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Im Rahmen einer Querschnittsuntersuchung wurden die Punktpravalenzen von Osteoporose und Osteopenie bei Patienten mit rheumatoider Arthritis (RA) ermittelt und die Versorgung mit Osteoporosemedikamenten erfasst. In 9 Studienzentren wurden in den Jahren 2005/2006 insgesamt 532 RA-Patienten (98 Manner, 434 Frauen) im Alter von 23 bis 87 Jahren klinisch untersucht und zu Osteoporoserisikofaktoren befragt. Die Knochendichte wurde mit der Dual-X-ray-Absorptiometrie (DXA) an Lendenwirbelsaule und Hufte gemessen. Osteoporose und Osteopenie wurden nach der Klassifikation der WHO definiert (T-Score ≤-2,5 bzw. T-Score -2,5). Die medikamentose Therapie der Patienten wurde dem Dokumentationsbogen der arztlichen Untersuchung entnommen, der in Anlehnung an die rheumatologische Kerndokumentation der Regionalen Kooperativen Rheumazentren entwickelt worden war. 29% der Patienten hatten an beiden Messorten eine normale Knochendichte. 49% hatten im Bereich von LWS und/oder Schenkelhals eine Osteopenie und 22% eine Osteoporose. 60% der Patienten der Gesamtstichprobe erhielten eine medikamentose Osteoporoseprophylaxe oder -therapie (38% Kalzium/Vitamin D, 20% Kombinationen, uberwiegend Kalzium/Vitamin D + Bisphosphonat, jeweils 1% nur Bisphosphonat bzw. Hormone). Frauen bekamen mit 63% signifikant haufiger eine Osteoporosemedikation als Manner (49%; Chi-Quadrat-Test: p

Im Rahmen einer Querschnittsuntersuchung zur Pravalenz von Osteoporose und Osteopenie bei Patienten mit rheumatoider Arthritis (ORA-Studie) wurden Patienten sowie deren Hausarzte und Rheumatologen zur Einschatzung der Haufigkeit einer Osteoporose bei rheumatoider Arthritis (RA), deren Pravention, Diagnostik und Therapie sowie zur Leitliniennutzung befragt.

Increasing evidence points to a close relationship between the autonomic nervous system and the immune system. To further investigate mechanisms regulating beta2-adrenergic receptor (beta2R) expression in lymphocytes, the influence of cytokines on the density of beta2R on purified CD4+ and CD8+ lymphocytes was determined in vitro. beta2R were determined by means of a radioligand binding assay with (125I)iodocyanopindolol. CD4+ and CD8+ lymphocytes were incubated with catecholamines, interleukin 1beta (IL-1beta) and interleukin 2 (IL-2) for 6-72 h. The results demonstrate declining beta2R numbers on CD4+ and CD8+ lymphocytes in vitro augmented by epinephrine. IL-1beta has no effect on beta2R expression compared to medium. However, incubation with IL-2 resulted in an up-regulation of beta2R on CD8+ lymphocytes. Thus, the study demonstrates a differential regulation of beta2R on T-lymphocyte subpopulations with CD8+ lymphocytes being more susceptible to mechanisms of beta2R modulation than CD4+ lymphocytes. The findings further strengthen the concept of a close interplay between the autonomic nervous system and the immune system.

The guideline "Joint Swelling" is addressed to primary care physicians--general practitioners, internists or orthopedists without special experience in rheumatology. It provides a framework for interviewing patients, as well as for physical, laboratory and imaging examinations and for selection of treatment appropriate to the level of primary care. Situations which call for urgent evaluation and criteria for referral to rheumatologists are described. The appendix contains comments on signs and symptoms to differentiate arthralgia from joint swelling and on the diagnostic value of a history of joint swelling without confirmation by the physician. Further recommendations for the evaluation of patient history and physical and technical examinations are given in a tabular form. The significance of laboratory and imaging procedures is discussed.

