It is now generally accepted that immune complexes play significant roles in the pathogenesis of rheumatoid arthritis. The complement must also respond to immune complexes and evidence in support of this has been accumulating. Membrane factors that control the complement system, e.g., DAF (decay accelerating factors), MCP (membrane cofactor protein), HRF (homologonous restriction factor) and HRF 20 (20 kDa homologonous restriction factor), have been reported. This study was undertaken to investigate the distribution of DAF in the peripheral blood lymphocyte subset involved in the pathogenetic mechanism of rheumatoid arthritis, i.e., CD8-positive cells (suppressor and killer cells), CD4-positive cells (helper and inducer cells) and CD19-positive cells (B cells) . The peripheral blood lymphocytes were investigated with two-color FACS-can analysis in 24 RA patients and 24 healthy controls.
The results indicated there to be a significant difference between the CD8-positive cells (suppressor/killer) of healthy individuals and those of RA patients in the proportion of DAF-positive cells. A significant difference was also observed between the two groups of subjects in the positive rate for DAF of CD4-positive cells (helper/inducer) . These differences were in favor of the controls. No significant difference was noted between the two groups with respect to CD19-positive cells (B cells) . The use or nonuse of corticosteroids made no significant difference in this regard. No correlation could be found between the positive rate for DAF of either of the CD8-positive cell subpopulations or the rheumatic disease activity index (Lansbury index) . The mechanism of the decreased expression of DAF on T lymphocytes of RA patients thus remains to be elucidated.

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We performed studies on the clinical effects exerted by uncemented total knee arthroplasty (TKA) on the impairments and disabilities of severe cases of rheumatoid arthritis (RA) . The object of our survey was 60 joints of 42 MarkIII TKA cases on whom surgery was performed for severe RA, that in Steinbrocker's Stage IV, Classes 3 and 4. The postoperative periods for the cases ranged from 13 months to 5 years and 10 months, with an average followup time of 39 months. The following results were obtained:
1. The average total score for the RA knee treatment results criterion of the JOA in the 60 knees was 30.4 before surgery and 68.9 at the final follow up, an improvement of about 40 points.
2. There was a clear limit to the recovery from disabled ambulation.
3. The ambulation disability for TKA cases on both sides was worse than that for TKA cases on one side.

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Thirty-eight knees of patients with rheumatoid arthritis treated by total knee replacements were studied. The average follow-up period was six years, four months. The mean preoperative clinical score was 32, which was extremely improved to 67 after surgery. The range of motion of knee joints, however, was not improved because of impaired flexion movement of the joints. The clinical results were correlated with the preoperative clinical stage of rheumatoid arthritis, the sex, and the replacement of the patellar component. Complications were observed in 26% of the cases. These included infection, loosening of the components, and fracture of the femur. Radiolucent lines close to the tibial components were observed in 73% of the knees at one year after surgery. There was a close relationship between the radiolucent line and the insertion angle of the tibial components. The increase of the radiolucent line suggested the future occurrence of loosening of the components.

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A total of 60 patients (76 knees) suffering from either osteoarthritis (40 patients, 48 knees) or rheumatoid arthritis (20 patients, 28 knees) underwent total knee arthroplasty (TKA) without patellar resurfacing. The average follow-up period was 4.3 years. The alignments of the patellofemoral joint (P-F) were measured by the skyline view and the Q-angles. Parapatellar pains after operation were more present in RA cases than in OA cases. This suggests that the pain was independent of the P-F alignment in RA cases, and therefore that patellar resurfacing must particularly be done in RA cases. The Q-angle is correlated with the tilting angle and the lateral shift. By measuring the Q-angle during the operation through taking a X-ray (antero-posterior view) on marking the center of the patella and the tibial

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Unicompartmental arthroplasty using the Marmor modular knee was performed on 30 knees of 28 patients with unicompartment osteoarthritis between 1976 and 1982. Twenty-five of these knees, in 2 men (3 knees) and 21 women (22 knees) whose average age at surgery was 70.0 years, could be followed up for more than a year. The average length of follow up was 6.1 years (range, 1.1-12.7) . Medial replacement was done in 23 knees, and lateral replacement in 2, and 15 knees of 13 patients, 2 men and 11 women, were followed up for an average of 7.9 years (range, 5.3-12.7) . The thickness of the tibial component used in the arthroplasty was 6 mm in 12 knees, 9 mm in 10 and 12 mm in 3. The overall preoperative knee score, as evaluated by the JOA assessment criteria for evaluation of osteoarthritis of the knee, was 50 ± 12 points and the postoperative one was 77 ± 16 points. The mean score of the knees which were followed up for more than 5 years was 51 ± 13 points preoperatively and 75± 19 points at the final examination. The preoperative femoro-tibial angle was 186.7 ± 7.0 degrees and the postoperative 177.7±8.4 degrees in the knees with medial replacements.

