Some metabolic aspects of arthritis.
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Arthritis commonly accompanies clinical disturbances of metabolism, while diseases which are primarily articular may cause major general metabolic abnormalities. The relationship between diet, nutrition and joint diseases is complex and varies from simple mechanical factors (as in obesity) to complex metabolic processes. Current knowledge of these processes is extensive in some areas, such as in gout and hyperuricaemia, whereas in others, such as the arthropathy encountered after intestinal bypass surgery, it is very scant indeed. Joint disorders in hyperlipoproteinaemia and diabetes mellitus are varied and the pathogenesis of these articular problems is as yet ill understood. In view of the frequency with which these metabolic problems occur, these disorders offer no opportunities for the clinical study of the processes involved in joint inflammation and damage. In contrast, metabolic abnormalities such as hypergastrinaemia and elevated ionized calcium in rheumatoid arthritis are worthy of study, as they may offer clues to the underlying aetiology of the joint disease. This latter abnormality is suggestive of hyperparathyroidism, a condition which may present with polyarthritis and in which joint changes may be severe, although they are usually obscured by the more obvious bony problems in this disease. An illustrative historical vignette is included.
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