Alfonse T. Masi

The Epidemiology of Polymyositis

Incidence data and the descriptive epidemiology of polymyositis in a defined population area are reported. An age-adjusted incidence rate for hospital-diagnosed polymyositis of 5.0 cases per million population per year, over a twenty-two year period, for a racially mixed population, has been determined. The incidence of polymyositis was highest in Negro females, a rate significantly different from that for white females (p A bimodal distribution in the age-specific incidence of polymyositis suggests to us that the polymyositis that occurs in childhood may be of different pathogenesis or immediate precipitation than the disease that has its onset in adulthood. Prior infection, endocrine factors or other host mechanisms, e.g., associated malignancy, may be operative in the bimodal distribution observed. No epidemiologic evidence of a direct infectious agent or communicable disease etiology was found in this series of patients, and no socioeconomic or other environmental associations were uncovered.

Prospective study of the early course of rheumatoid arthritis in young adults: Comparison of patients with and without rheumatoid factor positivity at entry and identification of variables correlating with outcome☆

The early course of newly diagnosed RA among young adult patients (16-44 yr) is described from results of an ongoing study with a mean follow-up of 3.4 yr. Study diagnosis was based on the judgement of experienced rheumatologists, and data on several hundred variables were obtained on entry and annually for the purpose of defining patterns of onset and course of disease. Race and sex factors, as well as certain entry manifestations, e.g., RF, were found to correlate with onset and course patterns. Females, and especially white females, had significantly greater numbers of swollen upper extremity joints than males at entry and at last observation, with increased likelihood of developing bone erosions. At entry, RF positive patients differed only on few articular manifestations from RF negative patients, but had a higher frequency of positive ANA at entry and more subcutaneous nodules and bone erosions during follow-up. Seropositive white females at entry had significantly more swollen upper joints than their seronegative counterparts, but with no difference found at last follow-up. White females of each serogroup had more joint involvement at last examination than patients of other race-sex groups. Males had more acute onset, especially under age 30, with significantly greater improvement in arthritis and in ESR than did females. The majority (55%) of patients entered as seropositive, converted to seronegative during follow-up, and no correlation of either joint swelling or erosions was noted with this phenomenon. At last visit, RF positively did not correlate with bone erosions, but patients developing bone erosions had higher frequency of ANA and higher mean serum complement levels at last examination. The following entry factors were found to correlate significantly with a better outcome: maleness, acute onset under age 30, less swollen upper joints, and negative RF. Type of drug therapy tended to reflect severity of arthritis, rather than vice versa, and functional capacity improved significantly from entry to last evaluation in both males and females, even though the latter had stable or progressive arthritis. Further study is necessary over long intervals and in wider age range to more adequately interpret the biologic implications of findings of this ongoing study. A better understanding of the pathogenesis of RA may be derived from critical studies of the contribution of host factors, e.g., sex, and other variables predisposing to the development of RF positivity (and ANA), subcutaneous nodules, and bone erosions, particularly in systematic ongoing studies of patients with early diagnosed disease.

Hormonal contraception and thromboembolic disease: Effects of the oral contraceptives on hemostatic mechanisms: A review of the literature☆

Abstract Clinical and epidemiological data indicate that the oral contraceptives are thrombogenic. The important papers concerning the effects of oral contraceptives on hemostatic mechanisms were reviewed. This report summarizes the effects of oral contraceptives on: (1) platelet number and function; (2) tests of coagulation; (3) tests of specific clotting factors; and (4) tests of fibrinolysis and compares them with the findings in pregnancy, and in individuals taking estrogens or progestogens alone. Oral contraceptives, or estrogens alone, lead to an increase in platelet adhesiveness and aggregability. The oral contraceptives also enhance coagulability but induce little change in the fibrinolytic system. Progestogens alone enhance fibrinolysis without altering platelet function or coagulation. Pregnancy enhances coagulation and depresses fibrinolysis. It increases platelet reactivity but to a less extent than does the use of the hormonal contraceptives. Tentatively we conclude that the thrombogenic potential of the oral contraceptives appears to reside in the estrogenic components and may be due to their effect on platelet function rather than their effect on coagulation. Addition of this effect to the hormonally-induced vascular lesions and stasis may encourage thrombus formation. Further study of the effect of these hormones as it pertains to intravascular clotting is needed.

Relapsing polychondritis: Review of current status and case report☆

This communication has attempted to review the present state of published knowledge on the syndrome of relapsing polychondritis. Basic anatomic, physiologic, and biochemical changes in this disorder are summarized and the role of metabolic and immunologic alterations in the pathogenesis discussed. An additional case of relapsing polychondritis is reported, and the clinical features of this case, plus those of 131 previously reported, are reviewed with discussion of present day therapeutic experience and prognosis.

