L. A. Healey

Juvenile rheumatoid arthritis persisting into adulthood

Abstract Forty-six adults whose rheumatoid arthritis commenced in childhood were studied. Their disease appeared similar to adult-onset rheumatoid arthritis, most patients having symmetrical polyarticular disease, but there were minor clinical differences, including localized growth disturbances (micrognathia, small deformed feet) and a rarity of rheumatoid nodules (four of forty-six patients). Severe hip disease (eighteen of forty-six patients) was a major debilitating feature. Monoarticular and pauciarticular arthritis rarely persisted as such with long-active disease; in nine of fourteen patients with these types of onset polyarticular disease had developed by the time of study. Systemic manifestations, common in childhood juvenile rheumatoid arthritis, were uncommon in this group of adult patients. There was a high frequency of roentgenographic abnormalities of the hands (thirty of forty-four patients), wrists (thirty of forty-four patients), cervical spine (twenty-four of forty-four patients), sacroiliac joints (nineteen of forty-four patients) and hips (eighteen of forty-four patients). Abnormalities of the hips, cervical spine and sacroiliac joints were associated with polyarticular disease and functional impairment. Tests for rheumatoid factor were positive in thirteen of forty-six patients, usually in those with onset of the disease in late childhood. There was no relationship between the presence of rheumatoid factor and age of the patient at study, or duration or severity of disease. Many patients with active arthritis in adulthood were seronegative. The course of disease was highly unpredictable. Eleven patients with apparently mild disease in childhood had severe exacerbations in adulthood after years of symptom-free remission. Patients with active disease continued to have involvement of new joints in adulthood. Despite long-active disease, however, thirty-five of forty-six patients retained relatively good function at the time of study. No evidence was found from this study to suggest that juvenile rheumatoid arthritis is a different disease from adult-onset rheumatoid arthritis; patients with juvenile rheumatoid arthritis persisting into adulthood come to resemble closely those with the adult-onset disease.

Suppression of uric acid secretion in a patient with renal hypouricemia.

Despite much recent progress, we remain uncertain as to the precise mechanisms of uric acid excretion and the actions of interfering drugs. We have explored these questions with the assistance of an unusual individual with renal hypouricemia. Our patient is an essentially normal 55 year old woman who first consulted Dr. Skeith for low grade hypertension and mild obesity. Physical examination and laboratory evaluation are otherwise normal with no evidence of aminoaciduria or renal glycosuria. She consistently, however, has been found to have a serum urate level of 0.3 mg/% while her total uric acid excretion is within normal limits. Expressed in the conventional terms of renal physiology, this woman has a clearance of urate which consistently exceeds her glomerular filtration rate. In this respect, she resembles only two other reported humans, although the same property has long been recognized in Dalmatian dogs.

Anemia as a Primary Manifestation of Giant Cell Arteritis.

Excerpt This report describes seven older women whose primary problem was anemia. They sought medical attention because of fatigue and malaise; headache and muscle pains were either not present or ...

Giant Cell Arteritis—A Multifaceted Disease of Older People.

Excerpt Horton described temporal arteritis as a clinical syndrome in 1932 but considered it a benign self-limited illness. Several years later the serious complication of blindness was recognized....