Swelling of the metacarpophalangeal (MP) joint area in the rheumatoid hand results from articular and periarticular causes. Ultrasonography (7.5MHz) was used to demonstrate the location and extent of synovitis and effusion in the palmar aspect of 90 swollen MP joints in 30 rheumatoid patients.
The flexor tendon sheath in the swollen MP joint area was significantly thicker than that in the control group in the index, long and ring fingers. Swelling of the palmar capsule was noted in 12 joints (13%), synovial proliferation around flexor tendons in 21 joints (23%), and thickening of flexor tendon itself due to synovial invasion in 26 joints (29%) . In 12 MP joints with trigger phenomenon, 10 were caused by synovial thickening within the flexor tendon sheath and 2 by joint incongruity due to bone destruction.
Our findings suggest that ultrasonography is a easy and noninvasive method that can be utilized to detect the lesions in MP joint areas in early rheumatoid patients. In the treatment of trigger finger, the lesion can be confirmed objectively and accurately by the ultrasound measurement and the appropriate surgical approach can be determined preoperatively.

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The results of the analysis of rapid destruction of 7 hip joints in 5 rheumatoid patients, 1 male and 4 females, are reported. In 4 patients, activities of rheumatoid arthritis were remarkable when the destruction occurred. Corticosteroid was used in all these patients. X-ray films showed 3 patterns of destruction: 1) 3 hips showed absorption of the femoral heads and protorusio acetabuli; 2) 2 hips showed absorption or flattening of femoral heads and acetabular destruction upward or upward on the lateral part of the joint; 3) 2 hips showed rapid developing of cystic shadow on x-ray film followed by crushing of the weight bearing area of the femoral head. Pathological findings of hip joint synovium showed active synovitis with bone fragment and multinuclear giant cells. Using bone morphometry technique, the femoral head showed a high turnover of bone while the iliac bone showed a low turnover.

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In 54 RA patients whose disease was controlled relatively well by GST (Gold sodium thiomalate) administration, GST was changed immediately to AF (Auranofin) (6mg) in 32 (Group A), and gradually in 22 (Group B) by administering AF first at 3mg for 4 weeks and at 6mg thereafter with 8 week concomitant administration of GST. The clinical findings, laboratory data, immunological findings, serum gold level, and side effects in these two groups were examined for 24 weeks.
Clinical conditions were maintained at a similar level or were improved in both groups, but the number of swollen joints and the joint score was significantly reduced in Group B as compared with Group A after 24 weeks. No differences were observed in the results of laboratory findings or immunological findings between the two groups. There was also no difference in the frequency of side effects, but the administration was more often discontinued due to side effects in Group A.
The serum gold level showed no significant changes from the beginning of the administration to 24 weeks after in either group, and it was not affected by the substitution of GST with AF. No significant correlation was observed between the serum gold concentra-tions and changes in the values of various laboratory findings and side effects.
Maintenance therapy of RA with gold preparations was effective when GST was changed either immediately or gradually to AF.

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In order to investigate the therapeutic effect of high molecular weight hyaluronate (HA) on rheumatoid arthritis (RA), HA was injected into the proximal interphalangeal (PIP) joints of monkeys with collagen-induced arthritis, an experimental model of the disease. An immunohistochemical study was then performed using antibodies against collagen, interleukin1 (IL-1), tumor necrosis factor (TNF), and stromelysin. Intra-articular injection of HA at an early stage of arthritis inhibited the production of cytokines by chondrocytes and synovial cells, and also prevented the degeneration of articular cartilage and the proliferation of synovial tissue. In addition, the appearance of osteoclasts in the subchondral bone was suppressed by HA injection. Even in the advanced stage of arthritis, the hyaline cartilage matrix was relatively well preserved in animals treated with HA. These findings suggest that HA could prevent the progression of articular destruction by inhibiting the inflammatory response of articular cartilage, synovial tissue, and subchondral bone. Although the mechanism of this anti-inflammatory effect of HA is still unclear, it is implied that the intra-articular injection of HA into the affected joints of RA patients may improve their arthritis.

