A case of active chronic hepatitis with painless erosive arthritis

True arthritis is very much less common than arthralgia in patients suffering from active chronic hepatitis and only scanty information is available about the joint changes in this disease. We report here the case of a young woman with active chronic hepatitis complicated by a painless, erosive small joint arthropathy.     

Experimental cryo-irrigation of the knee joint.

Experiments have been carried out to test the feasibility of using cryo-irrigation as a means of ablating the synovium in the rheumatoid knee joint. Cryo-irrigation was performed by a cooling machine and pump, which circulated cold 200/10 centistoke (cSt) silicone through the knee joint of rabbits anaesthetised with intravenous (IV) 'Saffan'. Fluid left the joint at -5 to -10 degrees C. Sixteen normal New Zealand rabbits received cryo-irrigation of one knee joint for 10-20 minutes and were killed at one day, and one, two, and 12 weeks thereafter. Judged by radioactive sulphate incorporation there was no impairment of chondrocyte function in the articular cartilage of irrigated joints. Histological examination showed mild synovitis and some loss of staining of superficial cartilage in 6/16 irrigated joints (v 1/16 control joints). Similar treatment of rabbit joints in which the Glynn model of synovitis had been induced showed marked reduction of synovitis 14-45 days after silicone treatment. Nine of 26 animals in which synovitis was induced in both knees and cryo-irrigation performed in one knee died either immediately postoperatively or during the next week. These deaths remain unexplained. A single dog received cryo-irrigation of one knee (-6 to -9 degrees C for 22 min) and remained perfectly well up to sacrifice at six months, when the joint appeared histologically completely normal.     

Inability of rheumatologists to describe their true policies for assessing rheumatoid arthritis.

Eighty nine British and Australian rheumatologists took part in a study to discover how accurately they could describe their procedures for measuring disease severity in rheumatoid arthritis. The relative importance they attached to different clinical and laboratory variables showed a very wide variation, and these stated policies were generally poor at predicting their actual judgments when assessing 'paper patients' (r2 = 39%). Policies based on equal weighting of all variables, while also poor predictors (r2 = 41%), were nevertheless superior to their stated policies for 49 respondents. Policies calculated by judgment (linear regression) analysis were much more successful predictors (R2 = 73%). Unhurried, detailed interviews with four experienced rheumatologists provided carefully considered statements of assessment policy, but these also were poor predictors of routine assessments of outpatients (r2 = 34%) compared with policies calculated by clinical judgment analysis, even when these were applied to new data (R2 = 88%).     

Evolution and development of facial bone morphology in threespine sticklebacks

How do developmental mechanisms evolve to control changing skeletal morphology, the shapes and sizes of individual bones? We address this question with studies of the opercle (OP), a large facial bone that has undergone marked morphological evolution in the ray-finned fish. Attributes for developmental analysis motivated us to examine how OP shape and size evolve and develop in threespine sticklebacks, a model system for understanding vertebrate evolution. We find that when Alaskan anadromous fish take up permanent residence in lakes, they evolve smaller and reshaped OPs. The change is a reduction in the amount of bone laid down along one body axis, and it arises at or shortly after the onset of OP development. A quantitative trait locus is present on linkage group 19 that contributes in a major way to this phenotype.