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The purpose of this study was to determine the value of postoperative blood salvage in patients who had total hip or knee replacement. Sixty-five patients from May, 1991, who had 86 total hip or knee replacements (TKR or THR) including one who had femoral head unicompartment replacement were studied. Post-operative salvage of blood was performed using the Cell Saver. We did not use it during operations. Patients' hemoglobin and hematocrit were examined before their operation and 6 days after it, the bleeding volume during and after operation, wound drainage volume and reinfused concentrated blood volume were also checked. The average amount of postoperative salvaged blood was 348 ml in the TKR group, and 279 ml in the THR group. Approximately 80% of the salvaged blood was reinfused using the Cell Saver. No case had problems after autologous blood transfusion. The non-autologous blood transfusion rate in total joint arthroplasty was decreased by using the Cell Saver. We therefore think that postoperative blood salvage with the Cell Saver is both feasible and efficacious.

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We analyzed the radiographs and clinical signs of shoulder joints in 131 patients on longterm hemodialysis to confirm the major lesions resulting in shoulder pain. Radiological changes were noted in 71 joints (27.2%) . There were 24 patients who had persistant shoulder pain for over two months. The mean age of these patients was 53.2 years, ranging from 32 to 73. The mean duration of hemodialysis was 11.2 years, with a range of six months to 22 years. In patients who had been on hemodialysis for more than 15 years, the incidence of shoulder pain was high (36.6%) . A statistically significant correlation was observed between the site of the cystic bone lesion and shoulder pain. Cystic bone lesions with lesser tuberosity or intertuberosity were associated with the pain, but not those with greater tuberosity.

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Clinically significant myositis ossificans following total knee replacement is an uncommon event. Here we report on two women suffering from rheumatoid arthritis in whom lateral radiograms of their operated on knees taken about one month postoperatively revealed the presence of an amorphous mineralization in the supracondylar area of the distal femur. Gradual increment of bony density was observed in the following month. Three months after operation, however, the density had become somewhat subdued and the bone mass started to fuse with the underlying femur, concomitant with an alleviation of the patients' symptoms. Although the paucity of the literature about this complication after total knee replacement is evident, we recommend that such cases be followed very closely for a couple of months and more without taking any special maneuvers or interventions.

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In order to define the importance of type II collagen (C-II) in the activation of rheumatoid arthritis (RA) synovial fluid (SF) T cells, the proliferative response of these cells to C-II was examined. In 6 of 23 RA patients, SF T cells showed strong responses to C-II. Twelve clones from those SF T cells were established to assess the response of individual T cells. One of the clones showed a strong response to both collagen type I and type II as well as to purified protein derivative. Phenotypic analysis revealed it to have γδ T cell receptors. These results suggest that T cell response to autologous antigen plays an important role, at least in some patients with RA, in the development and persistance of rheumatoid synovitis.

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The effects of synovial fluid in rheumatoid arthritis (RA) and osteoarthritis deformans (OA) on the cell growth in a rabbit cartilage cell culture system were investigated with incorporated ³H-thymidine. Interleukin 1 β (IL-1β) and insulin-like growth factor 1 (IGF-1) were also determined. It was found that cell growth was promoted after the addition of the synovial fluid from RA and OA. A negative correlation was noticeable between the cell growth promoting activities of the RA synovial fluid and the activity and stage in RA. Significantly higher values were shown with IL-1 β in the RA synovial fluid than in the OA, but no manifest difference was recognizable in IGF-1 with RA and OA. A negative correlation was found to exist between the cell growth promoting activities of the RA synovial fluid and IL-1f, but no correlation was found between either of these and IGF-1. It was evident, as stated above, that the synovial fluid from RA and OA patients promotes cell growth in close relation to the activity and stage of RA.

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Two cases of rapid destruction of hip joints are reported, one in which both hip joints were affected by rheumatoid arthritis, and the other in which one hip joint was thought to be affected by rapidly destructive coxarthrosis. All three joints showed slight deformity of the body weight bearing part of the lateral surface of the femoral head upon initial X-ray. We think this is an important finding in the initial phase. Pathologically, the joints showed bony destruction and repair only, which might be assessed as indicating osteoarthrosis. We are, however, quite doubtful of the outcome, because we think that the pathological findings suggest that the current conditions do not reflect the active phase as of yet.

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