Long-term marginal zinc deprivation in rhesus monkeys. IV. Effects on skeletal growth and mineralization.

Skeletal maturation was evaluated from ages 1 to 3 y in rhesus monkeys that had been subjected to a diet marginally deficient in zinc (4 micrograms/g Zn) from conception through age 3 y. Skeletal development was assessed at 18, 24, 30, and 36 mo of age and compared with that of controls fed ad libitum. Skeletal maturation was determined by the presence of epiphyseal ossification centers. To evaluate endochondral bone mineralization the appearance of the zone of provisional calcification on the metaphyseal side of the growth plate and the width of the growth plate were observed. Marginal Zn deprivation was associated with delayed skeletal maturation in monkeys up to age 3 y. Defective mineralization of bone was evident in these monkeys up to age 6 mo. Between ages 6 mo and 3 y bone mineralization increased in some of the marginal-Zn monkeys to values that were only slightly below those for control monkeys.

Studies of marginal zinc deprivation in rhesus monkeys. V. Fetal and infant skeletal effects.

Skeletal maturation was evaluated in newborn and infant rhesus monkeys that had been subjected to a marginally zinc-deficient diet (4 ppm zinc) from conception through 12 months of postnatal life. Serial radiographic assessment of skeletal development was performed and compared to both ad libitum and pair-fed controls. Radiographs were obtained at birth and at 1, 3, 9, and 12 months of age. In each age group a maturation indicator was selected to identify individuals with abnormal skeletal maturation defined on the basis of presence of epiphyseal ossification centers. Animals were compared only within a given sex group. Additionally, to evaluate endochondral bone mineralization, the appearance of the zone of provisional calcification on the metaphyseal side of the growth plate and the width of the growth plate were assessed. A marginal level of zinc deprivation during gestation and during the 1st yr of life was found to be associated with significantly delayed skeletal maturation and defective mineralization. This abnormality of bone mineralization has many features similar to human rachitic syndromes and suggests that zinc plays an important role in endochondral bone formation.

Giant cell arteritis associated with mononeuritis multiplex and complement-activating 19S IgM rheumatoid factor.

Giant cell arteritis is a necrotizing granulomatous arteritis of large arteries, especially the aorta and its branches. Mononeuritis multiplex is a peripheral sensorimotor neuropathy usually producing foot or wrist drop, commonly associated with necrotizing arteritis of small and medium-sized arteries. Rheumatoid vasculitis is an example of the latter type of arteritis associated with high-titer 19S IgM rheumatoid factor typically occurring in patients with long-standing erosive rheumatoid arthritis. This report describes a 71-year-old man with biopsy-proved giant cell arteritis, mononeuritis (foot drop) multiplex, and high-titer complement-activating rheumatoid factor without rheumatoid arthritis. Possible pathogenic relationships are discussed.

Infectious arthritis due to Hemophilus influenzae.

A healthy 51-year-old male developed multiarticular infectious arthritis due to Hemophilus influenzae, a rare cause of infectious arthritis in adults. Previous case reports are reviewed. Predisposing factors include chronic illness, underlying joint disease, joint trauma, and respiratory infection. H. influenzae is frequently misidentified on Gram stain, being mistaken for gonococci or pneumococci. Infections due to H. influenzae may occur in normal adults. Aspects of immunity are discussed.

Peripheral hyperostosis in rheumatoid arthritis in the absence of axial involvement.

When diffuse idiopathic skeletal hyperostosis (DISH), or Forestier's disease, coexists with rheumatoid arthritis (RA), the radiographic features of RA are characteristically altered and may be diagnostically misleading. Altered findings include the absence of osteoporosis, bony proliferation around erosions, osteophytosis and ankylosis. Previously reported cases of coexistent RA-DISH have all exhibited characteristic spinal hyperostosis. Two cases are discussed which demonstrate that the distinctive peripheral radiographic findings of RA-DISH may occur in the absence of vertebral involvement.

Relationship of serum IgG rheumatoid factor to IgM rheumatoid factor and disease activity in rheumatoid arthritis.

Rheumatoid factors (RF) constitute the major autoantibodies in rheumatoid arthritis (RA). RF are directed against IgG Fc, are polyclonal, and are predominantly of the IgG and IgM classes. RF may participate in both synovial and extraarticular inflammation in RA, although the precise roles of serum IgG and IgM RF are unclear. The purpose of our study was to correlate serum IgG RF with serum IgM RF levels measured by radioimmunoassay and with clinical disease activity in 42 prospectively evaluated seropositive RA patients. IgM RF correlated with IgG RF levels and articular disease activity. IgG RF correlated with IgM RF but not with articular disease activity when adjusted for IgM RF.

