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The recent demonstration of ultramicroscopic "virus-like" cell inclusions in various organs in patients with collagen and autoimmune diseases suggest that viruses may play an aetiological role in these diseases. This paper reports briefly on some of the evidence for such "virus-like" structures in different cells of the synovial membrane from two patients with rheumatoid arthritis. The inclusions were localised in the vaculoes of the endoplasmatic reticulum of endothelial cells, lymphocytes, macrophages, fibroblasts and perithelial cells. They appear as tubular bodies of approximately 250 A. diameter. The tubules join together so that they form a 3-dimensional network. The possible viral or non-viral nature of these inclusions is discussed. A ultramicroscopical resemblance to the RNA-containing paramyxo-viruses suggests their virus nature. However, the negative results in testing with serum antibodies and immunofluorescence techniques argue against this. The authors suggest that the demonstration of these inclusions in other than collagen diseases points more in the direction of the correlation of these inclusions with immune globulin synthesis rather than the presence of a virus.

Studies were conducted in a group of patients with varose deformity. The present paper gives the results of indicidual bone metabolism studies conducted on 663 healthy controls and patients with articular disease without genu varum or with varose deformity. In subjects with genu varum intravenous administration of calcium causes the urinary elimination of hydroxyproline and nitrogen to fall. Among the groups under investigation this group of patients excretes the least amount of urine, has a relatively low calciuria and shows the highest retention rate of intravenously administered calcium. Patients with gonarthrosis associated to varose deformity excrete, a day after intravenous administration of calcium, the relatively least amounts of phosphorus, as compared to the healthy controls and other degenerative joint diseases without genu varum. Although the retention of intravenous calcium in the studied group resembles that seen in the process of generalized osteomalacia, no coinciding signs of osteomalacia c ould be found in subjects with gonarthrosis and varose deformity. X-ray examination of patients with genu varum revealed more marked changes in the bone structure, namely sclerosis, necrosis and osteophytes of shapes and sizes other than in gonarthrosis without varose deformity. Epidemiological analysis of 30 patients showed 83.3% of patients to have overweight type I to III according to the Broca formula. Pains in the knee joints started appearing at the mean age of 50 years. A large part of the patients showed the presence of serious varicose syndrome and relapsing phlebitis of the lower limbs. Although the clinical and X-ray pictures make it possible to conisder a larger amount of disease types, we assume that gonarthrosis with varose deformity may be regarded as an isolated clinical entity which refers primarily to a localized bone process.

In a review of organic changes of rheumatic diseases the more important changes of skeletal musculature, gastro-intestinal apparatus, kidneys, blood vessels and eyes are discussed. The paper is based upon investigations, publications and post-graduate activities of the Rheumatism Research Institute of Prague.

A reaction of the RES with its organs (lymph nodes, spleen, bone marrow and Kupffer's cells) is not uncommon in rheumatoid arthritis. Although these manifestations are pronounced in Felty's syndrome, reviewing articles about Felty's do not mention liver manifestations. This paper summarises the publications about liver findings in Felty's syndrome. Hepatomegaly, abnormal bromsulfalein tests, raised alkaline phosphatase and transaminases have been stated in many case reports. Among 34 patients, the frequency of hepatomegaly was 68%, of abnormal bromsulfalein tests 27%, of alkaline phosphatase 23% and of transaminases 18%, respectively (52). Alkaline phosphatase and transaminases were raised in almost all of 12 patients (3). The histological correspondence is an infiltration with lymphocytes of sinusoids and portal fields, a portal fibrosis and occasionally a cirrhosis. These histological abnormalities, as well as enlarged lymph nodes and splenomegaly, have to be considered as organic manifestations of rheumatoid arthritis. If the nodular regenerative hyperplasia of the liver, which has been reported also after use of contraceptives, is a manifestation of Felty's syndrome, remains unresolved.

Interactions between C1q and collagen are thought to be due to the similarity in the structure of collagen and part of C1q. In the present paper immunological and biochemical aspects of this similarity were explored. It was found that one of nine rabbit anticollagen sera studied showed a clearcut reactivity with C1q, while anticollagenantibody-positive sera and synovial fluids of patients with rheumatoid arthritis did not display any cross-reactivity with C1q. Eleven of twenty collagen-immunized guinea pigs, however, demonstrated cellular cross-reactivity with CLF, the collagen-like fragment of C1q. Gel filtration studies indicated the formation of complexes between CLF and collagen, simulating immunological inhibition of anti-C1q-antibody by collagen. Human RA synovial collagenase was found capable of splitting C1q at a position within its collagen-like fragment. The importance of the interactions between collagen and C1q for the pathological events characterizing RA is discussed.

