Ivan F. Duff

Estimates of the prevalence of rheumatic diseases in the population of Tecumseh, Michigan, 1959–60

Abstract Over 90 per cent of the more than 9000 residents of Tecumseh, Michigan participated in a program of comprehensive health examinations in 1959–1960. Included in the examination were inquiries regarding rheumatic symptoms, physical examination of the spine and peripheral joints, and the latex fixation test for rheumatoid factor and serum uric acid measurement. Joint pain or aching, joint swelling, morning stiffness, and past arthritis or rheumatism were common complaints, occurring in one-eighth to one-third of the population age 6 yr and over. The age-sex specific prevalence rates for each of these historical items rose with increasing age. Male and female rates were quite similar during the first four decades of life, but thereafter female rates were somewhat higher. The prevalence of positive latex fixation tests for rheumatoid factor was essentially the same for male and female subjects, 3.4 per cent for males and 3.35 per cent for females. The rates rose progressively from approximately one per cent in the 6–16 yr age group to almost 14 per cent for males and 9.4 per cent for females in the oldest age groups. The latex fixation test performed poorly as a case detection tool, only one-third of those respondents with positive tests having any other evidence to suggest a diagnosis of rheumatoid arthritis. Relatively high rates of latex positively occurred in individuals with a history of jaundice or infectious hepatitis and in those with evidence of emphysema or right heart failure. None of the respondents with psoriasis or pregnancy at the time of examination had positive latex tests. The prevalence of latex positivity showed a rise with increasing systolic blood pressure in persons over 30 yr of age, but appeared to be unrelated to diastolic blood pressure, serum cholesterol or serum uric acid. Prevalence rates for “definite” rheumatoid arthritis, based on the diagnostic criteria proposed by the American Rheumatism Association, were 0.4 per cent for all subjects age 6 yr and over and 0.5 per cent for all subjects age 16 yr and over. Prevalence rates for “definite” plus “probable” rheumatoid arthritis were 1.3 per cent in the age group 6 yr and over and 1.7 per cent in the age group 16 yr and over. In all diagnostic categories prevalence rates for females exceeded those for males. In the age group 16 yr and over the female to male ratio was 2.3: 1 for “definite” disease and 2.4: 1 for total suspected cases of rheumatoid arthritis. The prevalence rates for rheumatoid arthritis rose with increasing age; rates for “definite” disease rose from 0.44 per cent in the fourth decade to 0.79 per cent in the eighth decade for males and from 1.69 per cent in the fifth decade to 2.47 per cent in the eighth decade for females. The over-all prevalence rates for suspected ankylosing spondylitis, not confirmed by X-ray examination of the spine or sacroiliac joints, were 0.4 per cent for males and 0.05 per cent for females age 6 yr and over. Prevalence rates for osteoarthritis, diagnosed on the basis of physical rather than radiological examination were 2.2 per cent for males and 5.0 per cent for females age 6 yr and over. Rates were highest in the older age groups, being 20.3 per cent for males and 40.8 per cent for females in the age group 60 yr and over. The prevalence of Heberdens nodes was greater in female than in male respondents and demonstrated a similar rise with increasing age. The prevalence of “probable” gout, based on available clinical information was 0.5 per cent for male and 0.3 per cent for female subjects age 4 yr and over having serum uric acid determinations. The highest rates were observed in subjects in the age range 40–59 yr. The prevalence rates for a history of rheumatic fever and / or chorea were similar for male and female subjects age 6 yr and over, 0.8 per cent in the case of rheumatic fever and 0.1 per cent in the case of chorea. A history of chorea was not obtained among respondents under age 20. Physical evidence of rheumatic heart disease was recorded in all age groups and was slightly more prevalent in females, 0.6 per cent as compared to 0.4 per cent in males. Comparisons of the results of this investigation with those of other population studies have been made although the interpretation of any differences or similarities is inherently limited by methodological problems and observer variation.

A Clinical Study of Sjögren's Syndrome

Excerpt The association of rheumatoid arthritis, keratoconjunctivitis sicca, and xerostomia, with or without swelling of the salivary glands, has been termed Sjogrens syndrome. Since the initial d...

AGE-SEX SPECIFIC PREVALENCE OF RADIOGRAPHIC ABNORMALITIES OF THE JOINTS OF THE HANDS, WRISTS AND CERVICAL SPINE OF ADULT RESIDENTS OF THE TECUMSEH, MICHIGAN, COMMUNITY HEALTH STUDY AREA, 1962-1965*

Abstract Radiographs of the hands and wrists and cervical spine of 4415 residents of Tecumseh, Michigan, aged 16 yr and over, have been reviewed. Evidence of rheumatoid arthritis was observed in the hands and wrists of 0.19 per cent of males and 0.34 per cent of females. The prevalence of cervical spine changes, which could be attributed to rheumatoid arthritis or ankylosing spondylitis, was insignificant. Degenerative changes in both examined regions occurred much more frequently and showed a marked positive correlation with advancing age. Radiographic evidence of osteoarthrosis of the hands and wrists was observed in 19.5 per cent of males and 23 per cent of females. In the cervical spine, degenerative disc disease (16–19 per cent) was noted somewhat more frequently than osteoarthrosis (11 per cent). Among the other radiographic lesions which were observed, those of post traumatic changes, including amputation of digits, in the hands and wrists and fusion of cervical vertebral bodies, thought to represent a failure of segmentation in embryonic life, were most frequent.

