Palmoplantar pustulotic arthro-osteitis of the peripheral joints with no sternocostoclavicular lesions.

A 45 year old woman presented with swelling and pain on joint movement of her knees, although joint movement was relatively well maintained. Five years previously the patient had been diagnosed as having pustulosis palmoplantaris by a dermatologist. Treatment with non-steroidal anti-inflammatory drugs (NSAIDs) had no effect, but treatment with 5 mg/day prednisolone caused remission of both the joint pain and swelling and the pustulosis palmoplantaris. There were no sternocostoclavicular lesions at any time during treatment. Clinical findings in this patient were different from previous reports and she was diagnosed as having palmoplantar pustulotic arthro-osteitis affecting the peripheral joints.

Clinical features of 53 cases with pustulotic arthro-osteitis.

We have described clinical features of 53 cases with pustulotic arthro-osteitis. Anterior chest wall symptoms such as intersterno-costoclavicular or manubriosternal lesions were observed in all of 53 cases. Spondylitis or spondylodiscitis was found in 18 cases. Sacroiliitis resembling ankylosing spondylitis was seen in 7 cases. Peripheral inflammatory arthritis was seen in 14 cases, which were of nonerosive, of oligoarthritis type, and cured within 1 to 2 months, leaving no residue. HLA B27 was never found, and RAW factor was negative. Histological examinations revealed nonspecific chronic inflammation of bone and soft tissue. Pustulotic arthro-osteitis is apparently distinct from known rheumatic diseases such as rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, and Reiter's disease. We have proposed that this condition should be classified as a member of the "seronegative spondylo-arthritis' group as designated by Wright and Moll.

Incidence of arthro-osteitis in patients with pustulosis palmaris et plantaris.

Arthro-osteitis at the anterior chest wall was found in 12 (9.4%) out of 128 consecutive patients with pustulosis palmaris et plantaris. This finding indicates that the concomitance of arthro-osteitis with PPP is not incidental but is based on some common aetiological factor. We propose a term ;pustulotic arthro-osteitis' for this condition.

HLA DR4 and rheumatoid arthritis in Japanese people.

Eighty-eight Japanese patients with rheumatoid arthritis and 104 normal Japanese persons were typed for HLA A, B, C, and DR antigens. The frequency of HLA DR4 was 70.5% in patients compared with 46.1% in normal controls (P less than 0.001). However, a sex difference in the frequency of HLA DR4 in patients was noted. HLA DR4 was found in 80.6% of male patients, which was highly significant compared with controls (P less than 0.0005), while only a borderline increase of 60.5% was found in female patients (P less than 0.05). In addition, the frequency of HLA DR2 was remarkably low in male patients. These suggest the possible heterogeneity of rheumatoid arthritis in Japanese.

[[HLA in rheumatoid arthritis (author's transl)].

Despite many reports on the association between ankylosing spondylitis and HLA-B27, most studies have failed to find a significant relationship between HLA-A or B antigen and rheumatoid arthritis. Stastny, however, showed a significantly high frequency of HLA-Dw4 in rheumatoid arthritis in 1976. The study of HLA antigens in Japanese patients with rheumatoid arthritis are thought to be significant in view of the pathogenesis of disease. Eighty-eight Japanese patients with "definite" or " classical" rheumatoid arthritis according to the ARA criteria and 104 normal individuals were typed for serologically detectable HLA-A, B, C, and D antigens. Though small discrepancies were observed in several of the HLA-A, B, and C, antigens, they were not definitely significant. The frequency of HLA-DR4 increased to 70.5% in patients compared to 46.1% in the control (i.e. normal) group (p less than 0.001). However, the frequency increased to 80.6% in male patients (p less than 0.0005). Of interest was the significantly high frequency of HLA-DR4 in males, compared to the low frequency of HLA-DR2 (p less than 0.02). Rheumatoid patients were subdivided into different groups according to the year of onset, the presence of the the rheumatoid factor or rheumatoid nodules, the functional grade and treatment. There were no significant differences in the frequency of HLA-DR4 among subgroups. The results indicate that rheumatoid arthritis, especially in males, is associated with genes of the HLA-D region and that immunogenetic factors linked to HLA have an important role in its pathogenesis.

The HLA antigens of two Negrito populations in the Philippines.

HLA antigens were determined for the A, B and C loci among 86 Aetas of west-central Luzon and 87 Mamanwas of north-eastern Mindanao, Philippines. The overall antigenic profiles of these two groups were essentially similar to those of other Asian-Pacific populations with some peculiarities in common with Papua New Guineans. However, the results of heterogeneity tests and the comparison of statistically significant phenotypic associations showed a highly significant difference between the Aeta and the Mamanwa groups. It was postulated that the two "Negrito" groups represent different migrations to the Philippines.

Clinical features of 22 cases with "inter-sterno-costo-clavicular ossification". A new rheumatic syndrome.

We present 22 cases with inter-sterno-costoclavicular ossification. Clinical and pathological findings show that abnormal ossification observed in this situation is due to non-suppurative chronic inflammation of the soft tissues around the sterno-costo-clavicular region such as the costo-clavicular ligament. We have classified X-ray findings into three stages according to the extent of the ossification; localized, generalized, and hyperostotic, and show that the disease progressed in this sequence. A considerable number of the patients showed abnormal X-ray findings in the spine or the sacro-iliac joint. Frequent association of pustulosis palmaris et plantaris was noted in this disease. Most of the cases were treated effectively with anti-inflammatory drugs, but a few cases required surgical resection of the ossified mass with the clavicle or the first rib in order to relieve the severe pain.

Ankylosing spinal hyperostosis (ASH) and ossification of the posterior longitudinal ligament (OPLL).

The clinical and radiological features of 70 patients with ankylosing spinal hyperostosis are presented. Pain in some region of the back was found in 49 patients. No significant deviations were found in HLA typing. Radiologically, the most characteristic features were bony spurs or bridges in the dorsal spine, where they predominated on the right and anterior aspects of the spine, especially in the lower dorsal region. Ossification of the posterior longitudinal ligament was found in 21 patients.

A neutrophil chemotactic factor and its inhibitor found in DNCB-induced skin inflammatory lesions.

Neutrophil chemotactic factor(s) and their inhibitors were explored in the acute inflammatory skin lesions induced by the application of 4% DNCB solution with acetone in guinea pigs. Skin biopsies were taken periodically and tissue extracts were made from the biopsy specimens. Neutrophil chemotactic activity found in such extracts reached a peak at 12 to 24 hr after the induction of the inflammation, when the lesions were found to be infiltrated predominantly with neutrophils. After 24 hr, the activity gradually diminished. Physicochemical and antigenic characterization studies on the chemotactic substance indicated that the material was most likely the cleavage product of C3. On the other hand, inhibitors against the neutrophil chemotactic factor were found in the tissue extracts which were obtained from the lesions at a later stage (48 to 96 hr after the induction of the inflammatory reaction). These inhibitors blocked not only the complement-derived chemotactic activity but also that obtained from bacterial culture filtrates. They were heat labile and showed striking heterogeneity in size on Sephadex gel filtration.