Disseminated gonococcal infection (DGI) and gonococcal arthritis (GCA): II. Clinical manifestations, diagnosis, complications, treatment, and prevention*

This is the second part of an integrated review of disseminated gonococcal infection (DGI) and gonococcal arthritis (GCA). It covers clinical manifestations, spectrum of GCA, diagnosis and treatment. These disorders are important since DGI may be the most frequent form of acute arthritis in sexually active younger females, and other selected groups. Although the spectrum of disease is varied, it may be classified into stages and clinical subgroups. N. gonorrhoeae strains causing DGI in the U.S. have been highly sensitive to penicillin. Such findings require revision in beliefs that high-dose intravenous penicillin is needed for effective initial therapy of GCA. Recommended treatment protocols for localized gonorrhea and DGI are reviewed as well as the occurrence and implications for treatment of penicillinase-producing N. gonorrhoeae (PPNG) infection in the U.S.

Technical aspects of the haematoxylin-basic fuchsin-picric acid (HBFP) stain applied to skeletal muscle

SynopsisThe Haematoxylin-Basic Fuchsin-picric acid (HBFP) stain, a new non-enzymatic histochemical technique described previously to detect early myocardial ischemia, was applied to skeletal muscle. Several factors were found which have an important effect on HBFP positivity including ageing in room air of unstained tissue sections, and the precise timing of the differentiation step of this stain. Using carefully standardized techniques, repeatable staining was obtained and a high level of inter-observer consistency in the interpretation of staining results was achieved. Although the technical requirements of this new stain are rigorous, it offers promise and deserves further evaluation in the study of skeletal as well as cardiac muscle disorders. The histological advantages include vivid contrasts and the ability to use the stain on formalin-fixed paraffin-embedded muscle tissue.

Myocardial infarction in younger women. Associated clinical features and relationship to use of oral contraceptive drugs.

In a study of thromboembolism and oral contraceptive drugs, 136 cases of myocardial infarction in women aged 30 to 44 years were identified, a rare disease in women of this age group. Data from their hospital medical records were compared with those of several other groups, including women without chronic disease admitted for various acute or elective conditions unrelated to thromboembolism, patients with thromboembolic disease other than myocardial infarction, and women queried or examined in the National Health Survey. The following attributes were found to be associated with myocardial infarction in younger women: presence of diabetes; hypertension; history of increased cigarette smoking; and hypercholesterolemia. A history of the use of oral contraceptive drugs was found with greater frequency in cases than in controls. The literature on the possible association of myocardial infarction and the use of oral contraceptives was reviewed.

Earnings of early diagnosed arthritis patients and matched controls

Abstract Newly diagnosed arthritis patients who met ARA criteria for probable, definite or classical RA were matched on study entry to normal controls and earnings were compared both before and after onset of arthritis in the study groups. Significant differences were found in earnings of the ARA probable patients versus either their normal controls or definite patients, with the probable patients having earned significantly more than each of the other groups. The data are consistent with an hypothesis that milder arthritis manifestations may relate to increased striving as suggested by increased earnings of patients satisfying ARA criteria for only probable RA. The definite-classical patients had similar earnings to their controls pre-onset but decreased earnings after onset of disease and significantly less likelihood of having an earnings increase after onset of arthritis.

Thromboembolism, Oral Contraceptives, and Cigarettes

The relationship between oral contraceptives and death from thromboembolism shown by studies of vital statistics, and the contribution of cigarette smoking to these deaths are reviewed. In 1968 a British study showed that a slight increase in deaths from thromboembolism had occurred in young women, proportional to the increase in use of the pill. A study on U.S. thromboembolism deaths in 1962-1966 similarly showed increasing mortality among women compared to men. Another analysis of U.S. data on deaths among women 15-44 years of age in 1966 provided estimates of relative risk of 3 to 9-fold for pill users, increasing with age. Data from women of 20-44 years from England, Wales and Northern Ireland in 1966 yielded a 7-fold risk for pill users compared with nonusers, and an excess death estimate of 3 per 100,000 for users. A U.S. study of data from 1956, 1961, and 1966 estimated the excess thromboembolism deaths at 3.6 per 100,000 pill users. Although British reports showed no increased risk of thromboembolism for those who smoked 15 or more cigarettes daily, a U.S. rebuttal claimed that these data could be rearranged to show increased risk for pill users who smoked heavily compared to nonsmoking nonusers. A U.S. retrospective study also originally published no relationship, but could be recalculated to show that smoking and pill use were associated in both the case and the control groups.