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Evaluation of 158 synovial fluids, mainly from patients with rheumatoid arthritis (RA) and the crystal deposition fiseases (CDD), revealed differences in the differential white blood count and numbers of cytoplasmic inclusion bodies (CIB) present. Lymphocytes and CIB were increased in RA, suggesting a different pathologic mechanism from that of CDD. Lymphocyte-like cells contained CIB implying phagocytic capability. Lymphocytes were the initial predominant cell type in RA of less than six weeks disease duration. Later polymorphonuclear leukocytes increased, possibily representing a secondary non-specific inflammatory response similar to that seen in CDD.

Recent research shows that a bacterial life form, Erysipelothrix insidiosa, can produce rheumatoid arthritis in deer, swine, and dogs, and that a number of animals, including man, birds, and fish, may be infected by the organism. Examination of the archaeological record suggests that both cultural and biological variables may be interrelated in the maintenance of some forms of arthritis over long periods of time in geographically disparate populations. Re-examination of Cherokee folk beliefs concerning arthritis suggests that they had some recognition of this connection, and it also suggests that they had some recognition of this connection, and it also suggests that the term "magical" may relate more to the world view of the observer than to any actual inability of preliterate peoples to draw causal relations on the basis of their own intimate knowledge of their environments.

With reference to 27 cases reported in the literature (of which 1 was personal) of primary hypogammaglobulinaemia in adults (PHGGA) with rheumatic manifestations, and following a statistical study, the authors think that the rheumatic manifestations that precede, accompany, or follow primary hypogammaglobulinaemia in adults are not coincidental. These manifestations occur in 10 percent of patients. The clinical and radiological pictures, and the associated infections and immunological disorders form a particular clinical entity and lead to therapeutic difficultires. In this connexion, the authors mention in particular pathogenic problems related to hypogammaglobulinaemia in adults and the rheumatic manifestations.

The case of a 10-year-old girl with an infrequently observed lipid dermatoarthritis is reported. This is a systemic disease of unknown etiology characterized by a nodular eruption of the skin, mucosa and synovia, resulting in destructive arthritis and disfigurement of the facies. Biopsy of a nodule, whether from skin or synovia, discloses a cellular infiltrate consisting of histiocytes and multinucleated giant cells with lipid inclusions. No effective treatment is known.

Introduction: In part I of this paper (Schulz et al., 1975) it was shown that in the initial phase of experimental erysipelas a transition from the vascular processes to a systemic connective tissue reaction can be demonstrated in different species. It is the purpose of this paper to describe the chronic phase of the disease with special emphasis on polyarthritis., Materials and Methods: 12 spontaneously diseased and 22 experimentally infected pigs were used in experiments to study the pathogenesis of the disease. In addition, 74 Wistar rats and 148 Sprague-Dawley rats were used in the experiments. All experimental animals were specific-pathogen-free and were parenterally infected with the standardized E. insidiosa serotype B strain T 28. The observation period for the pigs was up to 2 years, for the rats up to 11 months. The methods used for pathohistological and electron microscopical studies are described in part I. Immunihistological studies were carried out on synovial tissue with peroxidase-conjugates of goat-anti-pig-IgG, goat-anti-pig-IgM, pig-collagen, E. insidiosa-homogenate and heat-aggregated-pig-IgG. Furthermore, goat-anti-pig-IgG and rabbit-anti-pig-C3 conjugated with FITC were used. Passive hemagglutination tests and Latex agglutination test (Singer and Plotz) were performed to demonstrate rheumatoid factors and collagen antibodies., Results: Polyarthritis occurred in pigs between the 4th and 10th day p.i. and between the 4th and 8th day p.i. in nearly 100% of the infected rats. Fibrinous exudation, proliferation and destruction with pannus formation are marked in most of the joints examined during the first three months. Fibrosis begins 30 days p.i. in the rats' joints and is most severe in both species between the 5th and 8th month. 3 types of lining cells may be differentiated electron microscopically: A (M) cells, B (F) cells and an intermediate form which is found in both species most frequently. Swelling of the endothelial cells together with constriction of the lumen and thickening of the basal membrane occurs in the capillaries., Discussion: A comparison of chronic erysipelas polyarthritis in pigs and rats with rheumatoid arthritis of men reveals many morphological and immunological similarities between the two diseases. Systemic connective tissue activation manifests itself in organs predilected for rheumatic changes, such as heart valves, endocardium and joints. The possible prepetuation of the processes by specific or nonspecific immunomechanisms or by deposits of fibrin is discussed. In addition, experimental erysipelas is reproducible in nearly 100% of the animals given one single subcutaneous application of one defined bacteria strain. Therefore too, erysipelas is suited as an animal model for human rheumatic diseases.