Die Leitlinie „Gelenkschwellung” richtet sich an den Hausarzt – Allgemeinarzt oder hausarztlicher Internist – sowie an den nicht spezialisierten Orthopaden. Sie beschreibt die Anamnese, die problemorientierte klinische Untersuchung, die labormedizinische und bildgebende Diagnostik sowie therapeutische Masnahmen, die auf der primararztlichen Ebene einzuleiten sind. Situationen, die sofortiger Abklarung bedurfen und Uberweisungsindikationen zum Spezialarzt werden genannt. Der Anhang enthalt Erlauterungen zur Differenzierung der Symptome von Gelenkschmerz und Gelenkschwellung, zur Wertigkeit der anamnestischen Angabe einer fruheren Gelenkschwellung ohne Nachweis durch den Arzt und zu Gelenkschwellungen aus mechanischer Ursache. In tabellarischer Form werden nahere Hinweise zur Anamnese und Untersuchung gegeben und die Bedeutung der labormedizischen und bildgebenden Diagnostik diskutiert.

Approximately one third of all patients with Crohn's disease and ulcerative colitis suffer from extra-intestinal manifestations of their inflammatory bowel disease. Most commonly those symptoms occur simultaneously with the CED symptoms; they can, however, either precede them or appear later on in the course of the disease. The most frequent extra-intestinal symptoms are arthralgias of peripheral joints and spine, which are usually bland and self-limiting, while ankylosing spondylitis and erosive arthritides are rare. Skin lesion and eye affections can also parallel the bowel condition, but occasionally they precede intestinal manifestations and can be a first diagnostic clue. In addition, different extra-intestinal symptoms tend to simultaneously co-occur more frequently in some patients with CED, while others are not affected at all. Immunogenetic parameters play a role for the manifestations of the pathologic immune response both in the gut and in the musculo-skeletal systems, as indicated by associations with MHC class I alleles. Enteropathic microorganisms are also thought to be involved in the pathogenetic mechanisms.

The aim of this study was to examine bone mineral density (BMD), frequency of osteopenia and osteoporosis in a representative sample of patients with rheumatoid arthritis (RA) and to describe chemoprophylaxis and treatment of osteoporosis compared to evidence-based guidelines.In 2005 and 2006, 532 patients with RA (98 men, 434 women) aged 23-87 years were recruited from 9 German rheumatology centers. Clinical examination included a detailed documentation of osteoporosis medication. Dual-energy X-ray absorptiometry (DXA) was used to measure BMD at the lumbar spine and femoral neck. Osteopenia and osteoporosis were defined according to the criteria of the World Health Organization.Of the RA patients 29% had normal BMD at the spine and femoral neck, 49% of the patients had osteopenia and 22% met the criteria for osteoporosis at any site. Of the patients 60% were receiving medication for prophylaxis or therapy of osteoporosis, 38% calcium/vitamin D alone, 20% as combinations mostly of calcium/vitamin D + bisphosphonate, 1% received bisphosphonate only and 1% hormone replacement therapy. Although the frequency of osteoporosis showed no significant differences between male and female patients, women with RA used osteoporosis medication more often than men (63% versus 49%, χ²-test, p0.05). A total of 101 RA patients (83 menopausal women, 6 premenopausal women, 12 men) received corticosteroids in a daily dose of 7.5 mg or less for at least 3 months and had DXA T-scores below -2.0 at any site. In this patient group 41% of the menopausal women, 17% of the premenopausal women and 42% of the male patients were reported to receive medication with calcium/vitamin D + bisphosphonate. Calcium/vitamin D was used by 35% of the menopausal women, none of the premenopausal women and 50% of the male patients and 18% of the menopausal women, 67% of the premenopausal women and 8% of men received no prophylaxis or treatment for osteoporosis.According to the DVO (German Society for Osteoporosis) guidelines for osteoporosis (2009) menopausal women with corticosteroid therapy 7.5 mg per day for at least 3 months and DXA T-scores below -2.0 should receive treatment with bisphosphonate and calcium/vitamin D. The data show that there were still deficits concerning prophylaxis and treatment of osteoporosis in RA.

Rheumatoid arthritis is associated with increased morbidity and mortality due to cardiovascular events. Elevated concentrations of acute-phase proteins and cytokines and endothelial dysfunction, demonstrated also by lack of traditional risk factors, play an important role in these complications. Antirheumatic drug treatment can modify the frequency and severity of cardiovascular events.