The paper presents the results of study of 28 synovial exudations in which the uricase method was used for uric acid determination with simultaneous pyrophosphatase and cathepsin C and D activity determination. The presence of crystals in these exudations was investigated as well. From the study follows that a higher uric acid level and higher pyrophosphatase activity coincide with the finding of urate and pyrophosphate crystals. The reported method of examination applies also to other identifications of microcrystals or crystalline split of urates or calcium pyrophosphate dihydrate in the exudation. The activity of cathepsin D permits to conclude on potential participation of peptides and/or polypeptides in the formation of crystals in the exudation.

Previous reports describe the presence of immunoglobulins and complement components within rheumatoid articular cartilage, thereby suggesting an effect of immune complexes on the formation of pannus. This hypothesis is reinvestigated in this paper. As confirmed in our work, the superficial layer of rheumatoid hyaline cartilage may fulfill the immunohistological criteria for the presence of immune complexes. In osteoarthritis, however, a noninflammatory disease not mediated by immunologic mechanisms, similar results can be obtained. The presence of immune-proteins within hyaline cartilage therefore requires a cautious interpretation. Hyaline cartilage in rheumatoid arthritis is replaced by granulation tissue growing not only at its surface (pannus), but also in subchondral bone. We therefore also thoroughly investigated deep layers of hyaline cartilage in the vicinity of such subchondral tissue, but could not obtain any evidence for the presence of immune complexes therein. The growth of subchondral granulation tissue and the accumulation of PMN in the region of its junction with hyaline cartilage therefore appear to be independent of immune complexes within rheumatoid hyaline cartilage. It is suggested on the basis of these data that immune complexes possibly present in hyaline cartilage do not play an essential role in the formation of granulation tissue replacing cartilage in rheumatoid arthritis. It is, however, not entirely excluded that during advanced stages of rheumatic cartilage degradation immune complexes are formed within the matrix or carried into it from the extra-cartilaginous environment, and that they may then contribute to further cartilage destruction by enzyme release during phagocytic processes.

During the preparation of the government program "Health Research and Development", which was started in 1978, an attempt was made to involve the scientific community directly in establishing priorities for research on rheumatic diseases. At a planning conference open to all interested research scientists the following questions were considered: 1. What are the methodological requirements for therapeutic trials? 2. What are the open questions in the field of clinical rheumatology and which of them should be given priority? 3. What are the conditions for running multicenter therapeutic trials successfully? This paper describes the methodology and the results of the analysis of research needs and priorities and discusses the special problems of clinical rheumatology research in the Federal Republic of Germany.

In arthritis surgery "urgent" indications are a relatively subjective definition--apart from few exceptions. The aim of this paper is to give a substantiated classification--under practical aspects--for frequently occurring rheumatoid lesions in all parts of the locomotor system requiring surgical treatment.

By means of radio-immunoassay the concentration of human growth hormone (HGH) was measured in the blood plasma of 61 patients with psoriasis (21 suffering from psoriasis vulgaris and 40 with psoriatic arthritis), 30 patients with ankylosing spondylitis, 9 with atypical spondylarthritis and 34 patients with diseases of the soft tissue or degenerative joint and spinal column disease. No connection was found between the HGH concentration and the skin lesions in psoriasis. On the other hand a correlation between HGH and the sacroiliitis in psoriatic arthritis and seronegative spondyloarthropathies may be possible. In contrast to the plasma of psoriatics, the mean HGH concentration was higher in the plasma of patients with degenerative joint diseases. Therefore the results of this paper confirm those opinions in the literature which deny increased HGH concentrations in psoriatics. The beneficial effect of the therapeutic administration of somatostatin, an inhibitor of the release of HGH, in psoriasis vulgaris and psoriatic arthritis is - if indeed it occurs - attributable to other hitherto unidentified mechanisms.

