Kauko Vainio

Finger deformities caused by rheumatoid arthritis.

In this study, we have tried to clarify the role of rheumatoid lesions of the tendons and adjacent soft tissues in the development of finger deformities. Other factors, such as loss of cartilage and bone substance, rheumatoid pannus formation, growth (in children), shrinkage as a result of scarring,

Shoulder Affections in Rheumatoid Arthritis

Rheumatoid involvement of the shoulder seems to be, according to the literature (except Weil and others, 1951), relatively rare compared with the involvement of peripheral joints, but painful symptoms in this region are common. Our knowledge of the aetiological relationship of these symptoms to rheumatoid arthritis is scanty and there are few if any detailed studies. We have therefore studied 277 cases of rheumatoid arthritis to determine: (a) the incidence of shoulder affections in rheumatoid arthritis, (b) the varieties of painful disorders and their aetiology.

Posterior (dorsal) Synovectomy for Rheumatoid Involvement of the Hand and Wrist: A Follow-up Study Of Sixty-six Procedures

More or less complete excision of diseased synovial tissucs-syniovectomy--lias beeni recomnienided for years as one method for surgical treatment of rheumatoid arthritis, especially arthritis of the knee joint. Surgical treatment of rheumatoid arthnitis of the hands has received mu(-h less attention. However, recent articles have described excisiomi of hypertrophic inflamed symiovial tissue around flexor tendons in the digital sheath, in the carpal tunnel, or mi both. Although widely used, symiovectomy on the dorsal aspect of the hand has received little attention in the literature. Considering the frequent involvement of this particular site , a thorough study of the surgical reconstruction of this region seemed to be justified. Dorsal synovectomies have been mentioned briefly in several reports dealing is-ith the rehabilitation of the rheumatoid hand. These reports have emphasized, as a rule, the importamice of surgical d#{233}bridement of diseased synovial tissue on the dorsum of the hand in order to stop or delay progression of the disease at. this site amid especially to prevent tendon ruptures. In 1952, Kestler described six patients surgically treated for collagenous pseudotumors of the hand. Five of them seemed to have been rheumatoid synovitis. while the sixth is-as proved to have a tuber-ulous lesion. Howard, iii 1955, reported eleven cases of rheumatoid tenosynovitis, in eight of which surgical d#{233}bridenicnit of the diseased synovial tissue had been performed becau c of involvement of the posterior tendons of the ss-rist. Jacobs, Hess, and Hesis-ick, in 1957, described three cases, in two of which lobulated painless fluctuant masses on the dorsum of the wrist is-crc removed. Recently, Flatt discussed synovectoniy of the extensor tendons in his monograph “The Care of the Rheumatic Hamid,” describing technical details of the procedure and recording his impressions. Fortythree cases is-crc reported by Vainio, in 1964, who noted promising results is-bent operation is-as performed early enough. In 1965, Lipscomb and, during the same year, Campbell and Straub emphasized the value of posterior synovectomies in the reconstruction of rheumatoid hanids, recommending early synovial d#{233}bridement of the dorsum of the ss-rist to avoid rapid progression of the disease anid severe dest ruct ive (-baRges. Although all the articles published indicate increasing interest in posterior symiovectoniy, is-c were niot able t.o find in the literature at our disposal any detailed studies describing late results in a relatively large group of cases. The object of this paper is to report our observations during a follow-up study of sixty-six hands cighteeni months to seven years after synovectomy amid to clarify the inidicat.ions for this procedure.

Ulceration of the skin in rheumatoid arthritis.

SummaryAmong about 2,000 cases of rheumatoid arthritis twelve cases were found in which single or multiple ulcerations of the skin were present. These ulcerations were mostly located in the lower part of the leg. The development had been preceded by an oedema. Varicose veins were present in only one case. The ulcers were torpid and histologically there are signs giving cause to suppose that the origin of these features is a cutaneous rheumatic nodule in connection with grave inflammatory changes in the blood vessels.

Occurrence of Amyloid in Rheumatoid Arthritis: Some Observations

SummaryAt 289 biopsies made on patients with rheumatoid arthritis the presence of amyloid could be demonstrated in 83 cases (28.7 per cent).In 55 cases (19 per cent) the findings were less distinctly positive.There seem to be variations in the occurrence of amyloid in different tissues.

Protease3.75 Activity in Rheumatoid Tissues

Protease activity was estimated polarographically at pH 3.75 from specimens of serum, synovial fluid, synovial tissue and cartilage. Marked protease activity was found in rheumatoid synovial fluid and synovial tissue. In cartilage, however, the activity was low. Protease activity values in rheumatoid sera did not differ significantly from those of the controls. In osteoarthritic joint fluid protease activity was also low, and in traumatic synovium extremely low. No correlation was found between protease activity and several parameters of rheumatoid inflammation.