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Biomedical subjects

J L Sosman

Publications and source records attributed to J L Sosman.

6 recordsLinked to original sources

Radiographic findings in the hands in patients with systemic lupus erythematosus.

Hand radiographs of 59 patients with systemic lupus erythematosus (SLE) were examined. Thirty-four revealed radiographic abnormalities, most commonly periarticular soft-tissue swelling or demineralization. Alignment abnormalities, acral sclerosis, avascular necrosis, soft-tissue calcification and terminal tuft resorption were also seen. All patients with periarticular calcification or terminal tuft resorption had Raynaud's phenomenon. Clinical indicators of disease activity (including low serum complement levels) did not correlate with the presence or severity of radiographic abnormalities. Patients with abnormal radiographs generally were older at the time of diagnosis than those with normal studies.

Adolescent

Spontaneous fractures of the olecranon process in rheumatoid arthritis.

Spontaneous fractures through the olecranon process occurred in 3 patients with long-standing rheumatoid arthritis. In each case the elbow was severely damaged, particularly in the midportion of the trochlear notch, which was thinned either by erosion or cyst formation. The thin trichlear notch is the weak pivot point of a lever (the olecranon process) which pivots on the distal humerus. Excess stress on the lever, by the action of the triceps on the olecranon process, will produce a fracture at the weakest point: the midtrochlear notch.

Aged

Lesions resembling gout in patients with rheumatoid arthritis.

Although roentgenographic appearances are seldom important in establishing the diagnosis of rheumatoid arthritis or gout, atypical appearances of individual lesions may confuse the distinction between these two conditions. Sixteen patients with rheumatoid arthritis were selected to illustrate joint and soft tissue lesions which resemble gout. The lesions are divided into five broad categories on the basis of the appearance and sites of bone erosion as well as the nature of soft tissue changes. Symmetrical bilateral joint involvement was found to be especially helpful in distinguishing rheumatoid arthritis from gout.

Arthritis, Rheumatoid

Rheumatoid synovitis: complement and immune complexes.

The pattern of complement component utilization within the joint space of patients with RA is consistent with activation by immune complexes. Immunogluorescent studies of SF leukocytes revealed intracytoplasmic inclusions of immunoglobulins and complement components, particularly in cells from SF with low complement levels and containing materials which precipitated with either C1q and/or rheumatoid factor. RA patients with low levels of SF complement tended to have an unremitting course, subcutaneous nodules, and to have been treated with gold. Their joints had more periarticular demineralization, joint space narrowing, cortical impaction by X-ray; and synoviocytic giant cells, fibrosis, lymphocytes, congestion, and fibrin exudation by pathologic examination than did joints of RA patients without low levels of SF complement. Patients with systemic hypocomplementemia had active classical RA with evidence of severe joint involvement and vasculitis. These findings suggest that rheumatoid inflammation of joints is mediated by immunologic activation of the complement system.

Antigen-Antibody Complex

Pseudogout in ochronosis. Report of a case.

Calcium pyrophosphate dihydrate crystals were identified in synovial fluid white blood cells during an episode of acute arthritis in a patient with ochronosis and chondrocalcinosis. Review of the histories and radiographs of 5 other patients with ochronosis demonstrated two additional instances of chondrocalcinosis. Both of these patients had episodes of arthritis consistent with pseudogout. This suggests that pseudogout, which has been found in increased incidence in some metabolic diseases, may also be more common in ochronosis.

Arthroplasty