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August 19, 1939

ENVIRONMENTAL FACTORS IN RHEUMATOID ARTHRITIS: A STUDY OF THE RELATIONSHIP BETWEEN THE ONSET AND EXACERBATIONS OF ARTHRITIS AND THE EMOTIONAL OR ENVIRONMENTAL FACTORS

JAMA. 1939;113(8):668-670. doi:10.1001/jama.1939.02800330034009
Abstract

Rheumatoid arthritis is a chronic disease of unknown etiology. It respects neither age, sex, race nor social position, although it does affect women more frequently than men, white persons more often than Negroes and the poor more commonly than the rich. In addition to the articular involvement, which is usually symmetrical and more likely to affect small joints first, the patients complain of constitutional, vasomotor and neurologic symptoms. These associated symptoms frequently precede those referable to the skeletal system and in many instances persist throughout the course of the disease. Rheumatoid arthritis may be unrelentingly progressive from the onset but is more commonly characterized by remissions and relapses of varying degree and duration. In a small percentage of cases the remissions are complete and of years' duration; in the majority they are incomplete and short lived with recurrent symptoms and telltale evidence of previous fascial or joint involvement persisting. Irrespective

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