LETTERS TO THE EDITOR
D. M. GRENNAN, M. C. HILLARBY
Rheumatic Diseases Centre, Hope Hospital, Salford M6 8HD Accepted 28 August 1991 1. Lanchbury T, Sakkar L, Welsh K, Panayi G. Genetics of rheumatoid arthritis. Br J Rheumatol 1991:30:319-20. 2. Sansom DM, Bidwell T, Maddison P, Campion G, Klouda P, Bradley B. HLA DQA and DQB restriction fragment length polymorphisms associated with rheumatoid arthritis. Human Immunol 1987;19:269-79. 3. So ARL, Wamu C, Sansom D. Walport M. DQB polymorphisms and genetic susceptibility to Felty's syndrome. Arthritis Rheum 1988;31:990-4. 4. Hillarby MC, Clarkson R, Grennan DM, et al. Immunogenetic heterogenity in rheumatoid disease as illustrated by different MHC associations (DQ, Dw and C4) in articular and extra-articular subsets. Br J Rheumatol 1991 ;30:5—9. 5. Clarkson R, Bate AS, Grennan D, et al. DQw7 and the C4A null allele in rheumatoid arthritis and Felty's syndrome. Ann Rheum Dis 1990;49:976-9. Does the Weather affect the Osteoarthritic Patient?
SIR—Changing weather patterns have often been blamed by our osteoarthritic patients for the wide daily variety in their symptoms of pain and stiffness. Despite the severity of their disease, our joint replacement patients frequently offered this information. With this in mind we conducted a study over a 6-month period where aspects of the weather could be compared with the patient's symptoms. While there have been some inconclusive papers from other parts of Europe and North America [1-5], the UK has surprisingly escaped attention. Fifty-three consecutive patients completed a questionnaire for 30 days each, over the summer and winter months of 1990. A rating scale was used each day to assess the generalized feelings of pain and stiffness in the joint which was due to be replaced. At the same time on those days atmospheric pressure and humidity were measured. Statistical analysis using Wilcoxon's matched pairs signed ranks test found no correlation between our patients' symptoms and these weather variables. The conclusions we have reached are naturally tightly
limited. Changes in temperature could not be assessed as each patient's home environment would have differed, giving us erroneous results, whereas barometric pressure and humidity are not subject to these variations. Also, the influence of rapidly changing weather patterns is extremely difficult to assess. Nevertheless we did find that it was remarkable how constant patients' daily symptoms were despite marked changes in our weather variables. There is no doubt room for further study particularly in the more 'inflammatory' patients such as the early rheumatoid . Unfortunately and inevitably most of our patients have end staged disease. We would welcome other people's experience. A. M. CLARKE, J. NICHOLL
King Edward VII Orthopaedic Hospital, Sheffield and Medical Care Research Unit, Sheffield University Medical School Accepted 29 August 1991 1. Laborde JM, Dando WA, Powers MJ. Influence of weather on ostcoarthritics. Soc Sci Med 1986;23:549-54. 2. Sibley JT. Weather and arthritis symptoms. J Rheumatol 1985;'l2:707-10. 3. Rasker J, Peters HJG, Boon KL. Influence of weather on stiffness and force in patients with rheumatoid arthritis. Scand J Rheumatol 1986;15:27-36. 4. Patberg WR, Nienhuis RLF, Veringa F. Relation between meteorological factors and pain in rheumatoid arthritis in a marine climate. J Rheumatol 1985:12:711-15. 5. Guedj D, Weinberger A. Effect of weather conditions on rheumatic patients. Ann Rheum Dis 1990:49:158-69. Assessment of Disability in Male and Female Rheumatoid Patients
