Klaus A. J. Järvinen

A Study of the Interrelations of Rheumatoid Arthritis and Diabetes Mellitus

In investigations on the interrelations of rheumatoid arthritis and the various endocrine disturbances, very little attention has been paid to diabetes mellitus. Thus, there exist only short notes on the occurrence of rheumatoid arthritis among diabetics (Wolf, 1936), and only the effects of an insulin treatment given to rheumatoid arthritis patients have been subjected to a closer examination (Copeman, 1946). A further reason for analysing the interrelations of rheumatoid arthritis and diabetes mellitus was that an increased secretion of the adrenocortical glucocorticoids (as cortisone or Compound E) and of the antehypophyseal hormones (ACTH) is at present regarded as a feature of diabetes mellitus; and these hormones are those upon which the interest in rheumatoid arthritis is now concentrating. Material The study comprises the rheumatoid arthritis and diabetes mellitus patients treated at the Third Medical Clinic of the University of Helsinki and in the medical wards of the Kivela Hospital during the 15-year period 1934-1948. Rheumatoid Arthritis Patients.-There were 1,008 in this group, of whom 725 were female and 283 male. The average age in the whole group was 48-7 years. Diabetes Mellitus Patients.-There were 766 altogether, of whom 490 were female and 276 male. The average age was 51 -6 years.

On the Occurrence of Neuropathic Arthropathies in Pernicious Anaemia

Among the admissions to our clinic there was a case of severe anaemia perniciosa myelosis (subacute combined degeneration of the spinal cord) associated with painless joint disease. The tendon reflexes of the lower limbs were lost, there was considerable decrease in pain sensibility and deep sensibility, and the gait was markedly ataxic. The x-ray findings revealed alterations in the joints, and particularly in the knee bone a close resemblance to neuropathic joint changes. These alterations suggested to the radiologist that tabes dorsalis might be present in this case. Since the possibility oftabes was excluded by thorough examination, the suspicion arose that the patients joint changes, which so closely resembled neuropathic ones, might be attributed to myelosis funicularis. As we have not been able to find in the literature descriptions of joint deformation associated with anaemia perniciosa myelosis, we consider a presentation of our investigation of this problem to be justified.

Differential diagnosis of hepatitis and liver cirrhosis by means of cholecystography.

19 patients suffering from acute or subacute hepatitis and 19 cases of liver cirrhosis were subjected to cholecystography with dye given per os in the usual manner, at a time when the icterus index was below 1:30. The shadow of the gallbladder appeared normal in 15 cases of hepatitis, was less pronounced than normal in 3 cases, and in one case in which the patient suffered also from cholelithiasis, it did not appear at all. In the cases of liver cirrhosis, the shadow of the gallbladder did not appear normal in any of the cases; in 6 of the cases a slight shadow was observable, and in 13 cases, no shadow could be observed. A comparison with some hepatic function tests also suggested that cholecystography may be of some help in the differential diagnosis of hepatitis and liver cirrhosis.

Rheumatoid Arthritis and Arterial Pressure

SummaryThe material examined consisted of 541 rheumatoid arthritis patients, 398 women and 143 men. All were over 15 years of age. In age groups under 50 the mean arterial pressure was somewhat higher than the corresponding figures in the general population. The blood pressure in patients over 50 was about normal. The systolic pressure in patients under 40 was highest in the most active rheumatoid arthritis group. The duration of rheumatoid arthritis did not seem to affect the blood pressure.

Fatal diffuse haemorrhage in cases of laennec’s liver cirrhosis

Of 19 cases of liver cirrhosis of Laennec’s type, three died of haematemesis and melaena. In these three patients, the post mortem examination revealed a diffuse haemorrhage from the wall of the gastro-intes-tinal tract. No bleeding had occurred from the varicose veins of the lower part of the oesophagus or from corresponding formations in other parts of the gastrointestinal tract. The results of the study are considered to suggest that such a diffuse gastro-intestinal haemorrhage is more common than generally thought in connection with liver cirrhosis. It is indicated that this possibility must be seriously considered, e.g. when planning local therapeutic measures for varicose veins of the lower part of the oesophagus, for stopping haematemesis.