Pulmonary manifestations of juvenile rheumatoid arthritis. A report of eight cases and review.

Pleuropulmonary disease was seen in 4 per cent of patients with juvenile rheumatoid arthritis. Roentgenographic abnormalities seen in association with juvenile rheumatoid arthritis include: transient pneumonitis, interstitial reticular and nodular infiltrates, pleural and pericardial effusions, and patchy pleural infiltrates. Pathologic abnormalities seen in association with juvenile rheumatoid arthritis include pulmonary hemosiderosis, lymphoid follicular bronchiolitis, and lymphocytic interstitial pneumonitis. Patients with juvenile rheumatoid arthritis and pleural disease recover fully. In children with parenchymal disease, residual abnormalities include roentgenographic evidence of interstitial fibrosis and minimal abnormalities of pulmonary function.

Articular manifestations of polymyositis and dermatomyositis.

Nine patients with polymyositis or dermatomyositis associated with arthritis without antinuclear antibodies have been studied. In eight patients a mildly inflammatory nonerosive arthritis occurred coincident with early manifestations or before the appearance of symptomatic muscle disease. Hands, wrists and knees were prominently involved. This arthritis responded to corticosteroids given for the myositis. One patient had erosive arthritis and periarticular calcifications associated with acute inflammation that seemed to diminish with colchicine therapy. Synovial biopsy specimens showed surface fibrin deposition, focal loss of lining cells and mild inflammation--findings similar to those in scleroderma. By electron microscopy tubuloreticular structures were found in vascular endothelium in synovium, as in other tissues in polymyositis. All patients surprisingly had pulmonary manifestations suggesting the possibility that the condition in this group of patients may represent a distinctive subset of polymyositis.