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ID PMID Title PublicationDate abstract
11793624 Severe pancytopenia associated with low-dose methotrexate therapy for rheumatoid arthritis 2001 Dec OBJECTIVE: To report the occurrence of severe pancytopenia associated with low-dose methotrexate (MTX) therapy for rheumatoid arthritis. CASE SUMMARY: Two patients developed severe pancytopenia after 10 days (cumulative dose 15 mg) and 23 months (cumulative dose 1030 mg), respectively, of low-dose MTX therapy for rheumatoid arthritis. Both patients had renal impairment. One died and the other recovered completely. DISCUSSION: Pancytopenia is a rare adverse effect of low-dose oral MTX therapy. The exact mechanism for development of pancytopenia is unknown, although it is likely that several factors play a role. The most important risk factor for MTX toxicity is impaired renal function. This adverse effect may occur at any time during MTX therapy. CONCLUSIONS: Severe pancytopenia associated with low-dose MTX therapy for rheumatoid arthritis is a potentially serious complication that may occur at any time during therapy. This adverse effect is more likely to occur in patients with renal impairment.
9645541 A kinematic and kinetic analysis of the sit-to-stand transfer using an ejector chair: impl 1998 Mar Twelve elderly female rheumatoid arthritis patients (mean age = 65.5 +/- 8.6 yr) were assessed rising from an instrumented Eser Ejector chair under four conditions: high seat (540 mm), low seat (450 mm), with and without the ejector mechanism operating. Sagittal plane motion, ground reaction forces, and vertical chair arm rest forces were recorded during each trial with the signals synchronised at initial subject head movement. When rising from a high seat, subjects displayed significantly (p < 0.05) greater time to seat off; greater trunk, knee and ankle angles at seat off; increased ankle angular displacement; decreased knee angular displacement; and decreased total net and normalised arm rest forces compared to rising from a low seat. When rising using the ejector mechanism, time to seat off and trunk and knee angle at seat off significantly increased, whereas trunk and knee angular displacement, and total net and normalised arm rest forces significantly decreased compared to rising unassisted. Regardless of seat height or ejector mechanism use, there were no significant differences in the peak, or time to peak horizontal velocity of the subjects' total body centre of mass, or net knee and ankle moments. It was concluded that increased seat height and use of the ejector mechanism facilitated sit-to-stand transfers performed by elderly female rheumatoid arthritic patients. However, using the ejector chair may be preferred by these patients compared to merely raising seat height because it does not necessitate the use of a footstool, a possible obstacle contributing to falls.
11057359 Immune-mediated corneal melting disease. 2000 Corneal melting disease is, as illustrated, a very severe problem for patients. Correct diagnosis and aggressive management is critical. Help from general physicians and rheumatologists as required is essential, given that the medications used have significant toxic effects.
10692740 New therapeutic approaches for rheumatoid arthritis. 1999 Oct Better understanding of the immunopathogenesis of rheumatoid arthritis over the past few decades has promoted the innovation of new therapeutic approaches targeting the disease more specifically. In addition, refinements in the non-steroidal anti-inflammatory drugs (NSAID) may offer advantages for patients with RA. This brief review reports and analyses some of the important aspects of these new therapies available for treatment of RA and in which situations you might consider each. Before using any of these agents, physicians should become thoroughly familiar with the package inserts.
9105364 Silicone-associated rheumatic disease: an unsupported myth. 1997 Apr Anecdotal, reports have raised the issue of an association between silicone breast implants and the development of rheumatic diseases. Fortunately, this issue has now been extensively addressed by controlled studies, which demonstrate no association between breast implants and rheumatoid arthritis, systemic lupus erythematosus, and scleroderma. Moreover, several studies that now have addressed the issue of "atypical connective tissue disease" indicate no association between a number of rheumatic complaints and silicone breast implants. Additionally, several controlled studies show no evidence of chronic inflammation in patients with silicone breast implants. These observations should be reassuring to women with breast implants and the individuals who care for them.
