Histiocytic necrotising lymphadenitis in systemic lupus erythematosus.

Histiocytic necrotising lymphadenitis is the pathognomonic histological appearance of lymph nodes in Kikuchi's disease, a condition characterised by a brief systemic illness and lymphadenopathy. The case is described of a young man, originally diagnosed as having Kikuchi's disease by lymph node histology, who subsequently developed systemic lupus erythematosus with symmetrical polyarthritis, Coombs' positive haemolytic anaemia and haemorrhagic pneumonitis. The case emphasises that a range of diseases is associated with histiocytic necrotising lymphadenitis, belying the unitary impression given by the term Kikuchi's disease.

Premature development of erosive osteoarthritis of hands in patients with chronic renal failure.

The prevalence of grade III or IV osteoarthritis was determined in 210 patients with chronic renal failure, of whom 94 were receiving chronic haemodialysis and 116 had functioning renal transplants. The prevalence of grade III or IV osteoarthritis was three times greater in patients under 65 than in a control population, and all but two affected patients also had erosion of subchondral bone in at least one affected joint. The excess of osteoarthritis was apparent in both the transplant recipients and those receiving haemodialysis. Over the age of 65 there was no significant difference in prevalence. Metabolic bone disease, including osteopenia, might contribute to the development of erosive osteoarthritis in chronic renal failure.

Is chronic renal failure a risk factor for the development of erosive osteoarthritis?

Erosive osteoarthritis of the hands of unusually early onset and severity was seen in two patients treated for chronic renal failure by long term haemodialysis and renal homograft respectively. The significance of this observation is discussed in the light of previous studies of erosive arthropathy in patients with chronic renal failure. Factors associated with chronic renal failure may predispose to the development of erosive osteoarthritis.

The influence of cigarette smoking on blood gold distribution during chrysotherapy.

Plasma and erythrocyte gold concentrations were measured in 35 patients taking gold sodium thiomalate (GSTM) for rheumatoid arthritis. In 6 patients with adverse effects attributable to gold therapy at the time of sampling, gold concentrations in plasma and erythrocyte fractions were no different from those without adverse effects. A significant difference was seen in the distribution of gold in the blood of cigarette smokers compared to non-smokers, with smokers having higher erythrocyte and lower plasma gold concentrations. A prospective study on 15 patients commencing treatment with GSTM showed that the higher concentrations of erythrocyte gold seen in smokers were achieved within the first 2 weeks of treatment.

Calcium pyrophosphate dihydrate deposition disease and familial hypomagnesemia.

A 40-year-old woman presented with calcium pyrophosphate synovitis and chondrocalcinosis. She was subsequently found to have hypomagnesemia, as did her 22-year-old son. Metabolic studies demonstrated normal gastrointestinal absorption of magnesium, and impaired renal conservation of magnesium without other evidence of renal tubular dysfunction. It seems likely that a genetically determined abnormality of magnesium metabolism was responsible for the occurrence of chondrocalcinosis in this patient.

Longterm follow-up of posterior cervical fusion for atlanto-axial subluxation in rheumatoid arthritis.

Surgical fusion of the upper cervical spine was used to treat atlanto-axial subluxation in 7 patients with rheumatoid arthritis. Postsurgical follow-up was 3 to 16 yr. Despite progressive and often severe radiological changes in the cervical spine, no patient has had a clinical recurrence of neck symptoms requiring further surgery. These results suggest that surgical fusion is successful in the longterm, despite the often dramatic radiological changes which occur in the cervical spine with the passage of time.

Metoclopramide. Management of gastrointestinal intolerance in rheumatoid arthritis patients.

Ten patients with rheumatoid arthritis who were unable to tolerate anti-inflammatory doses of non-steroidal anti-inflammatory drugs (NSAIDs) were admitted to the study. After endoscopy three patients were taken out of the study because of frank gastric ulceration. Seven patients entered the six-week study during which anti-inflammatory doses of NSAIDs were preceded by 30 minutes by a 10-mg dose of oral metoclopramide. The insults of this pilot study suggest that pretreatment with metoclopramide enables patients with rheumatoid arthritis who have non-ulcer dyspepsia to tolerate full dosage of NSAIDs.

Circulating and intra-articular immune complexes in rheumatoid arthritis: a comparative study of the C1q binding and monoclonal rheumatoid factor assays.

The C1q binding assay and the nephelometric monoclonal rheumatoid factor assay were able to discriminate 79% and 57% respectively of rheumatoid arthritis (RA) patients from healthy blood donors. In addition these assays could distinguish those patients with active arthritis from those with inactive disease, and the C1q binding assay correlated significantly with other laboratory indices of the rheumatoid process, including the erythrocyte sedimentation rate, low molecular weight or 7S IgM, and the rheumatoid factor titre. High levels of C1q binding were also seen in rheumatoid vasculitis. Both assays gave higher mean values in synovial fluid compared with the corresponding serum, but it appeared from ultracentrifugal analysis and from a lack of a consistent correlation between these assays that each assay was measuring different forms of immunecomplex-like material which may be involved in the immunopathogenesis of this disease. The C1q binding assay is of some value in the laboratory assessment of rheumatoid arthritis and appears to offer greater advantages than the monoclonal rheumatoid factor assay, although the usefulness of this latter assay may be very dependent on the monoclonal rheumatoid factor used.

Granulomatous hepatitis and Seatone.

Granulomatous hepatitis developed shortly after a patient with mild chronic polyarthritis started taking Seatone, a proprietary product. No other likely cause for her liver disease could be determined.

Spontaneous osteonecrosis of the medial femoral condyle.

Six patients with osteonecrosis of the medial femoral condyle were seen during a 3 1/2-year period in a rheumatology unit. This condition, which may not be rare, is characterized by the sudden onset of pain in the knee of elderly people (usually women) without significant trauma. Physical signs include effusion and tenderness at the medial margin of the knee joint. Radiographic changes may not be evident for weeks or even months. The later appearances are characteristic and the site of the lesion is remarkably constant.