Marian W. Ropes

The role of pleuropneumonia-like organisms in genitourinary and joint diseases.

THE high incidence of acute joint disease in male patients with positive prostatic cultures, in addition to the knowledge that animals infected with L organisms frequently have arthritis, suggests ...

THE ORIGIN AND NATURE OF NORMAL SYNOVIAL FLUID

The physical and chemical properties of normal synovial fluid have never been well established. In consequence there exists no uniformity of opinion concerning its mode of formation. If we possessed information concerning the origin and nature of normal synovial fluid, we would be in a position to interpret more correctly the abnormalities encountered in pathological joint effusions and to determine their diagnostic significance. Information of this type should also increase our knowledge of the factors involved in the production and maintenance of joint effusions. In 1691, Havers (62), on the basis of histological examinations, concluded that synovial fluid was a secretion from synovial membrane glands. Since then various descriptions of synovial fluid and theories concerning its origin have appeared. This lack of agreement is readily explained if one examines the data upon which the various theories are based. Some of them are based solely on histological studies. Others represent conclusions drawn from chemical analyses of pathological synovial fluids. The data on pathological fluids, many of which are incomplete, vary markedly and are difficult to interpret without knowledge of the normal and a better understanding of the factors responsible for the formation of pathological fluids. The existing data pertaining to normal synovial fluid are very meagre, except for complete cytological studies (6, 73, 122). The various theories proposed and the data on which they are based are presented in brief. 1. That synovial fluid is the secretory product of synovial membrane cells or glands. This theory, originally proposed by Havers (62) and supported by many subsequent workers (4, 11,

A case of lymphoproliferative disease presenting as juvenile rheumatoid arthritis: Diagnosis by synovial fluid examination

Abstract Lymphoproliferative disease can present as arthritis, most commonly mimicking acute rheumatic fever. The finding of arthritis rarely leads to the correct diagnosis, in fact, it frequently suggests inflammatory rheumatic diseases. We present a case closely resembling juvenile rheumatoid arthritis in which the diagnosis was made by demonstration of malignant cells In the synovial fluid at a time they were absent from the peripheral blood and initial bone marrow specimen. Closed synovial and bone biopsy specimens, the latter of an osteopenic area, revealed the infiltrative character of this disorder.

The natural course of rheumatoid arthritis and the changes induced by ACTH

T HE course of rheumatoid arthritis is characterized by spontaneous remissions which are unpredictable in time and duration. The variability of the natural course of this disease can be appreciated only after long-continued study of a large, unselected group of patients. Observations of this type on a large series of rheumatoid arthritis patients during the past twenty-two years have made possible a better definition of the natural course of the disease and have provided a control series by which the effects of therapeutic measures may be evaluated.’ In addition, wc have learned that rheumatoid arthritis is a generalized disease characterized by well marked constitutional manifestations which may be the first symptoms experienced by the patient and are not merely secondary to the articuIar lesions2 The value of such long-continued obsrrvations is well exemplified by the case of a young woman with rheumatoid arthritis who between 1942 and 1949 was studied carefully during the initial period of active disease and during spontaneous remission and postoperative exacerbation. This background provided a unique opportunity to observe the effect of ACTH on the clinical and laboratory manifestations of rheumatoid arthritis3 and to compare the hormone-induced changes with those which occur spontaneously. This phase of the study extends over a ten-month period and includes observations on an ACTH-induced remission and two A(:TH withdrawal exacerbations. The effect of ACTH on articular inflammation, as determined by microscopic examination of synovialis before and after the ACTH-induced remission, was studied; synovial membrane biopsied during the spontaneous remission was available for comparison. The purpose of this paper is to report these observations, particularly as they concern similarities and differences between the spontaneous and ACTH-induced remissions and the postoperative and ACTH withdrawal exacerbations, and to discuss the implications of this long-term study.

Rheumatoid Arthritis: Its Varied Clinical Manifestations

ONE of the greatest difficulties in recognizing rheumatoid arthritis, except in a severe, advanced form, arises from the fact that the disease may have many types of onset and may vary greatly in i...

The Value of Enteric-Coated Aspirin

BECAUSE of its analgesic value, acetylsalicylic acid (aspirin) is used extensively. In the treatment of certain rheumatic disorders, maximal dosage over long periods is frequently necessary if opti...

Action of Ascorbic Acid and Hydrogen Peroxide on Collagen and Thymonucleohistone.

Summary Ascorbic acid and hydrogen peroxide cause an irreversible reduction of viscosity of solutions of collagen and thymo-nucleohistone.

Case 42-1968

Presentation of Case An eighty-year-old physician was admitted to the hospital because of urinary frequency and urgency and dysuria. For thirty years he had had progressive rheumatoid arthritis ass...

Case 9-1966

Presentation of Case A fifty-one-year-old man was admitted to the hospital because of gastrointestinal bleeding. His right shoulder had been injured in an automobile accident seven years previously...

Case 23-1965

Presentation of Case A seventy-eight-year-old man was admitted to the hospital because of hemoptysis. He had been well until thirteen years previously, when there was the onset of rheumatoid arthri...