Cutaneous absorption of ionized substances is forced by iontophoresis. This was shown by Pratzel and Hillmeier's investigation of the permeation of salicylic acid (increasing factor 150) and Pratzel and Dittrich's experiments with indomethacin (factor 10) in pigs. In the present paper it is shown that in human volunteers iontophoretic application of indomethacin for one hour onto the skin of the back (surface 1380 cm2) increased indomethacin plasma levels after 2 hours to a maximum of 221 ng/ml, and increased urinary excretion of indomethacin from 24 micrograms (control) to 138.7 micrograms in 5 hours. Iontophoretic application of salicylic acid for one hour daily in human volunteers onto a skin area of 400 cm2 increased serum levels in five days to 690 ng/ml and urinary excretion of salicylic acid and salicyluric acid to 24 mg, as opposed to 2.5 mg by control without current. However, after 30 min iontophoresis only 4 mg is excreted in the urine. In conclusion, if the iontophoresis is practised over a long period of time on large skin areas, systemic effects can be expected.

The paper takes a retrospective view back to the historical beginning of roentgenology. The development of radiology of bone and joints is high-lighted with special respect of rheumatology. Completeness was not intended regarding the size of this paper. It is shown, especially to our younger colleagues, how hard it was in the past 90 years to achieve our today-knowledge in x-ray-diagnostic. Three factors determined Roentgenology to become an indispensable method. The continuing development and improving of efficient x-ray-machines. The development and improving of investigation methods. The scientific workup of radiological signs leading to radiomorphologic features. Some milestones of technical development of conventional radiology are listed up. Also, innovations in microelectronics. Computed tomography and Magnetic Resonance are listed up. Remarks are made about costs of "big machines" and about declining knowledge in conventional radiology in young american radiologists. Recommendations are made for efficient collaboration of rheumatologists and radiologists.

The present paper reviews the different therapeutic uses of D-penicillamine and outlines the dosage regimen of D-penicillamine for treatment of rheumatoid arthritis. While many open clinical trials are published, only a few controlled, double-blind studies investigate the "optimal" dosing of D-penicillamine. From these findings, a uniform regimen cannot be named but the heterogenous appearance of chronic polyarthritis requires an individual therapy. In order to minimize the risk of side effects, however, it is necessary to follow the guideline "go low--go slow" as postulated by Jaffe.

Rheumatoid arthritis is a chronic lifelong disease, facts which must be considered when concepts of therapy are developed. This paper reports retrospectively analyzed results of long-term therapy using D-penicillamine. One-hundred-sixteen patients were selected for critical analysis from among 257 treated patients. Judgment was made according to the parameters: inflammation activity, radiological progression, remission rate, clinical outcome-measurement. The results show that the clinical course of the disease is influenced by the treatment and they confirm the need for long-term therapy with an emphasis on immunomodulation.

This paper is the result of a symposium that addressed the problem of disablement and social pension for patients with psychosomatic-rheumatological complaints. This especially concerns patients suffering from psychosomatic manifestation at the locomotor apparatus, who are increasingly disabled and necessitating a pension, without actual somatic findings justifying a vocational disablement. Primarily it is a clinical picture of a generalized tendomyopathy, often underestimated in its importance. Definitions, causes, and clinical pictures are presented. A critical phase decisive for the disablement, the personality of the would-be pensioner, considerations for the physician regarding diagnostic and therapeutic efforts, elements of time and environment, and conditions at the work-place are discussed. In some cases a pension will be unavoidable and justifiable, even if the somatic findings seem not to be sufficient. The psychogenic picture must be carefully determined differentiated from simulation; determining the cause of aggravation is essential.

As compared to other imaging modalities, magnetic resonance imaging (MRI) is characterized by superior soft tissue contrast, multiplanar display, and lack of ionizing radiation and other hazards. Contrast media, including paramagnetic substances, (e.g., gadolinium-DTPA) are useful for further improvement of diagnostic capabilities of MRI. In this paper the results of MRI in rheumatoid arthritis and related disorders, as well as the potentials of its clinical use are discussed.

This paper first tries to relate the four types of immuno-pathologic reactions to certain basis-reactions of the lung. Subsequently, radiologic patterns will be correlated to these basis-reactions and will be further related to certain rheumatic diseases. It is shown that these basis-reactions cannot be clinically and radiologically distinguished from one another in all cases, and that in most cases there are combinations of several types of reaction to be found. The radiological patterns in the most important rheumatic diseases are demonstrated in an immunological arrangement. The possibilities of conventional radiological techniques and modern imaging techniques are described.

This paper describes an experimental method for the assessment of analgesic effects of NSAIDs in healthy human volunteers. Pain was induced by repeated controlled pinching of interdigital webs. The painfulness of the stimulus was assessed by the subjects at regular intervals on an electronically controlled visual analog scale. Furthermore, computer supported infrared thermography, laser Doppler flowmetry and photoplethysmography were used to measure the cutaneous vascular reactions. The results of two double-blind cross-over studies are described in which analgesic effects of acetylsalecylic acid, ibuprofen, and dipyrone were significantly demonstrated. In one of the studies it was also shown that ibuprofen reduced the local stimulus-induced vasodilatation. In summary, this algesimetric model seems to be suited to demonstrate the analgesic and perhaps also the antiinflammatory effects of NSAIDs in healthy subjects.

