Joseph L. Hollander

Studies on the Pathogenesis of Rheumatoid Joint Inflammation: II. Intracytoplasmic Particulate Complexes in Rheumatoid Synovial Fluids

Excerpt The etiology and pathogenesis of rheumatoid arthritis are not known. Many studies have described the clinical and pathological characteristics of the disease process. Numerous additional st...

The Mechanism of Hypoalbuminemia in Rheumatoid Arthritis

Excerpt Hypoalbuminemia is frequently encountered in rheumatoid arthritis, but the mechanism producing this abnormality has not previously been investigated. Tracer studies using isotopically label...

Locally administered hydrocortisone in the rheumatic diseases: A summary of its use in 547 patients

Abstract 1. 1. Hydrocortisone has been injected into inflamed joints or other non-infectious locally diseased tissues a total of 3,757 times in 547 patients with various types of rheumatic disease over an eighteen-month period. This includes 249 patients with rheumatoid arthritis and 210 with osteoarthritis. 2. 2. Repeated intra-articular or intrabursal hydrocortisone injections at least partially alleviated the local inflammation in 85 per cent of patients treated. An analysis of case results is given. 3. 3. Individual injections of the hormone failed to produce appreciable therapeutic benefit in 346 of 3,757 instances (9 per cent). An analysis of the results with individual joints is presented. 4. 4. Indications for and contraindications to this method are presented. 5. 5. Adverse reactions to this local therapy are few and transient. 6. 6. Intra-articular hydrocortisone is a useful adjunct to the usual methods of treatment for rheumatoid arthritis, osteoarthritis, gout, bursitis and other localized rheumatic disorders.

Local Anti-Rheumatic Effectiveness of Higher Esters and Analogues of Hydrocortisone

During the past 31 years we have given more than 17,000 intrasynovial injections of hydrocortisone (Compound F) into the joints, bursae, or tendon sheaths of nearly 1,300 patients for various forms of rheumatic disease (Hollander and others, 1951a, 1954; Brown and others, 1953; Hollander, 1953a,b). Numerous confirmatory and supplementary reports in the world medical literature have shown that this method has now been widely accepted as an adjunct in the local management of arthritis and related conditions (See Bibliography). While we have found that intra-articular hydrocortisone acetate (F a) produces a temporary alleviating effect in over 80 per cent. of all joints injected, the transitory nature of this effect limits its practical value as therapy in about one-third of our cases. Obviously, joint injections cannot be repeated every few days, even on hospitalized patients. Since the method has proved of value mainly in helping to preserve normal joint function in ambulatory patients who would otherwise be disabled by some local rheumatic inflammation, a search has been conducted to find an agent capable of prolonging the local palliative effect. Investigations into the disappearance of hydrocortisone from the synovial fluid, which revealed the absorption of the injected hormone by the cells of the synovial fluid and particularly by the lining membrane of the synovium, were reported by us a year ago (Hollander, 1953c, Zacco and others, 1954). The most significant finding was that the hydrocortisone acetate was apparently absorbed and retained by the lining of the synovium without splitting the ester, whereas unabsorbed hormone remaining in the joint fluid was rapidly hydrolysed and broken down. We therefore assumed that higher, and less

The Calculated Risk of Arthritis Treatment

Excerpt In the United States every year about 40,000 persons are killed by automobiles, and over a million are injured. Appalling as these statistics are, no one would suggest that auto travel shou...

Studies in Osteo-Arthritis using Intra-Articular Temperature Response to Injection of Hydrocortisone Acetate and Prednisone

The use of intra-articular hydrocortisone acetate in the treatment of osteo-arthritis has been shown to produce a temporary improvement of symptoms in many cases (Hollander, Stoner, Brown, and De Moor, 1951), although enthusiasm for this method has been tempered by warnings of the possibility of increasing the damage in joints subjected to excessive use in the periods of freedom from symptoms (Young, Ward, and Henderson, 1954). The results of treatment of the knee have been more encouraging than those of treatment of other joints, presumably because of the ease with which injection of the knee joint can be accomplished. The present study has been undertaken in a series of patients with osteo-arthritis, to determine what changes occur in the intra-articular temperature, before and after the injection of hydrocortisone acetate or prednisone into the knee joint. An endeavour was also made to correlate these temperature changes with the relief of symptoms in the affected joint.

AN ATTEMPT TO RATIONALIZE THERAPY OF RHEUMATIC DISEASE

The clinician responsible for treating the diseases of connective tissue listens to the scientific reports as presented in this symposium and wonders how this newer knowledge may help him in his difficult task. A prominent physicist recently asked: “HOW can you be sure of anything in medicine? You have no constants, and only an infinite number of variables with which to work.” To those in the exact sciences, the approximations, estimates, and conjectures used in the biological sciences seem a poor substitute for the formulas based on constants that are available to them. All workers in the field of biology in general, and medicine in particular, are accustomed to “usually” or “rarely” instead of “always” or “never,” and the number of variables reaches infinity in dealing with the total organism of man, as does the clinician. How, then, can a rationale for therapy be proposed for a heterogeneous group of connective tissue diseases of unknown etiology that seem at least slightly different in every victim? Obviously, such an assignment is impossible. This presentation cannol be scientific. It must be a patchwork of conjecture, remotely based on scattered facts, empiricism, trial-and-error, and experience. I t can be justified only as a working hypothesis formulated by a clinician who feels the need for a framework upon which to assemble widely scattered bits of knowledge. The interstices can be filled only with conjecture, but the physician must have some over-all plan for a rationalization of the various treatment measures that together may help his patient combat the connective tissue disorder. If these disorders are actually diseases of the immune mechanism of the body, with abnormal macroglobulins deposited in the connective tissues acting as autoantibodies, it can be understood why such conditions tend to be chronic and progressive, and the variations in severity throughout the course might even be explained, but still there is no clue to the etiological factor initiating the abnormal production and deposition of macroglobulins. It is possible that these abnormal proteins are merely accumulated waste products of the inflammation, comparable to amyloid or analogous to gouty tophi, which contaminate the tissues and make it still more difficult for the organism to cope with the disease. It still is possible that infection, perhaps from a yet unidentified virus, initiates the abnormal immune reaction. This appears plausible on the basis of the sequence of events observed in rheumatic fever, but the similar connective tissue lesions produced by the deliberate sensitization of experimental animals and the development of connective tissue diseases in man in the apparent absence of clinical infection leave important gaps in this line of conjecture. In the case histories of hundreds of individuals with rheumatoid arthritis, systemic lupus erythematosus, polyarteritis, and dermatomyositis it is noteworthy that in many the onset had occurred after some type of infection; in others the disease followed use of a drug; in still others it developed after a

Rheumatoid Arthritis, Rheumatoid Factor, and Gamma G Globulin Fragments.

Excerpt Rheumatoid factor (RF) is an antibody toalteredimmunoglobulin G (IgG), but its role in pathogenesis of rheumatoid arthritis (RA) has not been established, nor has the nature or origin of an...

When To Hospitalize The Rheumatoid Arthritis Patient

About one rheumatoid arthritis patient in five may require hospitalization at some time during the course of his disease. But, Dr. Hollander believes, in given circumstances this proportion may be far too high. The critical question: “What can be done for the specific patient in the specific institution?” The rheumatologist outlines criteria for appropriate hospitalization.