Differential tissue and organ anoxia in disease: the measurement of periarticular oxygen saturation levels in patients with arthritis.

A number of investigations testify to the association of vascular factors with joint disturbances. The Scientific Advisory Committee of the Empire Rheumatism Council concluded, as a result of a carefully controlled investigation (1950), that peripheral vascular abnormalities are not only associated with rheumatoid arthritis but frequently ante-date its onset; Davis (1941) analysed 88 cases in 27 families in which spontaneous ecchymoses had occurred, and concluded that an intimate relationship exists between arthritis and purpuric manifestations; Fletcher (1947) states that patients with rheumatoid arthritis usually have cold, clammy hands, the skin of which assumes the temperature of its surroundings sooner than the skin of normal persons, while the reaction to heat and cold is poor and slow. Increased periarticular vascularity, perivascular lymphocytic infiltration of the synovial membrane, and periarticular rheumatic arteritis resembling periarteritis nodosa, are described as typical of the pathology of rheumatoid arthritis. Factors connected with the functions of the capillaries have been investigated in cases of arthritis and abnormalities described: thus Race (1937) found a low blood ascorbic acid level in patients with all types of rheumatism, and Fletcher (1947), commenting on Race's work, remarks: although it is fairly clear that lack of vitamin C is not the cause of rheumatoid arthritis, it may well be one of the factors concerned in its production. Vitamin K has been similarly implicated, Rawls and others (1935) having described a low prothrombrin level in half their series of patients with rheumatoid arthritis. As with function, so with structure: capillary spasm, slowed blood flow, and distortions of the normal morphological capillary patterns, have all been described (Fox and Van Breemen, 1934). Finally, the local treatment of rheumatic disorders by means of oil of wintergreen and other rubefacients, injection of thiohistamine, massage, ultra-violet light, and various types of heat application from infra-red to hot wax baths, is treatment acting primarily on the vascular components of the disease process and achieves a success which is often in direct relationship with its efficacy in this respect.