Contrasting Worldviews in Revival: Ferryden, Scotland, in 1859

Objective-To investigate mortality, functional capacity; and prognostic factors for mortality in an inception cohort of patients with recently diagnosed RA followed up for up to 10 years. Methods-The observed mortality of this inception cohort with recently diagnosed RA, was analysed in relation to the expected mortality, calculated with the aid of life tables of the general population of the Netherlands (matched for age and sex). Functional capacity was measured by the Health Assessment Questionnaire. Prognostic factors for mortality were analysed multivariately by the Cox proportional hazards model. Results-Between January 1985 and April 1997, 622 patients entered the study, and were included in the analysis of mortality. The death rate in the first 10 years of the disease was not significantly different from that of the general population. Fifty five patients from the study group died (16% up to 10 years of follow up). The most commonly reported causes of death were of cardiovascular and respiratory origin. The other causes of death could be classified into cancer, sepsis, amyloidosis, leukaemia, renal insufficiency of unknown cause, perforation of the oesophagus, probably related to the treatment with non-steroidal anti-inflammatory drugs, and pancytopenia during aurothioglucose treatment. Functional capacity improved significantly during the first six years compared with the value at start. Statistically significant predictors for death were age at the start and male sex. Conclusions-In contrast with earlier studies performed, no excess mortality in the first 10 years of an inception cohort of patients with RA was seen. In addition, the functional capacity was relatively constant during the first six years after an initial improvement from baseline. Age at start and male sex were the only statistically significant predictors for death

Transient osteoporosis of the hip:Presentation of (a)typical cases and a review of the literature

Transient osteoporosis of the hip (TOH) is a rare disorder affecting primarily middle-aged men and women during the last trimester of pregnancy. The disease is character-ized by pain in the involved joint with temporary osteopenia apparent on radiology without joint space narrowing or destruction, in the absence of other recognizable causes of synovitis or osteoporosis. Within a few months the pain as well as radiological abnormalities disappear spontaneously with complete resolution. In this paper the literature is reviewed, with particular focus on the topic of the role of magnetic resonance imaging (MRI) in the diagnostic procedure. Two patients with TOH, a father and daughter; are described. Such a familial appearance has not been reported before. Based on HLA-typing, the existence of an HLA-associated genetic predisposition nevertheless seems unlikely