Important physiological parameters such as blood pressure, ECG and others are measured today on a continuous basis or at fixed intervals and are documented together with the date and the time. Individual results and subjective data are ascertained through questioning the patient, observation or patient's self-assessment and are documented with paper and pencil, without having any certainty of the exact time of ascertainment or that such is comprehensible. Battery-operated microcomputers have been developed in the form of electronic diaries (E.D.) for patients. Upon emitting an auditory signal, the questions appear in the computer display, and the questions are then correspondingly answered by the patient. These answers are fed to the permanent data store and are transferred on-line and processed at a later time in a PC. The time and data of the entries are simultaneously registered and are included in the complete document when it is later printed out. A capacity of 64 kbytes suffices to accommodate the data collected; likewise, the battery is sufficient for constant use. The entries are made as categorical data or numerically. Free-style entries are not possible. With the aid of a specially-developed program, the courses of a chronic pain syndrome in patients with degenerative joint diseases were studied. The percentage change in the pain course, benefit risk considerations, prognoses with the aid of sequential analyses and plausibility criteria can be calculated from the data. The advantages of this new instrument are its simple handling and reliable functioning. Its disadvantage is that it lacks the possibility to allow free-style entries.(ABSTRACT TRUNCATED AT 250 WORDS)

We describe a 53-year-old women with eosinophilia-myalgia syndrome who suddenly developed severe persistent myalgias of her arms, legs, back, and shoulder after a 5-month period of daily L-tryptophan ingestion, associated with fever, progressive stenocardia and left-sided congestive heart failure. Laboratory tests showed a leukocytosis of 11.2/nl with 3.14/nl eosinophils and an elevated erythrocyte sedimentation rate. There was a marked, predominantly proximal sclerosis of her arms, legs and trunk with a brownish discoloration. The skin of her arms and legs appeared dimpled (peau d'orange). Findings of the electrophysiological examinations were consistent with sensory neuropathy and myositis. Remarkable fasciitis and interstitial myositis were present in a biopsy specimen (from skin to muscle) taken from her thigh. However, eosinophilic infiltrates were rare. Angiography revealed an apical obstructive cardiomyopathy. In this paper, we describe the clinical findings, the course over 2 years, as well as the therapeutic management. Furthermore, the most important differential diagnoses are discussed and the literature is reviewed with special attention given to more recent pathogenic insights into this newly recognized multisystem disease.

This paper discusses the importance of cognitive representation and individual patterns of behavior for coping with chronic disease. Chronically ill patients differ very much in their psychic situation. Biographical and situational factors and the future perspective contribute to these interindividual differences. Diagnostic and therapeutical tools are discussed from a psychological perspective.

The sonographic examination of the shoulder has established itself in the diagnostic spectrum of the imaging methods. Especially the results of the rotator cuff have contributed to the fact, that arthrosonography is now indisputable for the shoulder examination. In this paper another scan--the examination through the fossa axillaris--is added to the standard ones, to find the early changes of the shoulder capsule in order to receive efficient results in discovering the omarthritis.

This paper tries to associate psychosomatic manifestations of the locomotion-system to one of the following four diagnosis: 1) conversion disorder, 2) anxiety disorder, 3) depressive mood disorder, 4) somatization disorder. For each of these diagnosis definition, clinical manifestation, diagnostic and differential-diagnostic criteria are mentioned. The diagnostic criteria can easily be associated to the new ICD-10 (V)F diagnosis.

In rheumatology, besides generally acknowledged so-called "natural treatment" methods, disputed and non-suitable methods are alleged as being also "natural methods". In particular, it is the "Action for Biological Medicine" which strives against any necessity of a differentiated approach on the basis of the benefit-risk relation. In this paper, after a short introduction covering the present legal situation in Germany, examples of unconventional diagnostic and therapeutic methods are discussed. Since the alleged benefit of these methods has never been proved, they must without any exception be considered as totally unnecessary. Moreover, because of the high risk involved, some methods must be warned against. Instead, demonstrably successful psychological and behavior-therapeutic methods should be recommended, the more so, as these can assist patients in becoming independent.