inexpensive and provides a new technique for the diagnosis of non-immunologically mediated bronchial hyperreactivity. DR antigens and rheumatoid arthritis: a study of two populationsThe prevalence of HLA-DR antigens was determined in a group of white patients with rheumatoid arthritis, similar patients originating from the Indian subcontinent, and corresponding controls. Rheumatoid arthritis was found to be highly associated with DR4 in the white patients but with DR1 in the Indian patients. These results raise the possibility that the DR antigens themselves do not play a part in increasing susceptibility to rheumatoid arthritis, but the locus for increased susceptibility is probably closely linked to the DR locus.

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SUMMARY Seven cases of diffuse interstitial lung disease (DILD) are reported with an unequivocal temporal relationship between the development of the lung disease and treatment with gold (6 cases) and penicillamine (1 case). They were characterised clinically by the sudden onset of dyspnoea and crepitations and radiologically by diffuse bilateral pulmonary shadowing. Most showed evidence of hypersensitivity such as eosinophilia, a raised serum IgE level in response to gold, proteinuria, thrombocytopenia, or an immediate postinjection reaction. DILD is a serious complication of treatment with gold and penicillamine that is commoner than generally realised.

SUMMARY A case report of manubriosternal joint (MSJ) dislocation in a rheumatoid patient with thoracic kyphosis is presented together with a review of the relevant literature. Variations in the anatomical nature of the MSJ between normal individuals are described. In 43% of the population its characteristics are noted to be such that it may be involved in rheumatoid arthritis (RA). A joint thus involved can be dislocated by forces generated by longstanding thoracic kyphosis and transmitted to the manubrium via the first rib. Xeroradiographs of the MSJ region in our patient showed dislocation of the joint in the upright position and its subsequent reduction on lying the patient flat. We suggest that this demonstrated reduction is secondary to the lessening of the thoracic kyphosis that occurs in the supine position. It is concluded that in RA MSJ dislocation is a function of thoracic kyphosis.

Benign soft tissue swelling affecting the interphalangeal joints can sometimes be misdiagnosed as an arthropathy. Garrods fatty pads (knuckle pad syndrome) is a relatively common and harmless condition characterized by discrete fibromatous skin pads over the dorsum of the interphalangeal joints. We describe a case which clinically resembles the rare but benign condition of pachydermodactyly with some pathological features of the distinct syndrome of pachydermoperiostosis. The possibility of an overlap syndrome is discussed.