Ultrastructure of cartilage.

reported that the nodule in Still's disease often resembled that of rheumatic fever histologically; this was based on biopsies of eleven cases compared with 57 with rheumatic fever and 22 with adult rheumatoid arthritis. We now report a small series of six children followed for 3 to 5 years, where multiple small nodules as seen clinically in rheumatic fever were the predominant clinical feature and were biopsied. Two were histologically of adult type and associated with the serum rheumatoid factor. Four histologically resembled the rheumatic fever nodule and, of these four cases, two were presistently seronegative and two seropositive. Five out of six survived for a mean follow-up of 4 to 6 years, all but one being then in the top functional grade. It is concluded that: (1) Nodule formation in juveniles is not always dependent on seropositivity; (2) It may be independent ofjoint involvement; (3) The histological appearance is no guide to the presence of rheumatoid factor in serum. (1937) reported the production of rheumatic fever nodules by subcutaneous injection of the patient's serum or of saline, but I was unable to reproduce this (Hart, 1939). Schwartz and Steinbrocker (1950) were also unable to verify their results. Why do you think this is? PROF. BYWATERS We also have not been able to produce genuine nodules in this way; even if they appeared this would not mean very much. In Still's disease we have found no correlation between length of history and the histological character of the nodules. DR. G. D. KERSLEY (Bath) Can the formation of nodules be controlled by drugs, such as steroids? PROF. BYWATERS We have been unable to affect nodule formation by steroid therapy, although we have found nodules to shrink on such treatment due to loss of lymphocytes and oedema. DR. J. D. GOODE (Hull and East Riding) Is the histology consistent in different nodules in the same patient? PROF. BYWATERS We have had only one or two patients who have had more than one biopsy. DR. R. GRAHAME (London) We have been unable to find joint or tendon lesions in patients with granuloma annulare. PROF. BYWATERS Granuloma annulare is very common and the idiopathic type is seronegative. I have seen this lesion occuring coincidentally in patients both with genuine rheumatic fever and with Still's disease as well as in adult patients with rheumatoid arthritis. It seems a quite different and local process despite its …