β Scribed by David George; Susan Hoch; Evan Cohen; Fred Kantrowitz; Michael Weinblatt
No coin nor oath required. For personal study only.
A predominance of monocyte-derived cells in inflammatory synovial fluid has been described in patients with self-limited arthritides such as viral arthritis (1-3) and serum sickness (4). These patients generally experienced an acute, rapidly resolving illness. It has been suggested that the presence of a monocyte-predominant inflammatory synovial fluid may be predictive of a self-limited process (5). We report a case of a patient with a persistent monocytic arthritis in association with a chronic rheumatic illness.
Case report. A 27-year-old Puerto Rican-born man experienced 2 months of fever, weight loss, skin rash, and symmetric polyarthritis. He denied sore throat, cough, diarrhea, drug exposure, or recent travel. There was no history of sicca syndrome or Raynaud's phenomenon. The patient had been seen at another hospital 1 month after onset of his illness. At that time a left knee aspiration revealed a white blood cell count of 52,800 cells/mm3 with a differential of 88% monocytes. No therapy was instituted, and the illness persisted.
Two months after onset of illness he was seen at our institution because of increasing fatigue, fever, and arthritis. He had a temperature of 102"F, a malar From the
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## Abstract The cytotoxic activities of human blood mononuclear cells against certain established cell lines were evaluated prospectively in 17 patients with rheumatoid arthritis before and after treatment with low (150 mg per week) and moderate doses (300 mg per week) of levamisole. Spontaneous or