To investigate whether polymorphisms in the corticotrophin-releasing hormone (CRH) promoter are associated with altered CRH gene regulation, we studied the reactivity of three recently described promoter variants in vitro. The 3625 bp variants A1B1, A2B1 and A2B2 of the human CRH promoter were cloned in the 5' region to a luciferase reporter gene and transiently transfected into both mouse anterior pituitary cells AtT-20D16vF2 and pheochromocytoma cells PC12. Incubation with 8-Br-cAMP alone or in combination with cytokines significantly enhanced the promoter activity in both cell lines studied by up to 22-fold. However, dexamethasone antagonised cAMP effects on CRH expression in AtT-20 cells while showing no effect on PC12 cells, indicating that tissue-specific factors play a crucial role. Among the haplotypes studied, A1B1 exhibited the greatest reactivity on various stimuli. Electric mobility shift assay (EMSA) was performed to study whether the described polymorphic nucleotide sequences in the 5' region of the hCRH gene interfere with binding of nuclear proteins. A specific DNA protein complex was detected at position -2353 bp for the wild type sequence only, possibly interfering with a binding site for the activating transcription factor 6 (ATF6). Taken together, this is the first study to demonstrate that CRH promoter reactivity varies between the compound promoter alleles.

Rheumatoid arthritis is the most common inflammatory joint disease and is characterized by chronic, symmetric, erosive synovitis of small joints of hands and feet. Prevalence in women is threefold higher than in man. Structural damage of the joints starts between the first and second year of the disease. Early therapeutic interventions can alter the course of rheumatoid arthritis by delaying the progression of radiographic joint destruction, which correlates with the grade of disability. Approval of new biologic antirheumatic drugs in the last few years improved the outcome of rheumatoid arthritis.

Approximately one third of all patients with Crohn's disease and ulcerative colitis suffer from extra-intestinal manifestations of their inflammatory bowel disease. Most commonly those symptoms occur simultaneously with the CED symptoms; they can, however, either precede them or appear later on in the course of the disease. The most frequent extra-intestinal symptoms are arthralgias of peripheral joints and spine, which are usually bland and self-limiting, while ankylosing spondylitis and erosive arthritides are rare. Skin lesion and eye affections can also parallel the bowel condition, but occasionally they precede intestinal manifestations and can be a first diagnostic clue. In addition, different extra-intestinal symptoms tend to simultaneously co-occur more frequently in some patients with CED, while others are not affected at all. Immunogenetic parameters play a role for the manifestations of the pathologic immune response both in the gut and in the musculo-skeletal systems, as indicated by associations with MHC class I alleles. Enteropathic microorganisms are also thought to be involved in the pathogenetic mechanisms.

The guideline "Joint Swelling" is addressed to primary care physicians--general practitioners, internists or orthopedists without special experience in rheumatology. It provides a framework for interviewing patients, as well as for physical, laboratory and imaging examinations and for selection of treatment appropriate to the level of primary care. Situations which call for urgent evaluation and criteria for referral to rheumatologists are described. The appendix contains comments on signs and symptoms to differentiate arthralgia from joint swelling and on the diagnostic value of a history of joint swelling without confirmation by the physician. Further recommendations for the evaluation of patient history and physical and technical examinations are given in a tabular form. The significance of laboratory and imaging procedures is discussed.

The objective was to assess whether changes of cartilage oligomeric matrix protein (COMP) serum levels can predict the development of osteoarthritis following traumatic knee injury. Sera and synovial fluids were acquired at surgery (T0) and postoperatively during the first (T1) and second (T2) year from 30 knee-injured patients. COMP levels and anti-COMP autoantibodies were quantified by ELISA. Radiographs and patient questionnaires were used to assess outcomes. At T0, compared with controls (1.6 +/- 1.6 micrograms/ml), the serum COMP concentration was significantly elevated (6.5 +/- 2.8 micrograms/ml) with a tendency to further increase (T0 vs. T1, P = 0.076) and subsequently decrease (T1 vs. T2, P = 0.074). However, individual variations are observed, e.g. persistently high (8/30) or increasing (T0 to T2, 8/30) serum COMP. Ten of these patients have elevated COMP at T2 that increased from T0. COMP levels in serum and synovial fluid correlated significantly (P = 0.012). Interestingly, some patients who revealed increasing serum levels of COMP from T0 to T2 displayed anti-COMP autoantibodies. These data suggest that local immune response could contribute to further joint damage. The subgroup of 10 patients (33%) with elevated and increasing serum COMP levels and in particular the patients with antibodies against cartilage matrix molecules appear at increased risk for developing posttraumatic osteoarthritis.

