| Popis: |
The case histories of two patients with severe prolonged rheumatoid arthritis complicated clinically by pericarditis and pleurisy are presented. These patients received long-term cortisone therapy. At postmortem examination necrotic and granulomatous lesions in all stages of evolution and healing were found in the pleura, pericardium, myocardium, endocardium, diaphragm, synovia, and in the kidneys and lungs. The primary lesion was fibrinoid necrosis of the wall of small blood vessels. Coalescence of several of these injured vessels and the inflammatory response resulted in a lesion indistinguishable from the rheumatic nodule. Evidence is presented that there is a malignant form of rheumatoid "arthritis" which is a systemic disease. The relationship of this fulminating disease to the reported high incidence of rheumatic heart disease in patients with rheumatoid arthritis is discussed. Long-term cortisone therapy apparently does not prevent the development of this form of rheumatoid disease. |
