic and the upper lumbar vertebral levels, but it was hardly seen at the mid-thoracic level. This difference can be correlated with the extensibility of the PLL. The experimental study revealed that the AchE-positive nerve fibres in the PLL and the IVD were mostly derived from the spinal ganglia, that the superficial nerve network was supplied by the spinal ganglia bilaterally and polysegmentally, and that the deeper nerve network was supplied bilaterally but unisegmentally.

Increased rate of hysterectomy in women undergoing surgery for osteoarthritis of the knee.

We performed a case-controlled study to determine whether previous gynecological surgery is associated with severe osteoarthritis (OA) of the knee, the hip or the spine, as well as mild OA of the knee. Patients who underwent surgical treatment for OA were defined as having severe OA. Patients with knee pain and radiographic grade 2 OA in a tibiofemoral joint on the Kellgren and Lawrence scale were defined as having mild knee OA. An increased rate of hysterectomy was observed in the severe knee OA group after adjustment for age and number of children, or even after adjustment for body mass index. Hysterectomy in this group was most often performed for myoma uteri. Patients with mild knee OA tended to have previous hysterectomy. From the results, we speculate that certain subsets of OA which often take a progressive course might be related to hysterectomy.