In patients with systemic rheumatoid arthritis (RA) and extraarticular manifestation treated with plasma exchange or prednisolute-pulse-therapy, respectively, and followed by an additional immunosuppression by cyclophosphamide we have assessed the lymphocyte subpopulations of the peripheral blood and the cells expressing activating markers by means of monoclonal antibodies using fluorescence microscopy or fluorescence flow cytometry. Before therapy the patients showed a very different level of lymphocyte subpopulations tested. During treatment in both groups of patients there was not any uniform tendency in CD3, CD4 and CD8 positive cells. The percentage of activated lymphocytes was initially elevated and we found significant reduction, mainly in the 4th week after starting of therapy. Following in the most cases the level recovered to the state before therapy. For the single patients an individual pattern of reaction was evident in relation to the initial position before treatment.

Clinical, laboratory, and scintigraphic features of 16 patients with polymyalgia rheumatica and 23 patients matched for age presenting with classical or definite rheumatoid arthritis (American Rheumatism Association 1958 criteria) of the elderly were compared in order to define features that might distinguish between these two syndromes. The sensitivity of proposed diagnostic criteria for polymyalgia rheumatica was always higher in the group with polymyalgia rheumatica, though only significantly so for morning stiffness. A comparison of 27 different laboratory features showed few significant differences between the diseases, though correlation between laboratory variables within each of the disease groups differed, perhaps suggesting a fundamental pathogenetic difference between them. Scintigraphy of the shoulder joint proved of no value in differential diagnosis. It was concluded that polymyalgia rheumatica and rheumatoid arthritis of the elderly are probably discrete clinical entities. Bilateral upper arm tenderness, lack of positive rheumatoid factor, and a normal caeruloplasmin are the most valuable features for distinguishing polymyalgia rheumatica from rheumatoid arthritis of the elderly.

Diagnosis of a primary functional syndrome requires: 1) the exclusion of an underlying organic condition; 2) the proof of criteria, including symptoms and clinical signs are necessary for positive diagnostics, and include the progression of symptoms, the history, neurotic symptoms, chronological connections with life events, age, and related symptoms as described by von Uexkull: globus sensation in the throat, paresthesia, breathing irregularities, cardiac sensations, restlessness, poor concentration, as well as general fatigue, anxiety, depression, sleep disturbance, as well as constipation and/or diarrhea, headaches, dysuria, and “atypical” pain syndromes. Clinically, we must consider vegetative and functional symptoms: cold hands and feet (Raynauds phenomenon), oral and/or ocular dryness (Sicca syndrome), hyperhydrosis, neurological indications, dermographism, vertigo (and under what conditions), extrasystoles, tenderness of the colon (irritable bowel syndrome), tender points in general, and posture faults (spine).

In our investigations 201 patients with rheumatoid arthritis show in 127 cases according 63.2% (123 women = 71.1%; 4 women = 14.3%) and 32 patients with collagen diseases in 11 cases according 34.4% (11 women = 43.3%) a goiter. In comparison to a control group with a goiter incidence of 29.5% in women (168 out of 570 women), we found in female patients with rheumatoid arthritis or collagen diseases a clearly higher prevalence of goiter. But there was no difference of goiter frequency between the small groups of men. A second aim of our study was to investigate, whether an increased occurrence of the hypertrophic kind of Hashimoto's thyroiditis is to find in patients with rheumatic diseases, because of a possible association of two immunological induced affections. The results of sonographical, immunological and cytological examinations of the thyroid gland suggested no high responsibility of Hashimoto's thyroiditis for the goiter frequency in rheumatism. Only in three out of 201 investigated patients with rheumatoid arthritis (1.5%) we were able to diagnose this disease. In comparison to a rheumatologically healthy population out of the same catchment area (HT-frequency less than 0.5%), indeed the morbidity rate in rheumatic patients seems to be 3 times higher. But for a goiter frequency of altogether 63.2% in this disease the Hashimoto's thyroiditis is only of very small importance. Other causes such as pharmacotherapy with goitrogenic antirheumatic drugs, conditions of iodine deficiency, disposition and probably also an increase of thyroid growth stimulating immunoglobulins may be alone or in combination or a much higher degree responsible for goiter development in patients with rheumatoid arthritis or collagen diseases.