Still's arthritis in adults: disease or syndrome?

Seven adults with a syndrome similar to systemic-onset (Still's) juvenile rheumatoid arthritis are reported. In addition to characteristic fever, rash, and arthritis prominent features included pharyngitis (7), lymphadenopathy (6), pleuropericarditis (4) and progression to joint damage (5). Three were over 50-years-old. Previous reports are reviewed. Symptoms, laboratory and physical findings are broadly comparable to the childhood disease. However findings may be quite variable in individual patients and the diagnosis remains a clinical one. Recognition of the variable presentations of this syndrome will assist in the differential diagnosis of fever of unknown origin.

Pyogenic sacroiliitis.

Two cases of pyogenic sacroiliitis are reported and the literature reviewed. Gluteal pain, tenderness in the sacroiliac area, and pain elicited by maneuvers which stress the joint are characteristic. Delay in diagnosis may result from failure to suspect the sacroiliac joint. Onset is acute in 86% with fever, severe pain, and inability to walk. A bone scan is useful for localization. Blood cultures are positive in one-third. Definitive diagnosis can be established by needle aspiration of the joint, a technically difficult procedure. Therapy is discussed.

Serous peritonitis in adult Still's syndrome.

Serous peritonitis may be an underrecognized feature of adult Still's syndrome. An illustrative case with pathologic findings is presented. Serous peritonitis generally occurs during an acute multisystem flare of Still's syndrome. Peritoneal signs, abdominal distension, and radiographic air fluid levels in the small bowel may suggest incomplete bowel obstruction. Corticosteroids and supportive management are often effective although surgical lysis of adhesions may be required.

Gout and hyperuricaemia in systemic lupus erythematosus.

Coexistent gout and systemic lupus erythematosus (SLE) have received increasing attention. An additional case is reported and published cases reviewed. Common clinical features of this group include nephritis, diuretic and corticosteroid therapy and a tendency to be older and more frequently male. Prevalence of hyperuricaemia (HU) was assessed in 38 patients with SLE. HU was found in 29% and was closely associated with renal involvement particularly proteinuria and diuretic therapy. The presentation of gout in SLE may be modified or suppressed by anti-inflammatory therapy and may be misinterpreted as SLE arthritis.

Complement activation by 19S IgM rheumatoid factor: relationship to disease activity in rheumatoid arthritis.

19S IgM rheumatoid factor (RF) in rheumatoid arthritis (RA) are polyclonal autoantibodies directed against the Fc piece of IgG. Rheumatoid patients with RF tend to have aggressive synovitis, nodules, and extraarticular manifestations. Although RF titer does not correlate with disease activity, RF activates complement (C) by the classical pathway. Thus, we postulated that selective stimulation of cell clones producing efficient C activating RF molecules might be associated with disease flares, independent of changes in serum RF concentration. To address the question, 42 patients with RA were evaluated prospectively. Serum RF concentration was measured by radioimmunoassay (RIA) and C activating activity by hemolytic assay. We then calculated the mean hemolysis (MH) of sensitized sheep erythrocytes (SRC) produced/ml of RF serum (MH/ml) and MH/microgram of RF as an expression of RF C activating properties (CAP). The following observations were made: RF CAP varied among the patients studied; RF CAP varied over time in individual patients; RF CAP differences varied in both groups independently from RF concentration; RF CAP correlated with both systemic and articular disease activity; and total RF concentration correlated with articular findings and nodules but less well with systemic disease activity.

Septic arthritis due to Fusarium solani.

A case of Fusarium arthritis is reported. Fusarium, a mold ubiquitous in soil and on plants commonly causes keratomycosis and infects burns. Recent reports demonstrate that Fusarium may produce serious visceral infection in compromised hosts. Disseminated infection has been universally fatal. In contrast, our case and several others with localized visceral infection were cured by intravenous amphotericin B and drainage. Although Fusarium grows readily on mycologic media, blood and other cultures have usually been negative in disseminated infection. Physicians should be aware of this uncommon but potentially lethal pathogen because deep fungal infections may first appear as arthritis.