SIR—We were interested to read the report by Thompson and Pegley [1] on their survey of male and female rheumatoid outpatients using the Stanford Health Assessment Questionnaire. The significant difference in functional status between the sexes is interesting, as apart from nodules being commoner in the men, there were no significant differences between the two groups in other disease parameters. This raises the question whether the subgroup of, so-called, rheumatoid arthritis robustus [2] may be more common than is appreciated. We have recently analysed the results of the Health Assessment Questionnaire in 100 patients with rheumatoid arthritis attending our unit over a 4-week period; there were 20 men and 80 women. Our results support those of Thompson and Pegley: the mean HAQ score in the men was 1.27 (SD 0.83) and in the women was 1.69 (SD 0.71) (P-cO.05). Perhaps less surprisingly the grip strength in the males was substantially greater than the females (217 mmHg, SD 80.5 and 109 mmHg, SD 50.6). We agree that the observable difference in disability from rheumatoid arthritis in men and women is worthy of further study. F. MCKENNA, A. TRACEY, J. HAYES
Trafford General Hospital, Rheumatic Diseases Unit, Davyhulme, Manchester M31 3SL Accepted 29 August 1991 1. Thompson PW, Pegley FS. A comparison of disability measured by the Stanford Health Assessment Questionnaire Disability Scales (HAQ) in male and female rheumatoid outpatients. BrJ Rheumatol 1991;30:298-300. 2. de Haas WHD, DcBoer W, Griffiocn F. Oosten-Elst P. Rheumatoid arthritis of the robust reaction type. Ann Rheum Dis 1974;33:81-4. Radionuclide Angiography
SIR—We describe a technique which uses radionuclide
Downloaded from http://rheumatology.oxfordjournals.org/ at Karolinska Institutet on July 18, 2015
[1]. In their letter Lanchbury and co-workers discuss the MHC association in Felty's syndrome with the DQB encoded variant DQw7 as described by several groups [2, 3]. Lanchbury and co-workers suggest that this association is secondary to a primary association at the DRB1 locus with Dw4. We have examined this possibility in a previous study [4] and have compared Dw4 frequencies in DR4 positive subjects with rheumatoid arthritis, rheumatoid arthritis and Felty's syndrome and controls. In this study the Dw4 frequency in these DR4 positive subjects was not significantly increased in the Felty's group although DQw7 was, so that the DQ association in Felty's syndrome is unlikely to be secondary to a primary effect at DRB1 and the results suggest that MHC genes at loci outside DRB1 may influence susceptibility to certain rheumatoid disease subgroups or may have a disease modifying effect. Felty's syndrome also shows an association with the class III C4B null allele and an association with the haplotype B44-Bf*s-C4A*3-C4B*QO-DR4-DQw7 and we have previously suggested that this haplotypic association represents an interaction between variants at several loci within the HLA region [5]. Different MHC associations are seen in other extra-articular subgroups [4] so that the clinical heterogeneity of rheumatoid disease is reflected in its immunogenetic heterogeneity.
477
D. M. GRENNAN, M. C. HILLARBY
Rheumatic Diseases Centre, Hope Hospital, Salford M6 8HD Accepted 28 August 1991 1. Lanchbury T, Sakkar L, Welsh K, Panayi G. Genetics of rheumatoid arthritis. Br J Rheumatol 1991:30:319-20. 2. Sansom DM, Bidwell T, Maddison P, Campion G, Klouda P, Bradley B. HLA DQA and DQB restriction fragment length polymorphisms associated with rheumatoid arthritis. Human Immunol 1987;19:269-79. 3. So ARL, Wamu C, Sansom D. Walport M. DQB polymorphisms and genetic susceptibility to Felty's syndrome. Arthritis Rheum 1988;31:990-4. 4. Hillarby MC, Clarkson R, Grennan DM, et al. Immunogenetic heterogenity in rheumatoid disease as illustrated by different MHC associations (DQ, Dw and C4) in articular and extra-articular subsets. Br J Rheumatol 1991 ;30:5—9. 5. Clarkson R, Bate AS, Grennan D, et al. DQw7 and the C4A null allele in rheumatoid arthritis and Felty's syndrome. Ann Rheum Dis 1990;49:976-9. Does the Weather affect the Osteoarthritic Patient?