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Unicompartmental knee arthroplasty has been reported to show good results as a method for treating severe osteoarthritis. However, appropriate surgical techniques are required since the operation is unilateral, and a high incidence of complications such as loosening, wear and sinking over time have been reported when the insertion has not been at the optimal site. In the present study, the causes for this were studied and a pathological examination of extirpated tissue was performed in two patients undergoing revision surgery. Both of them had unicompartmental osteoarthritis, and one received a Marmortype joint and the other a PCA-type joint.

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Nine shoulders in 7 patients with rheumatoid arthritis were treated with 8 Neer and one Kessel total shoulder arthroplasties. The clinical follow-up was done for a mean of 40 months (range 3 to 122) . Clinical symptoms of pain and joint function were quite improved. However, the range of movement was not changed in elevation, though slightly improved in external rotation. Radiological findings revealed radiolucent lines around the glenoid component in 3 patients (33%), and proximal migration of the humeral head in only one (11%) . There was no clinical evidence (motion pain) of loosening.
The joint kinetics after total shoulder arthroplasty in active elevation were recorded with a video recorder through an image intensifier, and the images obtained were analyzed by an analyzing system (MOVIAS, NAC HSV-400) . It was shown that scapulo-thoracic movement is larger than gleno-humeral movement in active elevation. Although postoperative improvement of ROM of the shoulder was poor, total shoulder arthroplasty was a valuable procedure for these patients with painful shoulder with respect to pain relief and improvement in ADL.

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Preoperative course and walking ability were studied in 58 cases with femoral neck fracture that subsequently resulted in PCA hemiarthroplasty. Cases of rheumatoid arthritis and pathological fracture were excluded. There were 10 men and 48 women, aged from 51 to 94, with an average age of 78. In 9 of the cases, PCA hemiarthroplasty was performed more than three weeks after injury. Approximately 80% of the 58 had fractures resulting from simple falls. Three patients were injured during activities of daily living.
Before injury 24 cases had the ability of walking outdoors without a cane, 12 of walking outdoors with a cane, and 11 of walking indoors. Only one-third of those over 80 were able to walk outdoors without a cane. After injury 12 cases had been able to walk for a while. We thought that several of these had had a non-displaced fracture at first. Seven of the 12 had surgery three weeks or more following injury.
It was considered to be quite important to diagnose precisely by using bone scan, CT or MRI in cases in which there are no obvious symptoms and no fracture line shown on a plain radiogram.

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Synovial lining cells have been identified as B- and A-types with transmission electronmicrographs. To electrophysiologically characterize these two types of cells, we studied, using a patch-clamp, the excitability and ion channels of cultured synovial lining cells from the bovine metacarpophalangeal joint. We made special efforts to collect pure samples of the lining layer for culture and could establish a clean culture system consisting of only synovial lining cells with little contamination originating from the sublining layer. Experiments using the whole-cell recording on 4- and 5-day short-term primary-cultured cells showed that the probable B-cells (E_r≤ca.-40 mV) responded to electrical stimulation with self-regenerative action potentials, but the probable A-cells (E_r=ca.-20 mV) were electrically inexcitable. The B-cells lost their excitability with time in culture. Using singlechannel recording, we identified in both B- and A-cells 4 high-conductance K-channels (170-250 pS) : 1) two types of depolarization-activated and Ca²⁺ -sensitive K-channels with a low rate of opening (I_{K (vd-1)} ) and with a high rate of opening at resting potential (I_{K (vd-2)} ) ; 2) a voltage-independent K-channel (I_{K (vi)} ) ; and 3) a depolarization-inhibited K-channel (I_{K (vh)} ) . There was also one small-conductance (10-20 pS) K-channel (I_{K (s)} ) ; it was voltage-independent, minimally sensitive to Ca²⁺, and highly open at resting potential in the cell-attached mode. This suggests that the cell's resting conductance is attributable mainly to this I_{K (s)} . The present experiments indicate that the B-cell is clearly different from the A-cell in terms of excitablity and the distribution of channels. A speculation on the possible role of ion channels in cell function of the synovial B-cell has been proposed.

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Two patients are presented with hip synovitis associated with chondroblastoma adjacent to the hip joint, a 14-year-old female with a chondroblastoma in the proximal epiphysis of the femur and a 13-year-old male with the lesion in the acetabular region. Both patients complained of pain at rest, pain in walking and limitation of range of motion of the affected hip joint. Magnetic resonance imaging (MRI) revealed joint effusion. The joint reaction is a reactive synovitis.

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