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OBJECTIVE: To identify predictors for radiological and functional outcome and bone loss in the hands in early rheumatoid arthritis (RA) during the first 2 yr of disease and to study the relationship between these variables. METHODS: An inception cohort of consecutively recruited patients was examined at baseline and after 12 and 24 months using X-rays of hands and feet, clinical [28-joint count, Health Assessment Questionnaire (HAQ), global visual analogue scale (VAS), grip strength] and laboratory (erythrocyte sedimentation rate, C-reactive protein, markers of bone formation and resorption) measurements and dual-energy X-ray absorptiometry measurements of the hands. RESULTS: Joint destruction increased significantly during the study, with the Larsen score at baseline as the strongest predictor. Radiological progression and bone loss over 24 months were significantly retarded in patients responding to therapy. The effects of the shared epitope and initial high inflammatory activity on radiological progression were overridden by the therapeutic response. Radiological progression correlated significantly with bone loss. Global VAS, Larsen score and HAQ at inclusion significantly predicted change in HAQ over time. CONCLUSIONS: Radiological progression and bone loss were retarded by early therapeutic response. Bone loss was related to radiological progression.

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The aim of this study was to identify potential markers of aggressive joint manifestations and HLA associations in patients with psoriatic arthritis (PsA) in northern Sweden. Patients with PsA were examined clinically, with laboratory tests and radiologically. The classification of the disease was based on peripheral and/or axial engagement. HLA B17, B37 and B62 were significantly increased in PsA patients. Univariate analyses suggest that the HLA antigens B37, B62 and some clinical variables were associated with disease course. However, in multivariate analyses distal interphalangeal joint affliction and polyarticular manifestations were the only variables remaining significantly associated with irreversible joint destruction or deformity. There were no significant effects of HLA antigens. In this cross-sectional study, clinical manifestations were more reliable predictors of aggressive joint damage than were specific HLA antigens. However, HLA antigens seemed to modify the expression of the joint disease rather than being involved in joint disease susceptibility.

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Thirty six members of a family with symptoms and signs from the skin and/or the joints were examined clinically and radiologically and HLA typed. Fourteen were classified as having inflammatory joint disease, eight of them with more than one disease within the spondylarthropathy group (SpA). Four had psoriasis of the skin, two of whom had psoriatic arthritis. Ten (five males, five females) had radiological signs of sacroiliitis, eight of them fulfilled the criteria for SpA. Five (four males, one female) with sacroiliitis had radiological signs of spine involvement. One female member was classified as having rheumatoid arthritis. Seven with sacroiliitis were HLA-B27 positive, related to the same haplotype. Two with psoriasis were B27 positive and the other two had another haplotype in common. No single HLA antigen or haplotype was associated with the inflammatory joint manifestations or skin lesions. This suggests involvement of other gene loci or coincidence of multicases.

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OBJECTIVE: To study the role of fibrinolytic enzymes in inflammatory joint diseases with different types of joint destruction. METHODS: Concentrations of the plasminogen activators pro-urokinase, tissue plasminogen activator, plasminogen activator inhibitors 1 and 2 (PAI-1 and PAI-2), plasminogen, and fibrin split product D-dimer in synovial fluid (SF) and blood plasma of 29 patients with rheumatoid arthritis (RA) were compared with the concentrations of 18 patients with spondyloarthropathy (SpA). Levels of the fibrinolytic components were also related to radiological destruction assessed using the Larsen grading system. RESULTS: Patients with RA had significantly higher PAI-1 antigen levels and PAI-1 activity in SF than patients with SpA. Plasma levels of PAI-1 antigen and D-dimer were significantly higher in RA than in SpA. There was also a tendency of lower tPA activities in SF and plasma of patients with RA. Joint destruction correlated significantly with increasing PAI-1 antigen and with decreasing plasminogen in SF when results from all patients were pooled. A significant negative correlation between plasma PAI-2 antigen and Larsen grade was also found. CONCLUSION: Our results indicate a possible association between joint destruction and mobilization of fibrinolytic enzymes in SF.

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Successful internal arterial embolization with steel coils in life-threatening bleeding after femoral fracture is described in an older patient.

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The frequency of radiographic signs of sacroiliac joint involvement (greater than or equal to 2 and greater than or equal to 3 according to the New York criteria) was significantly higher in 28 HLA-B27 positive patients with classical seropositive rheumatoid arthritis (RA), than in 28 B27 negative RA controls. The B27 positive RA patients had more subcutaneous nodules (p less than 0.01), worse functional class (p less than 0.05), and higher levels of erythrocyte sedimentation rate (ESR) (p less than 0.05) and haptoglobin (p less than 0.05). Sacroiliitis, independent of HLA-B27, was associated with higher levels of ESR (p less than 0.05), and with a higher frequency of positive ANA test (p less than 0.05). It is neither related to the functional class nor to the duration of the disease.

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Magnification angiography of the testis with selective injection into the testicular artery has been performed in patients with different lesions in the scrotum, either real or suggested. Characteristic angiographic appearances were found in epididymitis, testicular torsion, tumor, hematoma and hydrocele.

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Selective angiography of the testicular artery was performed in 12 boys (age 3-14 yr) with nonpalpable testis. The angiographic, operative, and microscopic findings are described. True aplasia was diagnosed in seven patients. In three patients previously operated upon, the second exploration was facilitated by angiography. This method might be a valuable diagnostic aid in selected cases previously operated for gonadal disorders or inadequately explored for cryptorchism in order to avoid more extensive surgical exploration.

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The resolving capacity of magnification testicular angiography, as related to the known vascular anatomy of the testis and epididymis, was analysed on the basis of 9 normal angiographies and 8 cases of hydrocele with proven normal status of the testis and epididymis. The intratesticular vascular arrangement was demonstrated remarkably well, but of the epididymal vascularity only that in the head of the epididymis. The vascular anatomy of the testis as resolved by angiography may be utilized in the diagnosis of the location and nature of intra- and extratesticular mass lesions.

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A selective angiography of the testicular artery was performed in 7 boys and 7 men without a palpable testicle in order to localize cryptorchid testes or to establish testicular agenesis. The examination could be carried out in all cases, and the angiographic diagnosis was confirmed at operation and at a subsequent microscopy in the 12 cases hitherto operated upon. The width of the artery and its branches are also presented.

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