9786430 Cloning of follistatin-related protein as a novel autoantigen in systemic rheumatic diseas 1998 Sep In an attempt to identify autoantigens of synovium in rheumatoid arthritis (RA), we constructed lambda phage expression cDNA libraries from synovium and screened them by IgG purified from synovial fluids, both of which were derived from RA patients. As a result of this unique combination of the libraries and probes, we cloned follistatin-related protein (FRP) as a novel autoantigen in systemic rheumatic diseases. FRP is a secreted protein containing a similar amino acid sequence to follistatin, an inhibitor of activin. FRP was first cloned as a transforming growth factor-beta1-inducible protein (called TSC-36) from a mouse osteoblastic cell line and was suggested to have some roles in the negative regulation of cellular growth. Immunoblotting analyses detected synovial fluid and serum anti-FRP antibodies of IgG class more frequently in RA than any other systemic rheumatic diseases and controls. Synovial fluid anti-FRP antibodies appeared in 44% of RA (n = 18) and none of osteoarthritis (OA) (n = 15) patients. Serum antibodies were detected in 30% of RA (n = 67), 17% of systemic sclerosis (n = 18), 10% of systemic lupus erythematosus (n = 51) and Sjögren's syndrome (n = 10), and none of polymyositis/dermatomyositis (n = 13) patients and healthy subjects (n = 30). These antibodies recognized an EC domain, an extracellular Ca2+ binding module. In anti-FRP antibody-positive RA patients, serum C-reactive protein level and erythrocyte sedimentation rate were more elevated than negative patients (P < 0.05 and P < 0.01, respectively). FRP gene expression was higher in RA than OA synovium (P < 0.05). However, there was no difference between these groups in the amount of synovial FRP, suggesting its elevated turnover in RA. As follistatin inhibits activin, FRP might inhibit some growth factor-like molecule. Detection of anti-FRP antibodies, possibly having disease-promoting effects as the blocking antibodies, could be one of the markers for clinical evaluation of systemic rheumatic diseases.
9292787 Quercetin, a bioflavonoid, inhibits the induction of interleukin 8 and monocyte chemoattra 1997 Sep OBJECTIVE: Tumor necrosis factor (TNF)-alpha is present in synovial fluid of patients with rheumatoid arthritis. It induces the expression of proinflammatory cytokines in synovial cells. Based on our recent finding that reactive oxygen intermediates play important roles in mediating TNF-alpha action, we examined the effect of an antioxidant bioflavonoid, quercetin, on TNF-alpha induced expression of interleukin 8 (IL-8) and monocyte chemoattractant protein-1 (MCP-1) in cultured human synovial cells. METHODS: The amounts of mRNA for IL-8 and MCP-1 were determined by Northern blot analysis. Electrophoretic mobility shift assays (EMSA) were performed for the detection of a transcription factor, nuclear factor-kappa B (NF-kappa B). RESULTS: Addition of quercetin suppressed TNF-alpha induced increase in the mRNA for IL-8 and MCP-1 in a dose dependent manner. Quercetin did not affect the stability of these mRNA. H2O2 mediated induction of IL-8 and MCP-1 genes was also inhibited by quercetin. EMSA revealed that quercetin inhibited the activation of NF-kappa B by TNF-alpha. CONCLUSION: Quercetin suppresses TNF-alpha mediated stimulation of IL-8 and MCP-1 expression, at least in part, by inhibiting the activation of NF-kappa B.