Rheumatoid arthritis and gout in Hiroshima and Nagasaki, Japan. A prevalence and incidence study.

Abstract Observations of definite rheumatoid arthritis in a fixed population of 11,393 atomic bomb survivors in Hiroshima and Nagasaki for the period April, 1965 through December, 1966, based on a prospective study designed for specific detection of rheumatoid arthritis are reported. Routine complete physical examinations were performed on all persons in the sample. Screening procedures utilized in all subjects included: completion of a questionnaire and performance of ‘rheumatoid factor’ tests. When indicated by results of clinical and laboratory examinations, PA roentogenograms of the hands and wrists were obtained. A rheumatologist (ID) reviewed the medical records of all individuals in whom there was evidence to suspect rheumatoid arthritis. 1303 of individual patients whose earlier examinations indicated the need, were recalled for clarification, confirmation and classification of their disease. The time of onset of disease was also established. The prevalence rate of definite rheumatoid arthritis was 0.38 per cent for males and 0.65 per cent for females, over 20 years of age, and 0.55 per cent for both sexes. This prevalence rate for females was significantly lower than the age adjusted rate in a comparable population in Tecumseh, but this was not so for males. The incidence rate of definite rheumatoid arthritis was 0.07 per cent for males and 0.11 per cent for females per year. In this sample of Japanese, the prevalence rate of positive latex tube fixation tests for the rheumatoid factor was consistently higher than reported for the comparable Tecumseh, Michigan, population. Adequate explanation of this difference is not now available. The relationship between rheumatoid arthritis or rheumatoid factor and environmental factors such as education, occupation, and other physical findings such as level of serum uric acid and blood pressure was studied. No relationship was detected between prevalence and incidence of rheumatoid arthritis and exposure to radiation from the atomic bombs. The age-sex specific mean uric acid values for Japanese men and women were very similar to those in a Caucasian population. In this population survey, as reported in others, very few cases of gout were detected.

Synovial specimens obtained by knee joint punch biopsy; histologic study in joint diseases.

Abstract The information obtained by punch biopsy of the synovium of the knee in fifty-five procedures in forty-nine patients with diseases of the joints has been analyzed. One complication occurred in the form of mild, transient, symptomatic hemarthrosis. Diagnoses made on the basis of this procedure included gout, rheumatoid arthritis, neuropathic joint disease and tuberculosis. The procedure is considered an important and practical diagnostic method in joint diseases in those instances in which conventional arthrotomy is inadvisable and other measures have not revealed the diagnosis.

Observations on the natural history of hyperuricemia and gout: I. An eighteen tear follow-up of nineteen gouty families☆

Abstract Follow-up information has been obtained regarding nineteen families of propositi with overt gout, originally studied in 1938–1946. During 1961–1962 it was possible to examine all nine surviving propositi and sixty-nine of the surviving eighty relatives, as well as 193 relatives who were studied for the first time. The results are similar to those of previous investigations in suggesting that the prevalence of gout and asymptomatic hyperuricemia is increased among the relatives of gouty patients. They are further in accordance with the accepted belief that in male subjects hyperuricemia tends to manifest itself after adolescence, whereas in female subjects it does not do so until after the menopause. They also suggest that hyperuricemia, in those relatives who once manifest it, tends to persist as a fixed trait subjecting the individual to an increased risk of developing overt gout.

Clinical studyObservations on the natural history of hyperuricemia and gout: I. An eighteen tear follow-up of nineteen gouty families☆

Abstract Follow-up information has been obtained regarding nineteen families of propositi with overt gout, originally studied in 1938–1946. During 1961–1962 it was possible to examine all nine surviving propositi and sixty-nine of the surviving eighty relatives, as well as 193 relatives who were studied for the first time. The results are similar to those of previous investigations in suggesting that the prevalence of gout and asymptomatic hyperuricemia is increased among the relatives of gouty patients. They are further in accordance with the accepted belief that in male subjects hyperuricemia tends to manifest itself after adolescence, whereas in female subjects it does not do so until after the menopause. They also suggest that hyperuricemia, in those relatives who once manifest it, tends to persist as a fixed trait subjecting the individual to an increased risk of developing overt gout.

THE CONTROL OF EXCESSIVE EFFECT BY ANTICOAGULANTS

Excerpt INTRODUCTION The decision to administer anticoagulant drugs should imply familiarity with the indisputable complication of hemorrhage which they evoke. This report is concerned with factors...

The Management of Anticoagulant Therapy

Safe, effective anticoagulant therapy requires observance of certain principles of management. The physician must be certain that an absolute contraindication to such therapy does not exist, must be familiar with the agents employed, and must know how to reverse their effects promptly. He must rely on the laboratory for specific information concerning the effects of the drug on the clotting mechanism, but it is his responsibility to interpret the test results clinically.