For the purposes of classification, it should be specified whether osteoarthritis (OA) of the knee is of unknown origin (idiopathic, primary) or is related to a known medical condition or event (secondary). Clinical criteria for the classification of idiopathic OA of the knee were developed through a multicenter study group. ____and radiographs were used to develop sets of criteria that serve different investigative purposes. In contrast to prior criteria, these proposed criteria utilize classification trees, or algorithms.

We reviewed the long-term natural history of 21 adult-onset Still's disease patients. Patient subsets were identified according to clinical course patterns. These included monocyclic systemic disease in 4, polycyclic systemic disease in 2, chronic articular monocyclic systemic disease in 10, and chronic articular polycyclic systemic disease in the remaining 5 patients. Functional outcome differed according to course patterns and the extent of articular involvement. Systemic manifestations, per se, did not contribute to poor functional prognosis. Chronic articular disease had the worst outcome: 27% evolved to functional class 111 status, compared with none in the cyclic systemic groups. Those patients who had a chronic articular pattern or a polyariticular onset and course were at higher risk to develop disabling arthritis. An aggressive approach to therapy, including the early use of remittive agents, should be considered in these patient subsets. _____

Thirteen patients are described in whom Still's disease began after age 15. All had objective evidence of arthritis, and 10 developed chronic synovitis of larger joints, especially the wrists. A characteristic evolution of roentgenographic changes was observed in 7 patients. Carpometacarpal and intercarpal joint spaces became selectively narrowed without erosions, and bony ankylosis eventually occurred. These roentgenographic changes may be a valuable clue to the diagnosis of Still's disease, regardless of the age at onset.

We report the second case of splenorenal fusion and the first occurrence of spleen fusion associated with a right retroperitoneal structure. Hypersplenism was cured by removal of the mass. A concomitant renal cell carcinoma and multiple adenomas within the mass were incidental clinical features. Aside from the rarity of the lesion, its documented occurrence on the right side is significant in that it provides evidence for the possible migration of spleen cells in embryogenesis as an explanation for some other splenic fusion anomalies.