Calorimetric Study of the Digital Blood Flow in Rheumatoid Arthritis.

Vascular changes in rheumatoid arthritis have been receiving increasing attention in the last few years. It is well known that cold hands are common in patients with rheumatoid arthritis and a peripheral circulatory disturbance has been considered to be one of the aetiological factors of the disease since the report of the Empire Rheumatism Council (1950), which showed that 40 per cent. of the 532 patients studied had a history of cold hands before other symptoms of the disease started, as opposed to 26 per cent. of the controls. It has been argued that the joints most affected are those of the hands and feet, so that it is probable that chilling of these joints in the presence of an inadequate circulatory response may induce greater susceptibility to damage by some agents already present in the tissues of the susceptible patients (Copeman, 1955). From the pathological studies so far carried out, three types of vascular changes are described: (1) A subacute vasculitis of the small vessels of the muscles reported by Sokoloff, Wilens, and Bunim (1951), and of the heart, muscles, and nerve sheaths by Cruickshank (1954). (2) A severe widespread necrotizing arteritis of the large vessels indistinguishable from that seen in polyarteritis nodosa, observed by Aronoff, Johnson, and Dworkin (1960), Graef, Hickey, and Altmann (1949), Levin, Rivo, Scott, Figueroa, Fred, and Barrett (1953), and Schmid, Cooper, Ziff, and McEwen (1961). (3) Obliterative endarteritis of the digital arteries, reported by Bywaters (1957). This was associated with visceral involvement, and it appeared to be morphologically different from polyarteritis nodosa.