9263019 Expression of the H2-E molecule mediates protection to collagen-induced arthritis in HLA-D 1997 Aug Transgenic mice expressing DQA1*0301 and DQB1*0302 (HLA-DQ8) molecules in class II-deficient Ab degree mice are susceptible to collagen-induced arthritis (CIA). To evaluate the role of the H2-E molecule (a homolog of HLA-DR) in DQ-restricted arthritis, the H2-E gene was introduced into DQ8.Ab degree mice to generate DQ8/E+.Ab degree mice. Expression of the E molecule protects DQ8.Ab degree mice against arthritis. In vitro studies using draining lymph nodes from mice primed with bovine type II collagen (BII) showed that the response to BII in both transgenics is DQ and CD4 restricted. Challenge with BII in vitro leads to production of high levels of IFN-gamma in DQ8 and IL-4 in DQ8/E+ mice. We have hypothesized that the H2-E molecule modulates the T cell repertoire and changes the cytokine balance, resulting in protection of disease.
11085770 Safety of low dose methotrexate in elderly patients with rheumatoid arthritis. 2000 Dec Weekly low dose methotrexate is an established treatment for rheumatoid arthritis, but its use in elderly people has not been adequately examined. The aim of this study was to evaluate its safety in elderly patients with rheumatoid arthritis. A retrospective review of the clinical records of rheumatoid arthritis patients over the age of 65 attending a rheumatology unit was conducted. Eligible patients were followed for at least two years and treated with methotrexate in a dose of 7.5 mg/week while being maintained on concurrent treatment. Thirty three patients were studied. Their mean age was 78.8 years; 32 were female and one was male. Treatment was discontinued in four patients, two because of raised serum liver enzymes and two because of gastrointestinal irritation. No serious adverse events were reported. After two years, haemoglobin levels increased from a mean (SD) of 12.4 (1.3) g/dl to 13.0 (1.1) g/dl (r = 0.226, p < 0.005). The white blood count was significantly reduced from 7.9 (1.8) x 10(9)/l to 6.8 (1.7) x 10(9)/l (r = 0.184, p < 0.05). No episodes of neutropenia or agranulocytosis were observed. There was a non-significant decrease in platelet count. The erythrocyte sedimentation rate decreased from 56.8 (30.8) to 35.2 (24.6) mm/h (r = 0.246, p < 0.01). In conclusion, low methotrexate treatment in elderly patients appears to be safe. Routine determination of serum liver enzymes and renal function may reduce individual risk.
10598684 A coculture model of synoviocytes and bone for the evaluation of potential arthritis thera 1999 Apr OBJECTIVE: To evaluate the symbiotic relationship between musculoskeletal cells in the intact joint utilizing a coculture system and to determine if the model can be utilized to evaluate potential treatments for articular diseases. METHODS: Two neonatal mouse calvariae were placed on steel supports on a monolayer of rabbit synovial fibroblasts, and net calcium flux, bone cell activity, and undecalcified histology were determined at 6, 24, and 48 h. To determine if the model was predictive of response to known therapies for articular disease, the coculture was incubated in the presence and absence of indomethacin or doxycycline, and the net calcium flux was measured. RESULTS: The coincubation of calvariae with synoviocytes led to a fivefold increase in net calcium efflux compared to calvariae alone. The concentration in the media of the osteoblastic enzyme alkaline phosphatase increased at 6 h but decreased thereafter, whereas the concentration of osteoclastic enzyme beta-glucuronidase increased with time. Undecalcified bone histology revealed progressive demineralization and an increase in the number of osteoclasts in calvariae incubated with synoviocytes compared to calvariae alone. Both indomethacin and doxycycline inhibited calcium flux from cocultures but the predominant effect of doxycycline was on the synoviocyte whereas the predominant effect of indomethacin was on bone. CONCLUSION: The coincubation of synoviocytes with calvariae led to an increase in bone mineral dissolution with time. This effect could be partially inhibited by known treatments for rheumatoid arthritis. Thus, the coculture model may simulate certain aspects of the in vivo processes relevant to rheumatoid arthritis. This model should prove useful for the study of potential therapies for inflammatory arthritis and distinguish between effects of these therapies on different cellular components of the joint.
