Variable histopathology of discovertebral lesion (spondylodiscitis) of ankylosing spondylitis.

Extensive discovertebral lesion is an infrequent complication of long-standing ankylosing spondylitis. Reported histopathological descriptions vary from predominantly inflammatory to fibrous granulation with reactive bone formation. We report variable histological findings in four symptomatic patients with extensive discovertebral lesions who required spinal fusion.

Synovial lymphocyte subsets in rheumatoid arthritis and degenerative joint disease.

There is considerable evidence to indicate that the synovitis of rheumatoid arthritis (RA) is immunologically mediated. Recently, it has been postulated that a suppressor-type cell deficiency may play an important role in the pathogenesis of the synovitis. In addition, an immune component may contribute to the synovial alterations in certain examples of degenerative joint disease (osteoarthritis, OA). Using monoclonal antibodies, we evaluated synovial tissue lymphocytes in 12 patients with RA, 2 with juvenile RA, one with adult Still's disease, and 2 patients with OA synovitis in order to delineate the T cell subset patterns. Helper-type cells predominated in 3 patients with RA, while suppressor-type cells were present in equal or greater numbers in 9. The patients with OA showed helper-type cell predominance. Helper-type to suppressor-type cell ratios vary widely in RA synovia which militates against the primacy of the role of a suppressor-type cell deficiency in this disorder. Patients with OA synovitis may display T cell infiltrates comprised mainly of helper-type cells.

Vasculitis in systemic sclerosis: association with Sjögren's syndrome and the CREST syndrome variant.

We describe 7 patients with established systemic sclerosis who developed clinical evidence of vasculitis 1 to 33 (mean 12.7) years after the first symptoms of scleroderma. Six had the CREST variant of systemic sclerosis and also had features of Sjögren's syndrome (SS). Five of 6 patients tested had serum anti-SSA (Ro) antibodies. Vasculitis presented primarily as cutaneous lesions with ulceration and/or mononeuritis multiplex, and 6 patients had severe systemic manifestations. Vasculitis was histopathologically documented in 6 cases in biopsies of skin (4 of 4), muscle (2 of 3) and sural nerve (3 of 3). Patients with systemic sclerosis with CREST syndrome and SS appear to be at increased risk to develop vasculitis.