[Message in joint diseases and joint injuries].
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Criteria for the specific diagnoses of the several arthritides, on the basis of exfoliative cytology examination of fluids aspirated from diseased joints, were derived from examinations of 126 specimens of synovial fluid. They were screened cytologically and wholly on the basis of the cytological findings were classified into seven groups: rheumatoid arthritis, osteoarthritis, traumatic arthritis, gouty arthritis, Reiter's syndrome, pigmented villonodualr synovitis, and septic arthritis. The cytological features of each group appeared relatively constant and reproducible. Subsequent comparison of the clinical and cytological diagnoses showed excellent correlation.
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The coincidental occurrence of schizophrenia and rheumatoid arthritis is considered to be low in relation to the prevalence of the two diseases. In the present study, data from the patient statistics prepared by the Swedish Social Welfare Board were examined for the occurrence of rheumatic disease in schizophrenic patients. With the aid of the statistics and of questionnaires, 58 case-records were collected and studied. Very few cases were found of co-existing schizophrenia and inflammatory joint disease, rheumatoid arthritis in particular. There were, however, some cases of genuine schizophrenia and definite seropositive rheumatoid arthritis in the same patient. Rheumatoid arthritis is possibly uncommon also in combination with other psychiatric diseases that require hospital care. The ankylosing-spondylitis cases were over-represented in relation to the rheumatoid-arthritis cases included in the statistics from psychiatric care. Most of the 13 ankylosing-spondylitis patients whose case-records were studied had schizoaffective psychosis or atypical psychosis. The results of the investigation should be confirmed by epidemiological studies; this may contribute to the understanding of the aetiology of rheumatoid arthritis and of schizophrenia.
Cutaneous hyperthermia represents a symptom of inflammatory joint diseases and "activated" arthroses. Arthritis and arthrosis may be differentiated by the different distribution and extent of hyperthermia. In an equal number of different joint diseases the symptoms and signs and the course of the diseases were investigated with the aid of contact thermography. The results indicate different exact localisations of temperature changes in the affected joints which together with the clinical findings may make it possible to establish differential diagnostic definitions between arthrosis and rheumatoid arthritis. In the authors' opinion contact thermography is, however, not suited for observations of the course of the diseases.
Tarsal degenerative joint disease (DJD) in 12 cattle was classified as primary or secondary, based on age, evidence of hereditary or congenital joint conformation defects, faulty hindlimb alignment, duration and type of usage joints were subjected to, and history or signs of repeated trauma. Three of the cattle had bilateral primary tarsal DJD, 7 had bilateral secondary tarsal DJD, and 2 had secondary DJD of the left tarsus. Analyses of synovial fluid samples provided a means of characterizing pathologic changes of tarsal DJD, Results of blood and synovial fluid analyses were grouped in compilation of data for cattle affected with either primary or secondary tarsal DJD. Corticosteroids and a long-acting synthetic progestational agent were injected singly or in combination with aqueous antibiotics into affected tarsal joints. Tarsal joints of 5 of the cattle responded favorably to a single intraarticular treatment, as manifested by palliative relief and functionally usable joints. Seven joints of 5 cattle were subjected to repeated intraarticular treatment. Serial synovial fluid analyses in 7 of the cattle provided a means of assessing tarsal joint response to intraarticular treatment or to therapeutic arthrocentesis, exclusive of patient objective response. One cow developed a mild self-limiting bilateral postinjection synovitis that was resolved after the 2nd and final intraarticular injection. Usable function returned to tarsal joints of cattle that responded favorably to intraarticular treatment at different periods after single or repeated injections. Three cattle with advanced tarsal DJD experienced minor temporary relief and were euthanatized at their owner's request. Improvement did not occur in the tarsal joint of 1 cow subjected to therapeutic aspiration only. Intraarticular treatment in all cattle was considered supportive to the animal's well-being rather than curative.
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The diagnostic procedure is given in the detail necessary to arrive at an accurate diagnosis of temporomandibular degenerative joint disease (TDJD). The differentiating clinical findings of degenerative joint disease (DJD) and rheumatoid arthritis of the temporomandibular joint (TMJ) are described. Principles and modalities of comprehensive management of TDJD are presented in the manner and sequence needed to allow practical clinical application. Methods of treatment are applied to the management of patients with acute and chronic TDJD. The surgical procedure for TDJD, intracapsular high condylectomy with a preauricular incision, is described in the detail required for individual application. Case reports are presented to illustrate the comprehensive management of TDJD.
Activity and results of therapy of joint diseases can be evaluated by means of cytological examinations of the synovia which is at the same time a prerequisite for differential diagnosis using the puncture fluid. Our cytological examinations of more than 700 puncture fluids stemming from different joint diseases were carried out immediately after the puncture on the fresh material, in order to prevent misinterpretation. This may occur through flaking out in stored material, which results in decrease in the cell count and a non-representative differential cell picture in the supernatant, as well as through degeneration of cells. In two thirds of our patients the local process activity, measured in terms of the cytological phase of activity, became evident in the total clinical activity. The synovia analysis furthermore permits objective assessment of the result of intra-articular injection treatment. Intractable activity, substantiated through synovia examination indicates synovectomy.
