Radiological cervical arthritis in populations

The prevalence of cervical rheumatoid arthritis and its relationship to rheumatoid serum factors and erosive arthritis in peripheral joints has been studied in radiographs of the cervical spine and of the hands and feet drawn from 12 population samples. The changes were graded in accordance with the Atlas of Standard Radiographs of Arthritis. Rheumatoid arthritis of the cervical spine (grades 2-4) was observed in 4.1% of males and 4.7% of females aged 15 and over. Prevalence was greatest in those born before 1900, 15% of whom were affected. There was a significant association with the sheep cell agglutination test but not with the bentonite flocculation test, though the latter correlated well with erosive arthritis in the joints of the hands and feet. Arthritis of the cervical spine showed a significant correlation with both seropositive and seronegative erosive arthritis in the peripheral joints. A significantly higher prevalence of cervical arthritis than expected was noted in two population samples, one in Germany and the other in West Africa, though in neither was there a high prevalence of peripheral arthritis. The German population had relatively high antistreptolysin titres. A low prevalence of cervical arthritis was noted in populations in Czechoslovakia and in Arizona. 'Congenital' block vertebra had a prevalence of 0.9% in persons born before 1935, but none was observed in those born since. The figures suggest that environmental influences predisposing to cervical arthritis and block vertebra have changed in the last 40 years.

Osteoarthrosis in a rural South African Negro population

The prevalence and distribution of osteoarthrosis has been studied in a South African Negro population. One or more joints were affected in 60% of the males and 48% of the females, compared with a prevalence of 55% in males and 63% in females in a comparable English population. Multiple osteoarthrosis was significantly less common in the African than in the English population, the difference here being greatest in females. Clinical Heberden's nodes were also very infrequent in the African population. However, the Tswana males had significantly more osteoarthrosis of the metacarpophalangeal and proximal interphalangeal joints than was encountered in English males. This is attributed to the traumatic effect of hard manual work which is carried on into old age among most African populations.

Comparative toxicity of gold preparations in treatment of rheumatoid arthritis

Patients with rheumatoid arthritis have been treated alternately with aurothioglucose and aurothiomalate. In the earlier part of the study an oily suspension of aurothioglucose and an aqueous solution of aurothiomalate were used, but later an aqueous solution of aurothioglucose was alternated with the oily suspension and an oily suspension of aurothiomalate with the aqueous solution. Skin eruptions, stomatitis, and albuminuria were significantly more common in patients treated with the aqueous solution than with the oily suspension.

Rheumatic disorders in the South African Negro. Part II. Osteo-arthrosis

The prevalence of osteo-arthrosis of the hip, the knee, the small joints of the hand and the metatarsophalangeal joint of the big toe, has been studied in a South African Negro population. The pattern of joint involvement differed considerably from that expected in a White population. Interphalangeal osteo-arthrosis was much less common in Black women than in White, and Heberden's nodes were seen in only 3 of 93 respondents who were over 65 years of age. Osteo-arthrosis of the metacarpophalangeal joints also, was less common in Black women than in White, but the Black men showed a much greater involvement than that seen in White men. As in White peoples, osteo-arthrosis of the metatarsophalangeal joint of the big toe was commoner in women than in men, but the over-all prevalence did not reach the high levels in Whites. Osteo-arthrosis of the knee was much commoner in the women than in the men; this was associated with a marked tendency to obesity in the older women. The hip joint which is a common site for osteo-arthrosis in Whites, was seldom affected in this Black population. It is clear from this study that the apparent rarity of certain forms of degenerative arthritis in the South African Negro is not owing to any inherent resistance to the disease, because osteo-arthrosis of certain joints, such as the knee in women and the metacarpophalangeal joints in men, is even more common in Blacks than in Whites. The differences encountered can, in many instances, be attributed to differences in occupation and life style in the two populations; but genetic factors, may also play a part in the sense that certain predisposing disorders, such as congenital subluxation of the hip, appear to be far less common in Blacks than in Whites.

Hypertension in relation to musculoskeletal disorders

Generalized osteoarthrosis was found to be significantly more common in older males with high than with low diastolic blood pressure. The excess of osteoarthrosis in those with hypertension was mainly in the hips, knees, carpometacarpal and metacarpophalangeal joints, and was independent of obesity in the hypertensive group. It was not associated with a higher cholesterol or uric acid level in the serum. Radiological evidence of avascular necrosis was present in 36% of males with osteoarthrosis of the hips and diastolic blood pressure above 100 mmHg, in 20% with a diastolic pressure of 81-100 mmHg, but was found in none of those with osteoarthrosis and blood pressure of 80 mmHg or below. Only those with osteoarthrosis and a diastolic pressure above 100 mmHg had significantly more avascular necrosis that expected. Osteoarthrosis of the knee in female was more frequent in the hypertensive groups independent of obesity. It is concluded that vascular disorders are involved in this form of generalized osteoarthrosis.

Rheumatoid factor in the United Kingdom. II. Associations with certain infections

Persons having positive tests for rheumatoid serum factors in population samples in Leigh (Lancashire) and Wensleydale (Yorkshire) were investigated for evidence of infection. Comparison was made with seronegative persons and with persons having doubtful titres matched by age and sex with the seropositive groups.

Routine cultures were made of throat swabs and mid-stream specimens of urine were also cultured. The blood serum was assayed for ASO in both populations but for salmonella and Brucella abortus antibodies only in Leigh. The latex fixation test (LFT) was tested in both samples on the follow up but initially only in Wensleydale.

There was a significant association between the results of the sheep cell agglutination test and radiological evidence of sinusitis. Salmonella or brucella antibodies were associated significantly with a positive or doubtful sheep cell agglutination test. There was no association with the presence of haemolytic streptococci in the throat. The mean ASO titre showed some relationship to the sheep cell agglutination test in Leigh but not in Wensleydale.

The latex fixation test showed no significant association with any of the infections studied but the number with positive tests was small. Higher bacterial counts were obtained in the urine of both sheep cell agglutination (SCAT) and LFT positive than in seronegative individuals but the differences were not significant.

There was no significant association between arthritis and any of the infections studied.

Of those with a positive SCAT at the final test, 41% had rheumatoid arthritis, 24% had evidence of salmonella or brucella infection, 15% had sinusitis, 3% tuberculosis and 3% influenza.

Rheumatoid serum factor in populations in the U.K. I. Lung disease and rheumatoid serum factor

In population samples in England and Wales a greater frequency of positive sheep cell agglutination tests has been found in Leigh and the Rhondda than in Wensleydale, the Vale of Glamorgan or Watford.

The urban population of Leigh had more X-ray evidence of lung pathology than the rural population of Wensleydale. Seropositive persons in both the urban populations of Leigh and the Rhondda and the rural populations of Wensleydale and Glamorgan had more X-ray evidence of lung pathology than seronegative individuals, the difference being significant for healed tuberculosis of the lungs, thickened basal pleura and increased basal vascular markings. The association between the first two and rheumatoid factor was equally present in those with and without arthritis but in the third it was limited to those with arthritis. A history of bronchitis was no more common in persons with a positive sheep cell test than in those with a negative test and the indirect maximum breathing capacity showed no significant relationship to rheumatoid factor titre.

No association was found between cigarette smoking and the sheep cell titre.

It is concluded that parenchymal lung and pleural disease may act as a stimulus to the production of rheumatoid serum factor and that this stimulus is independent of the presence or absence of arthritis.

Heberden Oration, 1969. Rheumatoid arthritis--nature or nurture?

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Disc degeneration. Its frequency and relationship to symptoms

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