9952028 An endogenous retroviral long terminal repeat at the HLA-DQB1 gene locus confers susceptib 1999 Jan Human endogenous retrovirus (HERV) long terminal repeat (LTR) elements contain regulatory sequences that can influence the expression of adjacent cellular genes, which may contribute to breakdowns of the immune function leading to autoimmune disease. Rheumatoid arthritis (RA) is associated with particular HLA-DR/DQ haplotypes that modulate the pathogenesis of this autoimmune disease. We have therefore studied a solitary LTR element (DQ-LTR3) of the HERV-K family at the HLA-DQB1 locus for a possible disease association among 228 RA patients and 311 unrelated blood donors. The DQ-LTR3 was significantly more frequent among patients (76% vs 33%, OR = 5.07,p < 0.0001), with the majority of patients being heterozygous for the DQ-LTR3 (61% vs 22%, p < 0.0001). HLA-DRB1*04 positive patients did still differ for the presence of the DQ-LTR3 (88% vs 70%, OR = 3.03, p < 0.001), with an increase of both DQ-LTR3 homozygous and heterozygous patients, when compared to DRB1*04 positive controls (p = 0.0015). HLA-DR/DQ genotype analysis among HLA-DRB1*04 positive individuals revealed significantly more DQ-LTR3 homozygotes among HLA-DRB1*04-DQBI*03 homozygous patients (72% vs 27%, P = 0.015), and the number of DQ-LTR3 homozygous (23% vs 19%) and heterozygous (66% vs 53%) individuals was also increased among HLA-DRB1*04 heterozygous patients (p = 0.034). The presence of the DQ-LTR3 element increased both the relative risk and the positive predictive value for either DRB1*04-DQB1*03 positive/negative individuals when compared to the presence of HLA-DRB1*04-DQB1*03 alone. In conclusion, these data suggest that this DQ-LTR3 enhances susceptibility to RA.
9883970 Serum levels of interleukin-6 type cytokines and soluble interleukin-6 receptor in patient 1998 We investigated the serum concentrations of interleukin-6 (IL-6) and two IL-6 family of cytokines (leukaemia inhibitory factor (LIF) and ciliary neurotrophic factor (CNTF) as well as IL-6 soluble receptor (sIL-6R) using an enzyme-linked immunosorbent assay (ELISA) in 66 patients with rheumatoid arthritis (RA) and 24 healthy controls. We examined a possible association between the serum levels of these peptides and RA activity according to the Mallya and Mace scoring system and Ritchie's index. We also evaluated the correlation between the serum levels of IL-6, LIF, CNTF and sIL-6R and duration of the disease and calculated sIL-6R/IL-6 ratio in RA patients and in the control group. IL-6 and sIL-6R were detectable in all 66 patients with RA and 24 normal individuals. LIF was also found in the serum of all patients with RA and in 16 (66.7%) normal individuals. In contrast CNTF was measurable only in 15 (22.7%) patients with RA and 24 (33.3%) normal individuals. The highest IL-6 and sIL-6R levels were found in the patients with Stages 3 and 4 of RA activity and the lowest in the control group. In contrast there were no statistically significant differences between the LIF and CNTF levels in RA patients and normal individuals. We found positive correlation between IL-6 and sIL-6R concentrations and Ritchie's index and a lack of such correlation with LIF and CNTF. IL-6 serum level correlated positively with the disease duration, but sIL-6R, LIF and CNTF did not. Serum sIL-6R/IL-6 ratio was significantly lower in RA patients than in healthy controls. In conclusion, an increase in the serum levels of IL-6 and sIL-6R, but not LIF and CNTF concentrations, may be useful markers for RA activity.
