Early diagnosis of arthritis of the hand; clinicopathological study of swollen painful hands in women over 40 years of age.

Swollen and painful joints in the hands of women over 40 years of age present a diagnostic problem. We have seen a number of patients whose signs and symptoms conformed to the criteria laid down by Kellgren and Moore (1952) for primary generalized osteo-arthritis but who, in addition, had swollen and painful metacarpophalangeal joints, particularly the second and third, and often involvement of the wrists. Frequently there was associated periarticular swelling. In these cases the differential diagnosis between osteo-arthritis and rheumatoid arthritis on clinical, radiological, or serological grounds was extremely difficult. The purpose of the present investigation was to determine to what extent biopsy of the small joints of the hand could contribute to an earlier diagnosis. Histological studies of joint tissue in rheumatoid arthritis and osteo-arthritis have mostly been confined to biopsy specimens from large joints or post mortem material. Early joint lesions in rheumatoid arthritis were described by Kulka, Bocking, Ropes, and Bauer (1955), using biopsy material from the knee joint. Cruickshank (1952), discussing changes in the synovial tissue in rheumatoid diseases, included the proximal interphalangeal joint, but we have been unable to find any reference to a series of biopsy studies of the small joints of the hand. The present study was therefore concerned with three main problems: (1) To find out whether biopsy of a small joint of the hand was a reasonable operative procedure, yielding sufficient suitable material. (2) To find out whether the histological picture of the biopsy material could be correlated