Robert S. Pinals

Leukocytosis in rheumatoid arthritis.

To determine the prevalence and clinical significance of leukocytosis in rheumatoid arthritis (RA), records of 98 consecutive outpatients with this disease were reviewed. Leukocytosis, defined as 2 or more white blood cell counts (WBC) greater than 10,000/mm3, was found in 27%. Among patients currently receiving steroid therapy (mean dose prednisone 7 mg daily), the prevalence was 40%; in all others, the prevalence was 7.5%. The WBC elevation was primarily caused by an increase in neutrophils. Patients with leukocytosis tended to have more active arthritis, but there were no differences in extra-articular manifestations or drug therapy except for the use of corticosteroids.A review of the literature confirms the contributions of both disease activity and steroid therapy to WBC elevation. There is little published information on the effect of chronic, low dose corticosteroids on WBC counts, but our study suggests that this is an important factor in leukocytosis in RA.Newly detected leukocytosis in RA should alert the physician to the possibility of occult infection. In the absence of suggestive signs and symptoms, an infectious cause is seldom found, but, despite the few infections found in this series, continuing vigilance is recommended.

Theodore Roosevelt's inflammatory rheumatism.

Theodore Roosevelts death at age 60 was probably caused by a pulmonary embolus, but it was preceded by a 2 1/2-month illness described as inflammatory rheumatism. He had intermittent fever and acute arthritis in several joints leading to hospitalization and enforced bed rest for 6 weeks. The details of his illness and its possible etiology are reviewed. Inflammatory rheumatism was a descriptive term within which several modern diagnoses might be included. Although it is not possible to identify Roosevelts illness with any certainty, it was most compatible with polyarticular gout, although reactive arthritis, rheumatic fever, and several other diagnoses cannot be ruled out.

A Renaissance Pope with arthritis following frostbite.

Pius II, a 15th century Pope, developed chronic foot pain following frostbite at age 30. Later in life he was progressively disabled by arthritis elsewhere and by colic, which may have been due to kidney stones. The differential diagnosis of his rheumatic disease and its effect on his career are discussed.

Rheumatic disease in wartime: the American Revolution--1775.

Before the modern era, the outcomes of military campaigns were often determined by illnesses among the troops or their commanders rather than by combat. The risk of illness was enhanced by fatigue, crowding, extreme climatic conditions, and poor diet and sanitation. Infectious diseases were the most important in wartime, but others, even including rheumatic diseases, have contributed to success or failure on the field of battle. I will illustrate this point by recounting events in 1775, the first year of the American Revolution. Late in the year, Gen George Washington ordered the invasion of Canada by 2 units of his army, with the goal of capturing Quebec, the greatest fortress in North America. Canada might then become the 14th state in the new nation, which would not declare its independence until the following year. There were many reasons for the expedition’s failure, but among them were 3 rheumatic diseases.

Annaʼs Bones: The Decline and Death of a Broadway Star

Anna Held was one of the most sparkling and popular musicalcomedy stars of La Belle Epoch in New York and Paris, even inspiring her husband Florenz Ziegfeld on to his own theatrical fame. However, Anna’s swift and painful decline and subsequent death in 1918 continues to remain a mystery. For decades, newspapers threw out guesses that anemia, dieting, or tight-lacing had killed Anna; even “rib removal” was blamed. In this report we propose a diagnosis for her illness.

The tale of a city saved by gout and a letter from Jesus.

In the 6th century a Persian invasion of the eastern provinces of the Roman empire resulted in the devastation of several cities. Edessa alone was spared, and it was widely believed that this city had divine protection because of postal communication over 5 centuries earlier between its gouty ruler and Jesus Christ. These events are reviewed in detail herein. Some appear to have a well-documented historic basis but others, including the letter from Jesus, have been considered highly questionable by various authorities. The story provides an interesting connection between gout and historic events in the ancient world.