The knee joints from males of two strains (CBA/ORT and STR/ORT) were studied histologically. The incidence of degenerative joint disease was very high in the STR/ORT strain. Degeneration of the cartilage invariably occurred first at the interface of the cruciate ligament and articular cartilage of the tibia. Lesions were only seen on the medial tibial and later the medial femoral condyles. Blocks of fibrillated, uncalcified cartilage were gradually lost across the condyle, leaving the tidemark as a secondary articulating surface. Meanwhile the subchondral bone thickened and erosion continued through the calcified cartilage into the underlying bone. A statistically significant relationship was found between the development of the lesion and (a) medial dislocation of the patella, (b) calcification and ossification of the medial collateral ligament. Patella dislocation gave rise to extensive cartilaginous and bony metaplasia of the synovial tissue. In joints with advanced degeneration there was often evidence of a slight lateral subluxation of the femur relative to the tibia.
Although degenerative joint disease is a most common type of arthritis in persons past 40 years of age, and associated with an aging process, this case has been presented as an interesting finding because of the early occurrence. Clinical symptoms, radiographic changes, and microscopic alterations were demonstrated. Conservative therapy was unable to relieve the symptoms and slow the progressive degeneration, and resolution of the subjective complaints was achieved by surgical intervention.
The failure of meniscal regeneration via a fibrous semilunar mold can be correlated with an increased incidence of degenerative joint disease. Experiments on rabbits revealed a statistically significant relationship between the failure of meniscal regeneration and the development of degenerative joint disease, characterized by osteophyte formation, cartilage pitting and erosions, and loss of carbilage proteoglycan. Similar results in limited studies utilizing adult fox hounds supported this observation. In dogs, variation in the extent of tissues resected about the meniscus, including synovectomy, did not inhibit the reformation of a fibrous semilunar mold. No specific "zone of regeneration" responsible for meniscal regeneration was identified.
Severe degenerative joint disease developed in three adults with mild to moderately severe hemophilia A, as judged by the clinical course and by levels of factor VIII coagulant. Bilateral total hip arthroplasty was required in one patient, unilateral hip arthroplasty in the second, and a recommendation for bilateral knee replacement in the third. The pathogenesis of the arthropathy may be multifactorial and the result of repeated joint hemorrhage that remains unrecognized and inadequately treated. These observations suggest the need for more careful monitoring of patients who have relatively mild hemophilia.
Gross anatomical and radioligical techniques have been used to investigate the form and incidence of degenerative joint disease in the knee joint of an inbred strain of mouse (STR/ORT). The disease was seen radiographically as a thickening of the subchondral bone in the medial tibial and femoral condyles predominantly in the males. In fresh and macerated joints only advanced lesions could be seen with light microscopy and these appeared as concave (tibial) or flattened (femoral) erosions with hard shiny eburnated surfaces. Medial patella dislocation was a common feature of the arthrotic joints and there was associated widespread periarticular heterotopic calcification. These growths started as peripheral exostoses from the patella and as small loci of mineralisation within the synovial tissue but later enlarged into plaques of calcified tissue. Ossific centres within the menisci were present in all knees but became greatly enlarged in the osteoarthrotic joints. Calcification of the collateral ligaments occurred in non-arthrotic joints, especially laterally, but progressed to thick ossification in the medial ligament of arthrotic knees. Eventually all these enlarging sites of calcification and ossification began to fuse together, thus limiting the degree of movement of the joint. There was a statistically significant positive relationship between the severe arthropathy and (a) marked patella dislocation and (b) the presence of calcification in the medial collateral ligament.
The boundary lubricating ability of eleven synovial fluids was measured in a miniaturized latex--glass test system. The specimens were obtained at necropsy from knees in which the degree of degenerative joint disease varied from none to very severe. The lubricating ability of the fluid was independent of the viscosity over a wide range of shear rates. It was not diminished even in advanced lesions. In two additional fluids, the mucin clot was poor; the lubricating ability of one of these was compromised. Thus, although degenerative joint disease, during its quiescent stages, is not associated with defective synovial lubrication, the possibility that transient defects might lead to cartilage wear during life has not been excluded. The measurements are believed to be valid indicators of boundary lubricating ability under physiological conditions despite the fact that the test surfaces were not cartilaginous and the loading was relatively low (up to 47 pounds per square inch).
The somatomedin activity in synovial fluids from 50 patients with a variety of joint diseases has been studied and compared with the activity in each of the patient's own serum and a standard reference serum (SRS). The porcine costal cartilage bioassay of Van den Brande and Du Caju (1974a) has been used with the isotopes 3H-thymidine and 35S-sulphate. Synovial fluids from most patients with post-traumatic and post-operative effusions, osteoarthritis and arthritis associated with psoriasis, Reiter's disease, and ankylosing spondylitis stimulated the synthesis of DNA and proteoglycans in cartilage. Synovial fluids from patients with rheumatoid arthritis either had impaired capacity to stimulate DNA synthesis, or they inhibited it; a similar, but less evident pattern was observed for proteoglycan synthesis. Some synovial fluids from patients with miscellaneous synovitides stimulated, while others inhibited cartilage metabolism. It is concluded that the synovial fluid from patients with rheumatoid arthritis and from some patients with miscellaneous synovitides contained an inhibitor(s) to DNA and possibly proteoglycan synthesis. The sera from nearly all the patients stimulated both DNA and proteoglycan synthesis, but the somatomedin potency ratios for serum in terms of SRS were generally less than 1.0. There was a significant inverse correlation between the serum somatomedin potency ratio and the age of the patient.