Fetal growth and autoimmune thyroid disease

To determine whether fetal and infant growth could influencesusceptibility to autoimmune disease in adults, the occurrenceof thyroid autoantibodies and autoimmune thyroiditis was studiedin 305 women, aged 60–71, born in Hertfordshire and forwhom details of birth weight, infant growth, and feeding wereroutinely recorded. Thyroglobulin autoantibody was detectedin 37% of the women, thyroid peroxidase autoantibody in 41%,and autoimmune thyroiditis, defined as biochemical or clinicalhypothyroidism in association with thyroid autoantibodies, in5.6%. The proportion of women with thyroglobulin and thyroidperoxidase auto antibodies fell with increasing birth weightbut was not related to weight at 1 year of age or the methodof infant feeding. The prevalence of both autoantibodies rosewith increasing adult body mass index but fell as the waistto hip ratio increased. These results demonstrate the importance of early environmentin determining the susceptibility to autoimmune thyroid disease.The contrasting effects of adult body mass index and waist tohip ratio on antibody prevalence could be explained by theirassociations with different hormonal environments.     

Variation in Mortality from Ischaemic Heart Disease between England and Scotland

A Comparison of mortality from ischaemic heart disease underthe age of 60 for 1980 to 1981 between the Grampian Health Boardand the North Staffordshire Health Authority has been made.A total of 993 deaths was notified by death certificate fromthe two areas of similar population of which 434 were from Grampianand 559 from North Staffordshire. After examination of generalpractitioner and hospital case notes, autopsy reports and deathcertificates, nearly all (532) of the North Staffordshire deathswere accepted as being due to ischaemic heart disease but onlythree-fifths (263) of the Grampian deaths could be begin besubstantiated as there was inadequate information for the remainder.Deaths from ischaemic heart disease seem apparently to be twofoldgreater in North Staffordshire than Grampian but much of thisdiscrepancy could be attributed to a widely different autopsyrate and to unavailability of case notes. Experience of thissurvey suggests that the results of other epidemiological investigationsmay be equally or even more unreliable.     

CERVICAL MYELOPATHY COMPLICATING MULTIPLE JOINT REPLACEMENT IN RHEUMATOID DISEASE

The incidence of cervical myelopathy and subluxation was investigatedin 48 patients with rheumatoid disease who had three or moremajor lower limb joint replacements. Eight (17%) developed cervicalmyelopathy requiring cervical fusion. This was the subsequentcause of death in two. Four further patients demonstrated clinicalfeatures of myelopathy. Cervical subluxation was present in29 of 44 (66%) in whom adequate radiographs were available.The development of cervical symptoms and signs could not havebeen predicted from the sex, age of onset, duration of diseaseor steriod therapy. Radiographic changes in the cervical spinewere independent of major lower limb joint destruction and wereoften not present when planning a programme of joint replacement.Fifty-one control patients were studied. Cervical myelopathyoccurred in 2 (4%) and subluxation in 24 (47%). The developmentof rheumatoid changes in the cervical spine was unrelated toinvolvement of the hip or knee joints in the control group. There was a significant (p<0.05) increase in the incidenceof cervical myelopathy in patients with multiple lower limbjoint replacements compared with the control population. KEY WORDS: Rheumatoid arthritis, Cervical myelopathy, Cervical subluxation, Arthroplasty