A PARENT in Old Lyme, Conn, reported to the state health department that physicians had diagnosed 12 cases of juvenile rheumatoid arthritis (JRA) in her community. That number is substantially higher than might reasonably have been expected.1 The difference between what is observed and what is expected sounds an alarm to the epidemiologist. Defining the illness to be examined is invariably his first task, although not often a major obstacle.
In their study of arthritis in Connecticut, Steere and his colleagues2 appear to have grappled successfully with exacting classification criteria for JRA3 as they defined the epidemic illness. They described 51 cases of a distinct rheumatic syndrome that closely resembles JRA. "Lyme arthritis" consists of one or more brief episodes of nondeforming, oligoarticular arthritis—variably accompanied by fever, fatigue, headache, myalgia, and skin rash—which usually remits completely. Lymphadenopathy, splenomegaly, and iridocyclitis were not seen. The patients had no
Kaslow RA. New England's Own Arthritis?. JAMA. 1977;238(4):330–331. doi:10.1001/jama.1977.03280040050020