The prevalence and incidence of juvenile rheumatoid arthritis in an urban Black population.

We determined the prevalence and incidence of juvenile rheumatoid arthritis (JRA) in an urban Black population in Baltimore, identifying three cases through review of computerized outpatient encounters and a fourth case by reviewing discharge records at area hospitals. The prevalence of JRA among Blacks, as of December 31, 1980, was estimated as 0.26 per 1,000 (95 per cent confidence interval: 0.07, 0.66), the average annual incidence 6.6 per 100,000 per year (0.8, 23.8) for the years 1979 and 1980. These data suggest that Black race is not associated with significantly increased risk of development of JRA.     

Body composition in Pima Indians: validation of bioelectrical resistance

To assess the validity of bioelectrical resistance (BR) in an obese population, body composition was determined by both hydrostatic weighing and by BR in 156 Pima Indian volunteers representing a wide range of body weight (46.1-202.6 kg) and body composition (11-52% fat). A predictive equation was derived by use of data on height, BR, weight, age, and sex from 130 randomly selected volunteers and was applied to the remaining 26 volunteers. When compared with the manufacturer's software, the new equation increased correlations with hydrostatic weighing for predicting percent body fat and fat-free mass (FFM) from 0.70 to 0.92 and 0.79 to 0.97, respectively. The manufacturer's software underestimated FFM by 5.3 +/- 8.6 kg (P less than 0.05) when compared with FFM derived from hydrostatic weighing whereas the new equation improved the accuracy to -0.1 +/- 3.3 kg (NS). There were no significant effects of fluid intake (700 mL) or breakfast consumption on body composition as determined by BR. BR represents a simple and accurate way to assess body composition in Pima Indians with our newly derived equation.     

Rheumatoid arthritis in the Pima Indians of Arizona: an assessment of the clinical components of the New York criteria.

When a prevalence study of Rheumatoid Arthritis (RA) was made in the adult Pima Indian population living on the Gila River Reservation, a high prevalence was found using the New York criteria (5-9 per cent). This was mainly due to the high frequency of limitation of motion which brought in many undesirable subjects. After excluding it as a component of New York criteria we found a prevalence for RA of 3 per cent with a predominance among the females (3-8 as against 2-0 per cent in males). The group so defined fulfilled the requirements of the Rome criteria, showed a higher concordance with serological or radiological evidence of RA, and appeared to identify subjects in whom the experienced clinical rheumatologist would more often agree with the diagnosis.     

The prevalence and management of hyperglycaemia in patients with rheumatoid arthritis on corticosteroid therapy

BACKGROUND AND AIMS: Corticosteroids are commonly used in the treatment of RA. Hyperglycaemia resulting from corticosteroid use can lead to problems, particularly in those with impaired glucose tolerance and diabetes mellitus. We have examined how rheumatology clinics monitored and managed hyperglycaemia at base line and during treatment of patients with rheumatoid arthritis on corticosteroids. METHODS: Case notes of 102 patients with established RA, on long-term steroids were reviewed. We recorded a) blood glucose level at base line and whilst on steroids b) when and whether hyperglycaemia was addressed. RESULTS: There were 24 males and 78 females, with mean age of 62 +/- 15 years. Patients were on corticosteroids for a median duration of 24 months. Seventy-five per cent of patients were treated with oral prednisolone, the rest, except one patient on deflazacort, were on methylprednisolone. Blood glucose was measured at baseline in 97% of patients with 37% and 38% being monitored at three months and six months respectively and 36% annually thereafter. Nine patients (8.8%) developed diabetes mellitus during treatment, but one patient was detected and managed. There were six patients with existing diabetes mellitus in whom glycaemic control worsened between three to six months, but only one patient had treatment adjusted. CONCLUSIONS AND RECOMMENDATIONS: Physicians need to be aware that corticosteroids can increase blood glucose, worsen pre-existing diabetes and predispose to diabetes mellitus. Patients on long-term corticosteroids should be monitored at regular intervals as corticosteroid induced glycaemic excursions may lead to the development of diabetes mellitus and increased coronary risk.     

