Resorption of the mandible in vinyl chloride acro-osteolysis.

97 1
necrosis, and foci of plasma cells and lymphocytes beneath
hypertrophic synovial epithelium, is seen and is typical
of the findings listed in the ARA criteria for diagnosis of
rheumatoid arthritis. The synovial membrane surface is
thrown into folds or villous projections which extend
into the joint space. Fibrovascular proliferation extending from the synoviocartilaginous junction across the
articular cartilage results in bony cartilaginous resorption.
These eroded areas of articular cartilage and periarticular
bone are visualized radiographically as “punched out”
or erosive lesions and are found most often in chronic
rheumatoid arthritis.
This disease is very similar to, if not identical
with human rheumatoid arthritis. I bring this to your
attention because some of these dogs may be found in
homes of human rheumatoid arthritis patients.
1.
REFERENCE
Newton CD, Allen HL: Rheumatoid arthritis in dogs. Am
Vet Med Assoc 168:113-121, 1976
CHARLES
D. NEWTON,
D.V.M., M.S.
University of Pennsylvania
School of Veterinary Medicine
3800 Spruce Street
Philadelphia, Pennsylvania 19104
Resorption of the Mandible in Vinyl Chloride
Acro-osteol ysis
To the Editor:
The article by Seifert, Steigerwald, and Cliff (A&R
18507-5 12, 1975) describing resorption of the mandible
i n patients with progressive systemic sclerosis prompts
us to report a similar observation in a patient with vinyl
chloride acro-osteolysis.
The patient was a 36-year-old male Caucasian
who had worked for 6 years in the manufacture of
polyvinyl chloride. Initially he was a reactor cleaner and
subsequently he worked in close contact with the reactors, although he did not actually enter them. After 3
years he developed progressive Raynaud’s phenomenon
and instability of his fingertips. There was gradual thickening and coarsening of the skin with generalized weakness and severe disability. Apart from finger changes
there was gross thickening of the skin of the hands,
forearms, upper arms, face, and around the angles of the
jaw. He also suffered marked limitation in opening his
mouth. X-rays revealed multiple areas of lysis. I n particular, typical changes affected the terminal phalanges
Fig 1. Orthopantomogram of the mandible showing erosion
0s bone
of the fingers with lysis of the central parts of the phalanges, but with preservation of the bases and tips of
these bones. Lytic areas were also seen around the sacroiliac joints, in the phalanges of the great toes, and
elsewhere.
X-rays of the mandible (Figure 1 ) showed gross
erosion of the posterior borders of the ascending rami
with complete loss of the angles of the mandible. These
erosions extended anteriorly to include the region of the
inferior dental canal. There was erosion of the left mandibular condyle, which was reduced to a spike, and
erosion of the right coronoid process. The patient was
endentulous, with an area of radial lucency around one
retained tooth root, but this lucency could well have
been inflammatory in origin.
Biochemical studies of the collagen in acro-osteolysis are similar to those of progressive systemic sclerosis ( I ) . The similarity of this complication confirms
that vinyl chloride acro-osteolysis has many features
similar to those of progressive systemic sclerosis and will
probably be a useful model in the study of that condition.
REFERENCE
I . Jayson MIV, Lloyd-Jones K , Black CM, et al: Collagen
changes in acro-osteolysis. Proc R SOC Med (in press)
MALCOLM
I. V . JAYSON, M . D . , M.R.C.P.
KENLLOYD-JONES,
M.D.
DAVID
C. BERRY,M . D .
MICHAEL
BROMIGE,
M.D.
Departments of Medicine and Dentistry
University of Bristol,
Harlow Wood Orthopaedic Hospital, and
The General Hospital
Nottingham, England