Infirmary at LeedsIveson, J. M. I., Thadani, U., Ionescu, M., and Wright, V. (1975.) Annals of the Rheumatic Diseases, 34, 312-320. Aortic valve incompetence and replacement in rheumatoid arthritis. Five cases of aortic incompetence and nodular seropositive rheumatoid arthritis are presented. Four cases underwent aortic valve replacement. Two of these had granulomatous involvement of the aortic cusps similar to subcutaneous rheumatoid nodules, and another showed a nonspecific fibrosis. One case had definite coincidental rheumatic aortic and mitral heart disease. Two patients had undergone pericardectomy previously for constrictive pericarditis. Good results were obtained in all four operated cases and cardiac surgery enabled continuation of rehabilitation for the rheumatoid arthritis, including major orthopaedic procedures.A review of 22 cases from the literature with rheumatoid granulomata within the aortic valve shows that they are associated with mitral valve granulomata in 63-6%. Congestive cardiac failure was found in 75 %. Macroscopical evidence of aortic incompetence was seen in 36-8 % and of aortic stenosis in 15 8%. Associated pericarditis occurred in 59-1 %, which was severe or complicated in 13.6%. The associated arthritis was severe in 77-8% with subcutaneous nodules (71-5%), rheumatoid factor (83 6%), and episcleritis (66 6 %). From these cases and a review of the literature the following points are emphasized. (1) Both the granulomatous and nonspecific aortic valvulitis of rheumatoid arthritis may result in significant haemodynamic abnormality. (2) The valve lesions found are often clinically and macroscopically indistinguishable from rheumatic valve lesions. (3) Granulomata, when present, are usually found in the valve cusp or ring and only occasionally in the aortic wall. (4) Associated joint disease, although usually severe, may be mild. (5) The valve lesion may be accompanied by a severe pericardial involvement-either tamponade or constriction. (6) Aortic valve replacement for aortic incompetence in rheumatoid arthritis is both feasible and worthwhile, despite severe joint disease.

No abstract

Two cases of bilateral shoulder-hand syndrome and symmetrical arthralgia are described in patients with tubo-ovarian carcinoma. Swelling and contracture of the hands continued to develop despite oral corticosteroid therapy, and one patient underwent surgery in an attempt to prevent the development of further deformity. The shoulder-hand syndrome has been associated with a variety of pathological conditions, including some cases of underlying malignancy.' Tumours of the lung and brain are most frequently linked with the syndrome,2 but isolated case reports have implicated neoplasms at other sites.3 There are just 2 reports6 7 in which ovarian tumours have been associated with this rheumatic syndrome. This paper describes 2 cases of disabling shoulder-hand syndrome and symmetrical arthralgia which occurred in patients with tubo-ovarian carcinoma. Case reports CASE 1 This 58-year-old woman presented in April 1980 with left-sided lower abdominal pain, which was found at laparotomy to be due to a well differentiated adenocarcinoma of the left fallopian tube. The tumour was adherent to nearby omentum, but there were no obvious peritoneal secondaries, so hysterectomy together with bilateral salpingo-oophorectomy was carried out. The patient remained well without further treatment for several months, but in April 1981 she began to complain of pain and swelling of the hands and knees with discomfort in the elbows and ankles. These pains were associated with morning stiffness, and the hand swelling made it difficult for her to make a fist. On examination there was oedema and thickening of the hands and forearms, with tenosynovitis of the right middle finger and a dusky

No abstract

The radiological confirmation of sacro-iliitis is essential for the early diagnosis of ankylosing spondylitis. Conventional radiography is too insensitive to detect early changes in these joints, and radionuclide scintigraphy is a non-specific, though highly sensitive, technique. This study describes a preliminary survey of the use of computed tomography (CT) of the sacro-iliac joints in the diagnosis of early sacro-iliitis. Patients were selected for study from a routine rheumatology clinic. Entry criteria included a clinical suspicion of sacro-iliitis and normal or equivocal findings on conventional radiography. Twenty-two patients were selected for study. Nine had normal plain films and normal CT; four had equivocal plain films with conclusive evidence of sacro-iliitis on CT; in two cases, conventional radiographs were normal but CT showed clear evidence of sacro-iliitis; two other patients had equivocal findings on straight X-ray examination but normal CT. Computerized tomography of the sacro-iliac joints can be useful in the early diagnosis of sacro-iliitis if conventional radiography is equivocal or normal. Further controlled studies are necessary to establish the sensitivity and specificity of the technique.