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To the Editor.—
I must take issue with the title, "Rheumatoid Disease Without Joint Involvement" (228:338, 1974). The authors state that during five years of clinical observation, the patient had "no significant arthritis." X-ray film changes commonly associated with early, mild, erosive rheumatoid arthritis were present, and such changes were observed by the authors two years after they dated the onset of the patient's "rheumatoid disease."Their point more appropriately refers to the mild degree of objective joint disease with severe systemic complications in the presence of rheumatoid nodules and rheumatoid factors, usually associated with severe progressive joint destruction. A less misleading title might be "Severe Systemic Rheumatoid Disease With Mild Joint Involvement."In the true absence of arthritis or residual joint changes compatible with previous active synovitis, a diagnosis of rheumatoid arthritis would not be justified.
Bluhm GB. Rheumatoid Arthritis. JAMA. 1974;229(4):393. doi:10.1001/jama.1974.03230420015011