Introduction: The similarities between erysipelas in animals and rheumatic diseases in man have been discussed since the work of Nieberle (1931). The present work sets out to investigate the course of organ manifestations in pigs, rats, and mice using germ-free or specific pathogen-free experimental animals. Particular consideration will be given to the initial systemic vascular processes as well as to the significance of the erysipelas antigen., Material and Methods: In several experiments, a total of 166 pigs--partly gnotobiotic or specific pathogen-free animals--37 specific pathogen free Wistar rats and 57 albino mice were orally and/or parenterally infected with standardized erysipelas strains of serotype B. Clinical examination post infection were carried out with the EKG and by x-raying the joints of the extremities. All large parenchymatous organs, as well as heart valves, aorta and synovia were examined histologically in paraffin sections. In mice and rats, joints of the extremities were embedded in toto in metracrylate. Besides various histological staining methods, histochemical reactions were used to demonstrate mucopolysaccharides and fibrin. The myocardium, central nervous system and synovia of several joints were examined with the electron microscope. In the pig, immunohistological methods demonstrating the presence of fibrin, complement and IgG, as described by Seidler et al. (1971) and Trautwein et al. (1972), were used., Results: The most important changes in joints, heart valves heart musculature and blood vessels occur during the early bacteriemic phase. A distinct sticking effect develops in the mouse 3.5 hours p.i., in the rat 24 hours p.i., and in the pig 36 hours p.i. Simultaneously, hyaline thrombi occur in capillaries and venules; these are seen as parallel, loosely-packed fibrin fibers in the electron microscope. With the aid of immunofluorescence fibrin, IgG and complement C3 can also be demonstrated here. Exudates rich in fibrin develop parallel to the microthrombosis. In pigs and rats vascular and myocardial necroses develop to 3 days p.i. The mice do not survive the 3rd p.i. 39% of the pigs showed edema and mesenchymal activation of varying intensity in the heart valves between the 3rd and 8th day p.i. Besides the insudation of the valves, endocardial thromboses developed in 80% of the mice. Endocarditis, aand in addition large aortic thromboses were recognized in more than 50% of the rats. As early as the 4th day p.i., coagulopathy, angionecrosis and exudation led to acute arthritic symptoms..

The authors give a general review of rheumatic manifestations associated with immunodeficiency in children with reference to 7 personal observations. The review demonstrates the high frequency of this association, the variable clinical picture in one, a few, or many joints, the prolonged, relatively mild evolution that is never deforming or ankylosing, the existence of frequent auto-immune and rheumatic manifestations in families, and the usual but variable effectiveness of gammaglobulins. The possibility of immunodeficiency should be considered in cases of mono-, oligo-, and polyarthritis. The results of humoral and cellular immunological studies demonstrated a low level of immunoglobulins, the presence of nonfunctional B cells, and the presence of T cells that were probably qualitatively modified. A physiopathological interpretation is suggested.

The anatomy and function of the temporomandibular joint (TMJ) are described in the detail needed to evaluate and treat temporomandibular degenerative joint disease (TDJD). Innervation of the joint and the mechanism of arthralgia are described and related to TDJD. The clinical course of TDJD, radiographic evaluation of it, histopathologic description, and etiology are presented.

Loss of the anterior cruciate ligament (ACL) in the dog results in a predictable type of arthritis. This condition can be prevented by successful prosthetic substitution of the anterior cruciate ligament (ACL). The condition is a practical model, and a sensitive index of success and failure for evaluation of prototype prostheses. Changes in the joint can be differentiated on the basis of cruciate insufficiency and reaction to the synthetic implant. The model was defined by replacing the ACL with a mesh or tape Dacron prosthesis in 16 Beagle dogs. Gait and anterior drawer sign are unreliable parameters of ACL insufficiency in dogs. At sacrifice up to 3 years postoperatively, 8 joints out of 32 joints were without arthritic changes. Arthritis developed in all joints in which the prosthesis elongated or broke. Failure always occurred intra-articularly at the mouth of a bone tunnel. Successes were inconsistent even with a single material and animal breed. The drillhole techniques used in ACL reconstructions are difficult to standardize. Variability in placement of the prosthesis is compounded by cutting action of bone edges. Porous mesh did not provide a lattice for true ligament regeneration through the joint. Fixation was not a problem in this series.