High prevalence of low dietary calcium and low vitamin D status in healthy south Indians

Calcium and vitamin D under nutrition can adversely affect the bone mineral metabolism. There is no population-based study from India documenting dietary habits, serum calcium and vitamin D levels. Our study investigated the dietary habits of rural and urban societies in and around Tirupati and their relationship with serum calcium, phosphorous and vitamin D [25(OH)D] levels. Four hundred and seven subjects from 5 villages around Tirupati, (rural population) and 125 asymptomatic staff of our hospital (urban population) were studied. Dietary intakes of calcium, phosphorous and phytates were documented by diet history. Serum calcium, phosphorus and 25 (OH) D levels were estimated in 191 rural subjects and 125 urban subjects. Compared to urban subjects, rural subjects had a significantly lower intake of dietary calcium (P <0.0001) and a significantly higher dietary phytate/calcium ratio and serum calcium and 25 (OH) D levels (P <0.0001). Dietary calcium intake was inadequate in both rural and urban subjects compared to the recommended daily allowances (RDA) for our country. About 31% of the population had normal vitamin D levels, 54% had vitamin D insufficiency and 15% vitamin D deficiency. About two-thirds of the population had low levels of vitamin D. Inadequate dietary calcium intake associated with high phytate/calcium ratio reduces the bioavailable calcium in the gut. Hence, there is a need to fortify food with calcium and to propose new guidelines for 25 (OH) D in Indian subjects. Multicentric studies with large sample populations are required to generate normal standards and nationally relevant guidelines.     

Bronchiectasis in rheumatoid arthritis. High resolution computed pulmonary tomography

To evaluate the prevalence of bronchiectasis in rhumatoid arthritis (RA) we have study thirty patients (24 women and 6 men), with a mean age of 45,2 years. All patients have a RA with a follow up of 5,84 years, positive rhumatoid factor were found in 22 cases. All patients have had high resolution computed pulmonary tomography, study of clinical, radiological and spirometry parameters. Bronchiectasis was found in 5 cases (16,6%) and is the most frequent abnormality found. These bronchiectasis are associated to an interstitial syndrome (2 cases) and pleural node (1 case). We don't find any significant difference in rhumatoid factor, extra-articular involvements, respiratory manifestations, smoke use or spirometry parameters between the sub group with or without bronchiectasis.     

High incidence of sudden infant death syndrome among Northern Indians and Alaska Natives compared with Southwestern Indians: Possible role of smoking

Epidemiologic studies of sudden infant death syndrome (SIDS) in the United States have found a particularly high incidence among American Indians and Alaska Natives compared with whites. This report shows that there is a remarkable difference in the incidence of SIDS between Northern Indians and Southwestern Indians. From 1984 through 1986, the incidence of SIDS was 4.6 per 1,000 live births among Indians and Alaska Natives in the Northern region of the United States, while the incidence among Southwestern Indians was 1.4 per 1,000 live births (risk ratio = 3.4; 95 percent confidence interval = 2.4-4.8). Among whites living in the same regions, the incidence of SIDS was 2.1 and 1.6 per 1,000 live births, respectively. The incidence among Native Americans in the Northern region was high in all five Indian Health Service Areas. Differences in socioeconomic status, maternal age, birth weight, and prenatal care did not appear to explain the higher incidence of SIDS among Northern Indians compared with Southwestern Indians. However, the prevalence of maternal cigarette smoking during pregnancy is exceptionally high among Northern Indians and Alaska Natives, while it is low among Southwestern Indians. This difference in smoking habits may explain, at least in part, the excess risk of SIDS among Indians in the Northern region. This report points to the need for effective smoking cessation programs for Native Americans, targeting in particular women of reproductive age.     

Survey of the Diet of Pima Indians Using Quantitative Food Frequency Assessment and 24-Hour Recall

Objective A dietary survey was conducted in the Gila River Indian Community in Arizona using two methods of dietary assessment — 24-hour recall and quantitative food frequency (QFF) assessment — to determine the usual intake of the population.Design Interviews were conducted by Pima women who were trained and monitored by a research dietitian. Energy and nutrient intake were calculated using a computerized dietary database that included specific Pima foods.Subjects An age- and sex-stratified sample of 575 Pima Indians (273 men, 302 women) aged 18 to 74 years participated in the study.Statistical analyses Spearman correlations were used to compare the results of the two survey methods for energy and each nutrient. Intraclass correlations were used to measure reproducibility.Results According to the 24-hour recall, mean reported energy intakes within decades of age were 95% to 112% of those in the US population for Pima women, and 76% to 94% of those in the US population for Pima men. Total energy intake assessed using QFF was 30% higher in men and 33% higher in women than the intake assessed using the 24-hour recall method.Conclusions A large dietary survey conducted using lay interviewers in a Native-American community was as reproducible as studies conducted in the general US population. The Pima diet was distributed among the major nutrients in a proportion similar to the US diet. J Am Diet Assoc. 1996; 96:778–784.     

