Über die mikroskopischen Kennzeichen und die Entstehungsbedingungen der Arthritis deformans (nebst neuen Beiträgen zur Kenntnis der Knorpelknötchen)

The influence of subchondral vascularisation on chondromalacia patellae

An experiment was carried out on 40 rabbits in which the blood supply to the patella was interrupted for periods from 2 weeks to 6 months. With prolonged ischaemia, there were clear changes in the articular cartilage which were comparable with those seen in chondromalacia patellae.

Femoral neck angles in osteoarthritis of the hip

Femoral neck angles were determined in 44 patients with unilateral or bilateral idiopathic osteoarthritis of the hip. The mean anteversion angle was 20 degrees +/- 9 degrees and the neck-shaft angle 131 degrees +/- 7 degrees. In comparison with a normal material the anteversion was significantly larger in the patients (P less than 0.001), but no difference was found in the neck-shaft angle. A positive correlation between the size of the anteversion and the severity of the disease was observed. It is concluded that increased anteversion of the femoral neck may contribute to the development of osteoarthritis of the hip.

Stress and the etiology of osteoarthritis

Although degenerative joint disease is an old and exceedingly common problem, clinical investigators have not reached a consensus regarding the etiology of this disease. Comparative osteological analysis of the knee, hip, shoulder, and elbow joints of 789 individuals from four human skeletal populations (Black and White Americans, Pueblo Indians, and Alaskan Eskimos) indicates that age of onset, frequency, and location of degenerative changes are directly related to the nature and degree of environmentally associated stress, as reflected by the variable life styles of the populations sampled. Eskimos have the earliest onset and most severe involvement for all four joints studied, the right side is usually more affected than the left, and Blacks are more frequently involved than Whites in the knee, shoulder, and elbow. Functional stress, when constant and severe in nature, becomes the primary focus of degenerative disease, but other background contributing agents such as age, sex, and hormonal influence must not be ignored.

Rheumatism in industry: a review

Anderson, J. A. D. (1971).Brit. J. industr. Med.,28, 103-121. Rheumatism in industry: a review. Information about causes, effects, and prevention of rheumatic disease among industrial workers lacks standardization, as shown by the literature in this field; one reason for this is that there are discrepancies about the range of diseases and syndromes which should be included under this heading. The Industrial Survey Unit of the Arthritis and Rheumatism Council defined a rheumatic complaint as musculo-skeletal pain not related to recent (i.e., within six weeks) trauma. A study by the Unit of the social and economic effects of rheumatism among 2 684 male employees from a range of manual occupations is considered in relation to the observations made by other investigators. Sickness absence (at present estimated to be about 29·8 million working days per annum in Britain) and premature retirement can be shown to result directly from rheumatic complaints, especially rheumatoid arthritis and disc disease; furthermore, there seems to be general agreement that sickness absence is more marked in heavy manual occupations than in light ones. However, the extent to which job changes ascribed to rheumatic complaints are in fact caused by them is more doubtful. Evidence supporting the view that occupational factors are related to the aetiology of some chronic rheumatic diseases is fairly strong. Chronic tenosynovitis, bursitis, osteoarthrosis, and, to a lesser extent, disc disease are among those in which such a relationship can be demonstrated; however, the reason why some men are more prone to develop these conditions than others working in similar jobs is still in doubt, suggesting that the aetiology is multifactorial. In other rheumatic diseases, notably rheumatoid arthritis, a fairly extensive study of the literature does not indicate any clear correlation between occupation and aetiology. A system of job analysis for individual workers based on effort, posture, and climatic conditions at work is suggested. Its use as an alternative to grouping employees under their occupational titles might help to clarify these points. Prevention of rheumatic disease (including the use of pre-employment medical examinations) seems impracticable at the present time, but some progress in tackling the problems of rheumatism among industrial workers might be possible by improving rehabilitative services. These improvements would depend on closer collaboration not only between government departments but among doctors themselves and between them and others working in this field.