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Rib lesions in rheumatoid disease.

Extra-articular osseous manifestations of rheumatoid disease have been described in the vertebral bodies (Seaman and Wells, 1961), in the femoral necks (Mather, 1954; Slocumb, Ferguson, Mayne and Hunder, 1967), and in the vault of the skull (Schlesinger, Forsyth, White, Smellie and Stroud, 1961). Bone biopsy in all these cases showed evidence of granulomatous necrosis and the lesions were considered to be true rheumatoid granulomata arising in bone. In addition, Kreel and Urquhart (1963) described surface erosions of bone in relation to adjacent rheumatoid skin nodules. These authors considered the bone erosions in their cases to be the result of pressure from the skin nodule. Alpert and Feldman (1964) described eight cases of rib erosions occurring in patients with long standing rheumatoid disease. Symmetrical involvement of the superior surfaces of the posterior aspects of the 3rd, 4th and 5th ribs was the most common manifestation. The lesions took the form of deep notches with a maximum width of 9 mm ...