SIR—Changing weather patterns have often been blamed by our osteoarthritic patients for the wide daily variety in their symptoms of pain and stiffness. Despite the severity of their disease, our joint replacement patients frequently offered this information. With this in mind we conducted a study over a 6-month period where aspects of the weather could be compared with the patient's symptoms. While there have been some inconclusive papers from other parts of Europe and North America [1-5], the UK has surprisingly escaped attention. Fifty-three consecutive patients completed a questionnaire for 30 days each, over the summer and winter months of 1990. A rating scale was used each day to assess the generalized feelings of pain and stiffness in the joint which was due to be replaced. At the same time on those days atmospheric pressure and humidity were measured. Statistical analysis using Wilcoxon's matched pairs signed ranks test found no correlation between our patients' symptoms and these weather variables. The conclusions we have reached are naturally tightly
limited. Changes in temperature could not be assessed as each patient's home environment would have differed, giving us erroneous results, whereas barometric pressure and humidity are not subject to these variations. Also, the influence of rapidly changing weather patterns is extremely difficult to assess. Nevertheless we did find that it was remarkable how constant patients' daily symptoms were despite marked changes in our weather variables. There is no doubt room for further study particularly in the more 'inflammatory' patients such as the early rheumatoid . Unfortunately and inevitably most of our patients have end staged disease. We would welcome other people's experience. A. M. CLARKE, J. NICHOLL
King Edward VII Orthopaedic Hospital, Sheffield and Medical Care Research Unit, Sheffield University Medical School Accepted 29 August 1991 1. Laborde JM, Dando WA, Powers MJ. Influence of weather on ostcoarthritics. Soc Sci Med 1986;23:549-54. 2. Sibley JT. Weather and arthritis symptoms. J Rheumatol 1985;'l2:707-10. 3. Rasker J, Peters HJG, Boon KL. Influence of weather on stiffness and force in patients with rheumatoid arthritis. Scand J Rheumatol 1986;15:27-36. 4. Patberg WR, Nienhuis RLF, Veringa F. Relation between meteorological factors and pain in rheumatoid arthritis in a marine climate. J Rheumatol 1985:12:711-15. 5. Guedj D, Weinberger A. Effect of weather conditions on rheumatic patients. Ann Rheum Dis 1990:49:158-69. Assessment of Disability in Male and Female Rheumatoid Patients
SIR—We were interested to read the report by Thompson and Pegley [1] on their survey of male and female rheumatoid outpatients using the Stanford Health Assessment Questionnaire. The significant difference in functional status between the sexes is interesting, as apart from nodules being commoner in the men, there were no significant differences between the two groups in other disease parameters. This raises the question whether the subgroup of, so-called, rheumatoid arthritis robustus [2] may be more common than is appreciated. We have recently analysed the results of the Health Assessment Questionnaire in 100 patients with rheumatoid arthritis attending our unit over a 4-week period; there were 20 men and 80 women. Our results support those of Thompson and Pegley: the mean HAQ score in the men was 1.27 (SD 0.83) and in the women was 1.69 (SD 0.71) (P-cO.05). Perhaps less surprisingly the grip strength in the males was substantially greater than the females (217 mmHg, SD 80.5 and 109 mmHg, SD 50.6). We agree that the observable difference in disability from rheumatoid arthritis in men and women is worthy of further study. F. MCKENNA, A. TRACEY, J. HAYES
Trafford General Hospital, Rheumatic Diseases Unit, Davyhulme, Manchester M31 3SL Accepted 29 August 1991 1. Thompson PW, Pegley FS. A comparison of disability measured by the Stanford Health Assessment Questionnaire Disability Scales (HAQ) in male and female rheumatoid outpatients. BrJ Rheumatol 1991;30:298-300. 2. de Haas WHD, DcBoer W, Griffiocn F. Oosten-Elst P. Rheumatoid arthritis of the robust reaction type. Ann Rheum Dis 1974;33:81-4. Radionuclide Angiography
SIR—We describe a technique which uses radionuclide
Downloaded from http://rheumatology.oxfordjournals.org/ at Karolinska Institutet on July 18, 2015
[1]. In their letter Lanchbury and co-workers discuss the MHC association in Felty's syndrome with the DQB encoded variant DQw7 as described by several groups [2, 3]. Lanchbury and co-workers suggest that this association is secondary to a primary association at the DRB1 locus with Dw4. We have examined this possibility in a previous study [4] and have compared Dw4 frequencies in DR4 positive subjects with rheumatoid arthritis, rheumatoid arthritis and Felty's syndrome and controls. In this study the Dw4 frequency in these DR4 positive subjects was not significantly increased in the Felty's group although DQw7 was, so that the DQ association in Felty's syndrome is unlikely to be secondary to a primary effect at DRB1 and the results suggest that MHC genes at loci outside DRB1 may influence susceptibility to certain rheumatoid disease subgroups or may have a disease modifying effect. Felty's syndrome also shows an association with the class III C4B null allele and an association with the haplotype B44-Bf*s-C4A*3-C4B*QO-DR4-DQw7 and we have previously suggested that this haplotypic association represents an interaction between variants at several loci within the HLA region [5]. Different MHC associations are seen in other extra-articular subgroups [4] so that the clinical heterogeneity of rheumatoid disease is reflected in its immunogenetic heterogeneity.
477