In patients with rheumatoid arthritis and other joint diseases the knee is frequently involved. There are different factors such as inflammatory, degenerative, periarticular and static mechanisms which may cause pain, effusions, Baker’s cysts and atrophy of the quadriceps muscle. There is particular interest in synovitis and the associated clinical signs such as effusion, hyperthermia and an increase of intra-articular pressure. We are evaluating different non-invasive diagnostic and assessment techniques to examine the different effects of therapy such as surgical synovectomy, intra-articular injection of an anti-inflammatory drug and isometric exercises.Arthrosonography is an imaging technique performed with ultrasound tomographic equipment. It is useful for the examination of liquid cavities such as the suprapatellar recess, arthroceles, Baker’s cysts and their communication with the joint space.Infra-red thermometry has been used to measure spot temperatures compared with contact plate liquid ...

The average time the test feed remains in sheep was determined with ewes during three stages of the reproduction cycle. The feed was labelled with 51Cr2O3. Experiment conditions are described under which the experiments can be carried out within the permissible limits.

Zonulafasern von Kaninchenaugen wurden polarisationsoptisch-histochemisch untersucht. Imbibitionsversuche weisen darauf hin, das eine wesentliche Volumenanderung der Gefugelucken der Zonula durch Quellung und Entquellung nicht moglich ist. Deshalb kommt es bei Phenoleinwirkung im Gegensatz zum Kollagen auch nach maximaler Entquellung nicht zum Auftreten negativer Doppelbrechung. Mit Hilfe der Rivanolreaktion bei abgestuften pH-Werten gelingt der Nachweis einer orientiert in die Fasern eingebauten mukoiden Strukturkomponente. Durch gerichtete Anlagerung des Rivanols erfolgt dabei eine pH-abhangige Umkehr des Vorzeichens der Doppelbrechung. Polarisationsoptische Befunde nach histochemischen Blockierungsverfahren sprechen dafur, das vorwiegend Karboxylgruppen fur die gerichtete Rivanolanlagerung verantwortlich sind. Sulfate lassen sich in den Zonulafasern nach Blockierung aller anderen sauren Gruppen mit Rivanol polarisationsoptisch nicht erfassen, obwohl sie biochemisch nachgewiesen wurden. Als Trager der Karboxylgruppen kommen im Zusammenhang mit den bekannten biochemischen Angaben und auf Grund eigener enzymatischer Versuche neben endstandigen Karboxylgruppen der Eiweisbausteine Hyaluronsaure und Chondroitinsulfat C in Frage.

On the basis of own observations of courses the author adopts a definite attitude to the early symptomatology of the rheumatoid arthritis. During the first weeks of the rheumatoid arthritis the following symptoms are found: articular syndromes, more frequently in form of obstinate polyarthralgias, mono-oligoarthritis, accompanied by morning rigidity and accelerated BSR as well as impairment of the general condition. In the majority of the patients only the tentative diagnosis rheumatoid arthritis may be made. After a one to three months' course of the disease the diagnosis becomes more probable. It is above all based on constancy and symmetry, characteristic localisation of the articular process, morning rigidity, radiologically paraarticular loosening of the structure and morphological symptoms of an acute and subacute synovialitis. 6 to 12 months after the beginning of the disease a clinical picture forms which allows to make the diagnosis of a certain or classical rheumatoid arthritis in accordance with the criteria of the ARA. The occurrence of a high activity of multiple affection of the joints (permanent symmetrical polyarthritis including the small joints of the hands and feet), distinctive morning rigidity, high fever and much accelerated BSR, beginning with the first weeks of the disease, speaks for the possibility of the development of an arthrovisceral form of the course of rheumatoid arthritis.