广西南宁市壮族人群类风湿关节炎的流行病学调查

目的了解广西南宁市壮族人群类风湿关节炎（RA）的患病情况。方法采用整群抽样方法对7407名≥16岁壮族人群进行病史询问，由风湿病专科医师对询问阳性者进行体格检查；对疑似RA病例，行血清类风湿因子定量检测和双手X线摄片，并将其结果与6826名当地的汉族人群作比较。结果广西南宁市壮族人群RA患病率为0．27％，而当地的汉族人群患病率为0．28％（P〉0．05）；壮族和汉族人群的RA知晓率分别为5．0％和10．5％（P〉0．05），治疗率分别为0％和5．25％。结论广西南宁市壮族人群RA患病率与汉族人群的差异无统计学意义，而对RA的知晓率、治疗率较低。     

Energy intake and physical activity in Pima Indians: comparison with energy expenditure measured by doubly-labeled water

To test the validity of survey techniques for measuring diet and activity patterns of Pima Indians, sequential 24-hour recalls, a food frequency questionnaire (FFQ), and an activity questionnaire were compared to free-living energy expenditure. Total energy expenditure (TEE) measured by doubly labeled water was 13.27 +/- 2.95 MJ/d for the 12 males (mean +/- SD: 35 +/- 14 yr; 97 +/- 35 kg; 32 +/- 9% body fat) and 11.67 +/- 1.85 MJ/d for the 9 females (31 +/- 13 yr; 106 +/- 32 kg; 49 +/- 6% body fat). Energy intake assessed by 24-hour recall was 13.59 +/- 7.81 MJ/d for men and 9.29 +/- 2.77 MJ/d for women, compared to 12.84 + 2.85 and 9.40 + 2.61 MJ/d for men and women, respectively, by FFQ. Both dietary methods indicated significant underreporting by women when compared to TEE. Energy intake assessed by FFQ was significantly correlated with TEE (r=0.48, p=0.03). This was true with 24-hour recall energy intake only when data from two extremely large alcohol consumers were eliminated (r=0.64, p=0.03, N=19). Although a low level of activity was apparent, the activity questionnaire produced significant correlations with measurements of energy expenditure and therefore represents an important tool for examining the relationship between physical activity and diseases.     

High prevalence of low dietary calcium, high phytate consumption, and vitamin D deficiency in healthy south Indians

BACKGROUND: Data on the vitamin D status of the population in a tropical country such as India have seldom been documented. Vitamin D deficiency is presumed to be rare. OBJECTIVE: The objective was to document the dietary habits and concentrations of serum calcium, 25-hydroxyvitamin D [25(OH)D], and parathyroid hormone of Indian urban and rural populations. DESIGN: Healthy urban (n = 943) and rural (n = 205) subjects were studied for their dietary pattern and concentrations of serum calcium, phosphorus, alkaline phosphatase, 25(OH)D, and immunoreactive parathyroid hormone. RESULTS: The daily dietary calcium intake of both the urban and rural populations was low compared with the recommended dietary allowances issued by the Indian Council of Medical Research. Dietary calcium and phosphorous were significantly lower in rural adults than in urban adults (P < 0.0001). The dietary phytate-to-calcium ratio was higher in rural subjects than in urban subjects (P < 0.0001). The 25(OH)D concentrations of the rural subjects were higher than those of urban subjects (P < 0.001), both men and women. In the rural subjects, 25(OH)D-deficient (<20 ng/mL), -insufficient (20-30 ng/mL), and -sufficient (>30 ng/mL) states were observed in 44%, 39.5%, and 16.5% of the men and 70%, 29%, and 1% of the women, respectively. In the urban subjects, 25(OH)D-deficient, -insufficient, and -sufficient states were observed in 62%, 26%, and 12% of the men and 75%, 19%, and 6% of the women, respectively. CONCLUSIONS: Low dietary calcium intake and 25(OH)D concentrations were associated with deleterious effects on bone mineral homeostasis. Prospective longitudinal studies are required to assess the effect on bone mineral density, a surrogate marker for fracture risk and fracture rates.     

Immunopathology of rheumatoid arthritis

The central place of immunologic aberrations in the pathology of rheumatoid arthritis is now well established. It is the nature and interactions of these aberrations that still remain to be elucidated. Among the many puzzles being studied are the uniquely self-perpetuating nature of rheumatoid arthritis immune complexes and the role of complement and the prostaglandins in joint damage and pain.