Our findings suggest that mirthful laughter affects the levels of serum pro- and anti-inflammatory cytokines differentially, depending on the RA disease activity.

We developed the Hy-Flex II total knee and ligament balancing system (Hy-Flex II total knee) which provides (1) a flexion angle of at least 120 degrees or more, (2) a range of motion (ROM) comparable to or greater than that before surgery, and (3) occasional full flexion. The system design has several features: small posterior femoral condyle radius, a 4 degrees posterior tilting of the tibial joint surface, and equal tension of the bilateral soft tissues obtained by using a ligament tensor. From September 1997 to June 1999, Hy-Flex II total knee arthroplasty was carried out on 114 joints of 84 patients with rheumatoid arthritis. One year after surgery, the average flexion in our series was 122.1 degrees +/-15.0 degrees. The number of knees operated on which had a flexion angle of 120 degrees or greater was 82 (71.9%) 1 year after surgery among the total of 114 knees. In total, 94 (82.5%) joints obtained the same level or better than the preoperative flexion; 26 (22.8%) attained full flexion 4 weeks after the operation and 15 (13.1%), 1 year after the operation. These results suggest that this system will be able to achieve our aims in almost all rheumatoid knees.

We assessed the anti-rheumatic effects of radical multiple synovectomy (RaMS) in patients with rheumatoid arthritis (RA) who did not respond to intensive medical treatment. The selection of patients into three groups, A, B or C, was randomised. Patients assigned to group A (n=28) continued the prescribed pre-operative medication and had RaMS. Patients assigned to group B (n=20) were started on a combination therapy with disease-modifying anti-rheumatic drugs (DMARDs) after radical multiple synovectomy. Nineteen RA patients who were started on the same combination therapy as group B but who did not undergo surgery served as controls (group C). The clinical and radiographic findings were assessed for at least 3 years after surgery. Patients in the surgically treated groups (groups A and B) showed a significant reduction in the number of swollen and painful joints and in their ESR and serum CRP levels, and this effect was maintained for at least 3 years. More than 40% of the patients remained in clinical remission during the observation period. The surgical outcome seemed to be superior to that of the controls and did not differ between group A and group B. Articular destruction (assessed by the carpal height ratio) did not progress in the patients who were in clinical remission.Résumé Nous avons étudié les effets anti-rhumatoïde de la synovectomie complète multiple dans trois groupes de patients atteints d'arthrite rhumatoïde réfractaire au traitement médical. La sélection des patients en trois groupes a été faite au hasard. Les patients du groupe A (n=28) ont continué le traitement pré-opératoire prescrit; ceux du groupe B (n=20) ont commencé, après l'intervention un traitement par médicaments anti-rhumatismaux. Enfin 19 patients qui ont commencé la même combinaison thérapeutique que le groupe B mais sans intervention chirurgicale ont servi de groupe de contrôle. Les patients ont été suivis au moins 3 ans après le traitement chirurgical. Les patients traités par synovectomie ont montré une réduction du nombre d'épanchement, de douleurs articulaires ainsi qu'une diminution de la vitesse de sédimentation et du niveau de la CRP ceci s'étant maintenu pour au moins 3 ans. Plus de 40% des patients sont restés en rémission clinique durant la période d'observation. Les destructions articulaires mesurées par la hauteur du carpe n'ont pas progressé pendant la période de rémission.

No abstract

A 57-year-old woman with RA of 10 years' duration presented with a history of right coxalgia. Three weeks after total hip arthroplasty, the patient developed an acute pulmonary embolism. The results of screening for hypercoagulable states revealed a protein S (PS) deficiency, and all PS values, i.e., total PS antigen, free PS antigen, and PS cofactor, were lower than the normal ranges, showing that the patient had type I PS deficiency. She had no past history of embolism or deep venous thrombosis. The values of three PS-related parameters were also lower than normal in her daughter. The responsible mutation may be located on exon 15 of genomic PS DNA, as indicated by polymerase chain reaction. We therefore diagnosed hereditary PS deficiency.