Promounced cases of disturbances of the function of the adrenal cortex may more certainly be found out with the help of the enlarged sinacthen test than after a stimulation done only but once. In a long-term prednisolone therapy of 10 mg/a day we could observe signs of disturbances of the function of the adrenal cortex. A clear evidence in the estimation of the individual value is possible only in decreased plasmacortisol levels which are during the whole course of the experiment. When a prednisolone therapy is established for a longer time apart from the sequels at the adrenal cortex should be thought also of the great number of the side effects caused by the catabolic properties of the cortico-steroids.

It is reported on results of comparative biochemical examinations in asymptomatic hyperuricaemia and manifest gout. Restriction of the urate clearance of the kidney, which could be proved also in young patients with asymptomatic hyperuricaemia, and a disturbance of the lipid metabolism which appeared in most cases are discussed from the pathogenetic point of view, in which cases the hyperlipoproteinaemia is regarded as a possible partial pathogenetic factor. For the separation of serum and urine the polyacrylamide gel-pore gradient electrophoresis was used. Using a modifiable concentration gradient this method is superior to the usual disc electrophoresis. The distribution pattern of the types of haptoglobin established by serum separation showed clear deviations from the normal distribution in hyperuricaemia or manifest gout and may be explained as a reference to the influence of genetic factors. By parallel performed electrophoretic separation of serum and urine a microproteinuria could be established and differentiated between glomerular and tubular proteinuria which is regarded as an early symptom of renal changes and was already present in 9 of 20 young patients with asymptomatic hyperuricaemia. These findings emphasize the necessity of an early renal diagnostics.

In a clinical 5-year-study on 200 patients with rheumatoid arthritis with the help of the dynamics of radiological changes (radiological progressing), the joint deformation, the reduction of function and the new affection of joints (clinical progressing) as well as the medium position of activity the progressing of the disease and a good, satisfying or missing success of the long-term therapy were estimated. From the characteristics of the individual groups of therapy conclusions for the therapy in the early phase of the rheumatoid arthritis were derived.

40 patients with so-called rheumatoid vasculitis, a special form of the course of rheumatoid arthritis with high rheumatoid titres and inclination to extraarticular organ manifestation were clinico-neurologically and electro-diagnostically examined. Neurologically in 10 patients a neuropathy was found, in which case polyneuropathies numerically prevailed. By means of the additional electromyographic and electroneurographic examination in altogether 75% of the patients pathological findings and thus a participation of the peripheral nervous system could by proved. The aetiology of the individual disturbance of the nerve function remains open. Questions of the pathogenesis are discussed.

An antigen (SF1 or TSGA) originally found in the inflammable synovial fluid of man, which comes from the cytoplasm of neutrophils, possesses the properties of an acute-phase-protein. The production of a specific antiserum against this antigen and the method of its quantitative determination by means of the Mancini-technique are described. In 89 sera of patients with rheumatoid arthritis the antigen was determined. First results of this investigation which speak for a dependence of the antigen concentration in the serum on activity and progression of the disease are reported.

In contrast to the X-ray examination the scintigraphy of the sacroiliacal joints in the early phase of the ankylosing spondylarthritis allows an evidence to the local processes of bone reconstruction directly depending on their activity. Positive findings of scintigraphy have a high sensitivity and a low specifity. They demand a further differential-diagnostic clarification. In this sense, supplementing the X-ray findings, the scintigraphy brings valuable informations for the early diagnostics of ankylosing spondylarthritis. The radiation exposure of the gonads which is smaller by factor 3 in comparison to the X-ray examination of the pelvis is an essential advantage in the above all young patients. The valuation of the scintigramme must be performed in close connection between clinical rheumatologists and specialists in nuclear medicine. Our results show that longitudinal examinations let expect a further improvement of the evidence.