11762952 Amelioration of joint disease in a rat model of collagen-induced arthritis by M40403, a su 2001 Dec OBJECTIVE: To investigate the effects of M40403, a synthetic mimetic of superoxide dismutase (SOD), on collagen-induced arthritis (CIA) in rats. METHODS: CIA was elicited in Lewis rats by intradermal injection of 100 microl of an emulsion of bovine type II collagen (CII) in Freund's incomplete adjuvant at the base of the tail. A second injection was given on day 21. RESULTS: Immunization induced an erosive arthritis of the hind paws. Macroscopic evidence of CIA first appeared as periarticular erythema and edema in the hind paws by days 24-26 after the first injection, with a 100% incidence by days 27. Severity progressed over a 35-day period. Radiography revealed soft tissue swelling and focal resorption of bone, together with osteophyte formation in the tibiotarsal joint. Histopathologic features included erosion of the articular cartilage at the joint margins and subchondral bone resorption associated with bone-derived multinucleated cell-containing granulomatous lesions. Treatment with M40403 (2-10 mg/kg/day) starting at the onset of arthritis (day 25) ameliorated the clinical signs on days 26-35 and improved the histologic findings in the joint and paw. Immunohistochemical analysis for nitrotyrosine (a marker of peroxynitrite formation) and poly(ADP-ribose) polymerase (PARP; a nuclear enzyme activated by DNA single-strand damage) revealed positive staining in the inflamed joints of CII-treated rats, suggestive of the formation of peroxynitrite and DNA damage, both of which were markedly reduced by M40403 treatment. Radiographic evidence of protection from bone resorption, osteophyte formation, and soft tissue swelling was apparent in the tibiotarsal joints of M40403-treated rats. Arthritic rats treated with M40403 gained weight at the same rate and to the same extent as normal, nonarthritic rats. CONCLUSION: This study shows that a low molecular weight mimetic of SOD, M40403, attenuates the degree of chronic inflammation, tissue damage, and bone damage associated with CIA in the rat, and supports the possible use of SOD mimetics as therapeutic agents for the management of chronic diseases such as rheumatoid arthritis.
10434575 [Urine C-peptide excretion in hypocaloric states and factors affecting its excretion]. 1999 Jun Recent evidence suggests that hyperinsulinemia may contribute to the development of various risk factors of atherosclerosis. To examine the effects of energy intake on insulin secretion, 24-h urine C-peptide was measured in twelve women with rheumatoid arthritis who were not taking any medicine and stayed in Koda hospital for a diet therapy which lasted 55 days. They were basically placed on a 1200 kcal/day vegan diet combined with three 3-5-day fasting periods (200 kcal/day). Urine C-peptide excretion markedly decreased from 31-40 to 8-14 micrograms/day during the fasting periods. Among the anthropometric variables examined, the average level of urine C-peptide excretions measured in the fasting periods showed a significant correlation with the percentage and the amount of body fat. However, such correlation was not observed while the calorie intake was 1200 kcal. No clinical laboratory parameter showed a significant correlation with urinary C-peptide excretion. These results suggest that the major determinant of urine C-peptide excretion is food intake and that hyperinsulinemia could be easily improved by restricting energy intake.
9260627 Wrist arthrodesis for failed wrist implant arthroplasty. 1997 Jul Thirteen wrist arthrodeses were performed for failed wrist implant arthroplasties between 1984 and 1992. Twelve patients were available for review, with an average follow-up period of 28 months. The original arthroplasties consisted of 8 silicone implants and 4 metal-plastic total wrist implants. The surgical method involved a tricortical iliac bone graft and an intramedullary Steinmann pin. There were 7 excellent results, 4 good results, and 1 poor result. All but 1 patient had markedly improved function with no or mild pain. Seven patients had solid fusions and 5 patients had pseudarthroses. Four pseudarthroses occurred at the graft-metacarpal junction and 1 occurred at the graft-radius junction. Each patient with a solid fusion had an excellent result. All graft-metacarpal pseudarthroses were painless and did not limit the patients' activities. There were 17 complications in 9 patients. Wrist arthrodesis can be a successful salvage procedure for failed wrist implant arthroplasty in patients with rheumatoid arthritis. However, the complication rate can be high. Owing to the high incidence of distal graft-metacarpal pseudarthrosis, we recommend using more rigid fixation techniques in patients with failed wrist arthroplasties.
