Scleromyxoedema associated with synovitis and myopathy.

Scleromyxoedema is a rare skin disease characterized by the deposition of hyaluronic acid in the papillary dermis and often associated with the presence of a monoclonal para protein. Patients with this disorder may also have systemic manifestations. A case of a patient with biopsy proven scleromyxoedema who, in addition to the skin changes had a steroid responsive myopathy and polysynovitis is presented.

Unusual paraspinal muscle lesions in ankylosing spondylitis.

Minicore, multicore, core-targetoid and other ultrastructural lesions were found in the paraspinal muscles of patients with AS. The 10 patients studied, all men with AS, showed varying degrees of muscle fibre atrophy, Z band streaming, rod body formation, minicores, multicores and core-targetoid fibres. Central core disease, rod body myopathy, minicore and multicore diseases are recognized clinical entities within the congenital group of structural myopathies. Target fibres are believed to be a feature of reinnervation. It is also known that experimental tenotomy causes core-targetoid changes, rod bodies, minicores and multicores. Therefore, it seems possible that tension is a necessary stimulus for the correct programming of synthetic muscle enzymes, and without this disorganization occurs. It may also be assumed, but in this case for genetic reasons, that similar biochemical systems are disturbed in the group of congenital myopathies.

Cardiac rheumatoid nodules.

Rheumatoid nodules in the heart are unusual specific manifestations of rheumatoid arthritis. This paper describes three cases in which these nodules were found at necropsy. The patients were women with long histories of rheumatoid arthritis, two of whom had significant but unexplained congestive cardiac failure. The rheumatoid nodules were present in the patients' myocardium and in one patient's pericardium. We suggest that in patients with rheumatoid arthritis with severe but unexplained cardiac failure, the possibility of rheumatoid nodules in the heart should be considered.

Eosinophilia in rheumatoid patients treated with D-penicillamine.

The prevalence of eosinophilia in 66 patients with rheumatoid arthritis receiving D-penicillamine was determined in a retrospective study. Eosinophilia occurred in 24%. The simultaneous occurrence of toxicity and eosinophilia occurred in 3%. In contrast, eosinophilia only occurred in 10% of those with suspected toxicity. The value of eosinophilia as a marker of toxicity is discussed.

Observer variation in grading sacroiliac radiographs in HLA-B27 positive individuals.

This study attempts to reconcile the apparent differences in the reported frequency of ankylosing spondylitis and radiological sacroiliitis in HLA-B27 positive individuals. Pelvic radiographs from 125 Busselton subjects were mixed with 81 other films selected to illustrate the possible range of sacroiliac changes and were graded by observers who were involved in 2 of the conflicting studies and by a 3rd independent observer. Concordance was high for advanced bilateral disease but not for unilateral and milder changes. Variation between observers and the interpretation of sacroiliac radiographs is sufficiently large to account for much of the disagreement between frequency estimates.

Prevalence of eosinophilia during gold therapy for rheumatoid arthritis.

The prevalence of eosinophilia in 82 rheumatoid arthritis patients receiving gold sodium thiomalate (GSTM) and 30 patients receiving auranofin (AF) was determined in a retrospective study. Eosinophilia occurred in 21% taking GSTM and in 13% on AF. The simultaneous occurrence of toxicity and eosinophilia occurred in 14% receiving GSTM and in 10% receiving AF. In contrast, eosinophilia only occurred in 24% of those with suspected toxicity receiving GSTM and in 30% of those with suspected toxicity receiving AF. The value of eosinophilia as a marker of toxicity is discussed.

Reactive arthritis associated with Clostridium difficile.

A case of reactive arthritis in a patient with a previously documented history of Reiter's syndrome is described. The precipitating agent appears to have been Clostridium difficile. High levels of toxin were demonstrable in the faeces and neutralising antitoxin was detected in the patient's serum but not synovial fluid. Resolution of the polyarthropathy was slow despite successful eradication of the C. difficile with a course of vancomycin.

Spinal stenosis: a review of 23 cases.

Twenty-three cases of spinal stenosis suspected clinically and confirmed by computed tomography (CT) scanning are reviewed. The usually prolonged delay from the onset of symptoms to the time of diagnosis can be reduced by an awareness of the frequently bizarre, but usually bilateral clinical features. Confirmation of stenosis has required myelography, but CT scanning frequently may confirm the diagnosis without myelography and, being noninvasive, may facilitate earlier and more appropriate treatment.

A study of the response of the leukopenia of rheumatoid arthritis to gold salt therapy.

Five patients with leukopenia and rheumatoid arthritis were treated with sodium aurothiomalate. An improvement in peripheral white blood count, neutrophil count and articular index was noted in all patients.

Acute progressive osteoarthropathy of large joints: report of three cases.

We report 3 cases of an acute progressive osteoarthropathy of large joints. This condition is characterized by an acute onset, severe constant pain, and a rapidly progressive course in the absence of clinical and histopathological evidence of inflammation. Prior references to this condition are lacking.

The prevalence of ankylosing spondylitis among B27 positive normal individuals--a reassessment.

Previous workers reported symptomatic, but undiagnosed, ankylosing spondylitis (AS) in some 20% of blood donors with HLA B27. As part of an ongoing population study, we compared 139 B27 positive individuals with 128 controls and found no differences in spinal mobility or back pain. There were no differences when all available radiographs were compared. No case of AS was identified. It is concluded that AS occurs in far less than 20% of B27 positive individuals and that the prevalence of AS is of the order predicted by conventional epidemiological surveys. Although HLA typing can be helpful in excluding AS suspected on clinical grounds, it cannot be used to confirm the diagnosis.

Clinical significance of antibodies to ribonucleoprotein.

Antibodies to ribonucleoprotein (RNP) were detected by an immunofluorescence technique based on the sensitivity of speckled antinuclear antibodies to ribonuclease. These antibodies were found to identify a group of patients with a consistent set of clinical features, especially arthritis, swollen hands, Raynaud's phenomenon, and myositis. The presence of anti-RNP antibodies in sera from patients with polymyositis, systemic lupus erythematosus, and systemic sclerosis was also associated with these clinical features. Other studies of the clinical significance of these antibodies support the concept that they appear to identify a group of patients with a distinct clinical condition.