The Serum Calcium in Rheumatoid Arthritis and Osteo-Arthritis and The Effect of Certain Types of Treatment Thereon

Currie, George M (1928) The Serum Calcium in Rheumatoid Arthritis and Osteo-Arthritis and The Effect of Certain Types of Treatment Thereon. MD thesis, University of Glasgow.

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Abstract

The scope of the cases examined is defined: from analogy with other diseases affecting the bony skeleton is pointed out the desirability for investigating the serum calcium; results which have been published already in similar series are given. The origin of calcium of the body from the ingestion of food, and its uses in the body have been detailed. Its constancy in health and most diseases has been noted, and its distribution in the elements of the blood given. Reasons are given for the serum calcium being taken as an index of the body calcium; the average varies from 9 to 11 mg calcium per 100 c.cs. serum but is usually round about 10 mg. This calcium is present in several forms: these are discussed and the average findings for them given: Ionised 10-20%. Diffusible but not ionised 40-50% [60-70%] Fixed or colloid 30-40%. The recent theories of the precipitation of calcium or of holding it in solution are given and the connection of the parathyroids with calcium metabolism gone into, showing the inverse ratio of calcium to guanidin in the blood and the interdependence of calcium, guanidin, and the parathyroid hormone in the body: this relationship is specially important with reference to the detoxicating action of the parathyroids. The most recent theory and that supported by most experimental work, is that the parathyroids control the calcium balance of the body and that excessive action causes a drain on the calcium of the bones: it is also said that excess parathyroid retains more calcium dissolved in the blood, possibly by raising the percentage of diffuse calcium. The chief functions of calcium, namely, clotting of blood, controlling the neuro-muscular activity, stimulating cardiac contraction, maintaining the acid-base and the ionic balance, and formation of bone are enumerated. From these it is noted that the calcium level may be upset in several ways; by disturbing the acid-base balance or the ionic balance, or by dysfunction of the parathyroids, or by want of calcium assimilation. That the parathyroid is the controller is shown that in any of these pathological conditions the calcium balance is restored if the former is functioning properly. The methods of estimating serum calcium are mentioned and that of Clark and Collip, which was the one used, is described fully and its advantages discussed. The technique of collecting the blood, etc. is gone into in detail. Examples of published normal oases are given. The pathology and biochemistry are discussed with a view to finding any relationship, hypothetical or otherwise, of the serum calcium to the etiology: if any is noted then it would be applied to treatment. The essential points of difference and similarity between osteoarthritis and rheumatoid arthritis are noted, the similarity consisting in the occurrence of rarefaction and fibrosis of bones. The chief biochemical findings in the literature are given under the proper headings: it is noted in which disease the figures are taken, as far as the terminology of the authors allowed. The well known chief etiological factor of absorption from a septic focus and its relation to hypercaloaemia is discussed: the possibility of an involvement of the endocrine organs is also noted, and the reasons for supposing the parathyroids to be at fault are given. It is also suggested that the guanidin level in the blood might furnish further knowledge as to whether the parathyroids are affected or not. It is pointed out that there is also a mild chronic acidosis in rheumatoid arthritis, and its possible effect on the serum calcium discussed especially in connection with the abnormal sulphur metabolism present. The conclusion come to is that rheumatoid arthritis is usually primarily a disease of tonic origin and that the joint condition and the biochemical changes are secondary, being probably effected through the endocrine system or by causing acidosis. In osteoarthritis no fresh suggestions can be made. Its resemblance, however, to osteitis fibrosa is noted: the latter has been blamed on hyperparathyroidism. There is want of pathological observations on the parathyroids in health and disease. The pathological cases which have been noted are discussed and especially the effect of a low calcium diet in rats. It has been attempted to compare osteoarthritis and osteitis fibrosa with hyperparathyroidism , but the latter is too vague an entity even in its experimental form to come to any definite conclusions. The chief findings in induced hyperparathyroidism are given. The points of similarity between rheumatoid arthritis osteoarthritis, osteitis fibrosa and hyperparathyroidism are given in tabular form.

Item Type: Thesis (MD)
Qualification Level: Doctoral
Keywords: Medicine
Date of Award: 1928
Depositing User: Enlighten Team
Unique ID: glathesis:1928-81072
Copyright: Copyright of this thesis is held by the author.
Last Modified: 31 Mar 2020 11:37
URI: http://theses.gla.ac.uk/id/eprint/81072

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