10481804 [Morphological aspects of load bearing of the wrist joint after midcarpal partial arthrode 1999 Jul Midcarpal fusion is a reliable treatment for advanced carpal collapse following scaphoid nonunion or scapholunate dissociation. It remains, however, unclear if the alignment of the fused carpal bones influences the redirection of load towards the lunate. The objective of this study was to assess the actual loading conditions after midcarpal fusion in patients by evaluating the patterns of subchondral bone mineralization in the distal articular surface of the radius. Nine patients, who were treated by midcarpal fusion with complete excision of the scaphoid, were examined after an average of 22 months postoperatively by means of CT osteoabsorptiometry. All patients showed peak mineralization in the lunate fossa of the distal articular surface of the radius. Six patients with correct carpal alignment had one large density maximum in the lunate fossa and none in the scaphoid fossa. Patients with incomplete correction of the radial translocation of the capitate, incomplete excision of the scaphoid, or incomplete correction of the extension position of the lunate, showed a second density maximum in the scaphoid fossa. These findings emphasize that a correct carpal alignment is necessary to achieve a complete unloading of the degeneratively altered scaphoid fossa.
9606850 [Results of cement-free implanted, Robert Mathys isoelastic acetabular cup]. 1998 Apr In 163 patients--125 (76.7%) female, 38 (23.3%) male--172 cementfree isoelastic acetabular cups were implanted. The average patient age was 72.6 years (range: 16 to 96 years). Sixty-seven (41.1%) patients with 72 (41.9%) cups could be followed-up for an average of 6.0 years (range: 2.0 to 12.2 years) after the procedure. Using the Harris-hip-score we found 49 (68.1%) "very good" to "fair" results. In 23 (31.9%) hips scoring had to be classified as "bad". The rate of cup-loosenings in the collective was low at 3.5% (6/172), probably due to the reduced physical activity of our comparatively older patients. Because after the 8th year symptomatic loosening must be routinely expected, the procedure is not indicated for younger patients. In older patients with femoral neck fractures the cementfree isoelastic acetabular cup has proven itself effective in our experience.
10343540 The immune suppressive effect of dexamethasone in rheumatoid arthritis is accompanied by u 1999 Jan OBJECTIVES: The influence of dexamethasone on interleukin 10 (IL10) production and the type 1 (T1)/type 2 (T2) T cell balance found in rheumatoid arthritis (RA) was studied. METHODS: Peripheral blood mononuclear cells (PB MNC) were isolated from 14 RA patients both before and 7 and 42 days after high dose dexamethasone pulse therapy. The ex vivo production of IL10, interferon gamma (IFN gamma) (T1 cell), and IL4 (T2 cell) by PB MNCs was assessed, along with parameters of disease activity (erythrocyte sedimentation rate, C reactive protein, Visual Analogue Scale, Thompson joint score). In addition, the in vitro effect of dexamethasone (0.02, 0.2, and 2 microM) on PB MNC IL10, IFN gamma, and IL4 production was studied. RESULTS: Dexamethasone pulse therapy resulted in a rapid and sustained decrease in RA disease activity. IL10 production increased after dexamethasone treatment and this was sustained for at least six weeks. A transient strong decrease in IFN gamma was seen shortly after corticosteroid treatment, while IL4 only decreased slightly. This led to an increased IL-4/IFN gamma ratio. In vitro, IL10 production was not detectable, IFN gamma and IL4 decreased, but the effect was more pronounced for IFN gamma than for IL4, which again resulted in an increased IL4/IFN gamma ratio. CONCLUSION: Dexamethasone therapy in RA patients leads to a rapid, clinically beneficial effect. The upregulation of IL10 production may be involved in the prolonged clinical benefit. The strong immunosuppressive effect is most evident in the decrease in IFN gamma, and is therefore accompanied by a relative shift towards T2 cell activity. In vitro evaluation showed that this shift in T cell balance was a direct effect of dexamethasone and thus independent of the hypothalamic-pituitary-adrenal axis.