23 patients with rheumatoid arthritis and high rheumatic factors (mean titres of rheumatic factors 1 : 1 434) within a prospective study on the diagnostic and prognostic significance of the rheumatoid vasculitis which was performed together with the Research Institute for Rheumatism Moscow underwent examinations for the proof of an extraarticular organ manifestation. In correspondence with the data in literature we found rheumatic nodes (70%) as most frequent extraarticular organ manifestation. In 1 patient each a participation of the lungs and a rheumatic exudate of the pleura, respectively, could be diagnosed. In another patient there were references to a vasculitis at the fundus of the eye. In only 2 patients there was a vasculitis of the digital arteries with necroses, in one of them a generalized vasculitis. 5 of the 13 neurologically examined patients showed polyneuropathic symptoms. Of the biochemical findings the C-reactive protein and the blood sedimentation rate showed clear increases and correlations.

On the basis of the results of a five-year examination of the course on 120 patients with rheumatoid arthritis the authors adopt a definite attitude to the prognostic significance of hypersiderinaemia, anaemia and height of the titre of the rheumatoid factor. With the help of the chi2-test and the rank correlation after Spearman the statistical relations to stage, activity, clinical and radiological progressing as well as to the number of the affected joints were examined. In seropositive patients we found a correlation of the titre of rheumatoid factor and stage. Furthermore a clear correlation existed to clinical and radiological progressing as well as to the number of the affected joints. Early highly positive titres of the rheumatoid factor as an expression of high immunologic activity suggest an unfavourable prognosis in the majority of cases. Constant anaemia and hyposiderinaemia as symptoms of a high basis activity of the disease also showed close relations to the progressing. From this result indications for the early use of important therapeutic measures. For the prognostic judgement of the course of the disease of rheumatoid arthritis it is necessary to have at disposal further methodically simply determinable parameters for the recognition of the basis activity and the immunologic activity.

The registration of the temperature of the body surface gains an increasing significance among others for the diagnosis of inflammatory rheumatic diseases. A criterion of the inflammation of the joint, the hyperthermy as well as the disturbances of the microcirculation may be made evident by means of the thermological methods. Own results in healthy persons and patients with rheumatoid arthritis as well as evidence of the literature confirm the possibilities of the measurements of temperature for the rheumatology. On account of the great inter- and intra-individual variability of the skin temperature an orientation at the temperatures of normal values of certain measuring regions is not reasonable. When the results of the temperature measurement are estimated, therefore, a comparison with temperature patterns of healthy persons must be done. Using dynamic measuring methods the evidence of thermological investigations may essentially be enlarged. The evaluation of the results of the measurement is increasingly performed with the help of computers.

Due to the unknown etiology of the ankylosing spondylarthritis up to now a causal therapy is not possible. By complex methods of treatment, consisting of chemo- and physiotherapeutic measures we succeed in controlling the course of the disease in as far that the most severe morphological lesions may be prevented. Decisive is the use of a basis therapeutic, in which case chlorochine has been proved favourable. In the last years by optimum dispensary care of these patients with regular controls of the course and controls of the therapy as well as use of all possible rehabilitation measures the premature rate of invalidisation could be reduced from about 50% to 10%. When the disease is recognized in the prodromal phase there exists established hope of preventing severe morphological lesions.

Local instillations of various medicaments with the aim of a so-called chemical synovectomy are compared with the experiment of a possible causal therapy by operative synovectomy. Under this aspect corticosteroids are used still relatively frequently also for the intraarticular treatment. They diminish transiently the inflammation of the pannus, but they do not remove it. On the basis of its good local compatibility in relapsing effusions of the large articulations, mostly of the knee-joints, which appeared in the course of a chronic progressive rheumatoid arthritis of Bechterew's disease, cyclophosphamide was applied intraarticularly and was compared with the results after injections of prednisolone. Apart from the clinical findings cytological and biochemical examinations of the synovial membrane, which more exactly than clinical parameters allow an objective estimation of the local inflammatory activity, were used for the judgement of the success. With the help of intraarticular treatment of cyclophosphamide within a complex chemotherapy an improvement of the findings and a stabilisation of the process can be achieved. Local applications of prednisolone often lead to a rapid, however, in most cases not remaining reduction of the activity at the joint. In uninfluencable high local activity of the process, objectified by examinations of the synovial membrane, an early synovectomy is indicated for the prevention of the formation of irreversible chondropathies.