9876535 Preparation and testing of cyclosporine microsphere and solution formulations in the treat 1998 Sep We prepared a microencapsulated sustained-release formulation of cyclosporine A (CsA) and compared its efficacy to the solution formulation of cyclosporine A (Sandimmune, Sandoz) in an attempt to improve the treatment of rheumatoid arthritis. Microspheres containing cyclosporine were prepared with poly(lactic co-glycolic acid) (PLGA), a polymer in the submicron particle range of 0.22-0.8 micron. Studies were carried out to determine uptake rates and mechanisms of lymphocyte inhibition mediated by macrophages containing CsA microspheres in vitro. The results of these studies were used to establish whether lower doses of the microencapsulated cyclosporine could be used in in vivo studies in the polyarthritic rat model for rheumatoid arthritis. In vitro dissolution testing revealed that CsA was released extremely slowly from microspheres for up to 48 hr (0.002%). Radiolabeled 3H CsA was incorporated into some PLGA microspheres or the microspheres were labeled using a 99mTc radioligand when needed, and radiolabeling efficiency was consistently above 50%. Uptake studies at various microsphere-to-macrophage ratios (1:1, 1:5, 1:10) were carried out using 99mTc radiolabeled microspheres and macrophages obtained from normal and polyarthritic rats. Normal macrophages behaved significantly differently from arthritic macrophages throughout the study. Arthritic macrophages cause increased amounts of CsA to be released (68% of the dose) into the culture medium past 24 hr compared to normal macrophages (48% of the dose). This factor may account for the significantly increased inhibition (68.2%) of mixed lymphocyte culture proliferation in the presence of arthritic macrophages containing CsA-loaded PLGA microspheres over normal macrophages (48.2%) that were pre-exposed to the same microsphere dose. The equivalent quantity of CsA as that contained in the microspheres when placed in solution or the same quantity of blank PLGA microspheres caused decreased levels of lymphocyte inhibition when compared to the effects of CsA microspheres in macrophages of normal cells, but significantly decreased levels of inhibition in arthritic cells. From the in vivo studies, it is evident that CsA microspheres, even at low dose levels, were highly effective in inhibiting polyarthritis in rats.
9342812 Distal fibular notch: a frequent manifestation of the rheumatoid ankle. 1997 Sep OBJECTIVE: To describe the distal fibular notch, an infrequently described manifestation of rheumatoid arthritis, and to speculate on its etiology through gross dissection, histologic correlation and MR imaging. DESIGN AND PATIENTS: One hundred and twenty-one conventional ankle radiographs were obtained and reviewed in 76 patients with clinically diagnosed rheumatoid arthritis. Additional imaging of three ankles was obtained utilizing CT and MR imaging. In addition to evaluating erosive changes, note was made of the presence and location of a well-defined scalloped defect along the medial border of the distal fibula. Ankle specimen dissection and histoanatomic examination was performed in an attempt to determine the exact pathogenesis of this fibular notch. RESULTS: The distal fibular notch was identified in 52 of 121 ankles (43%). Seventy-five percent of notches were syndesmotic and extended down to the horizontal ankle joint level, while 25% of notches were syndesmotic with extension below the joint. The majority of ankles (79%) demonstrated coexistent marginal erosions and/or joint narrowing. Ankle specimen dissection revealed a single-celled synovial fold within the distal tibiofibular syndesmotic recess without underlying articular cartilage extension. CONCLUSION: The fibular notch within the distal tibiofibular syndesmosis is a frequent manifestation of rheumatoid arthritis and appears to result from synovial proliferation rather than from mechanical instability.