THINKING relative to the so-called "collagen diseases" has been in the main in terms of entities or syndromes. The instances are not uncommon, however, in which the clinical picture begins as one syndrome, only to alter its course within months or years, to assume the picture of another. If the basic pathologic picture is kept in mind these transitional or intermediary manifestations are not disturbing. Furthermore, it is becoming more evident that medical thinking must include not only progressive vascular disease but also a disease of remissions and relapses. This is not a new concept but needs reemphasis. Osler1 in his three papers on the visceral manifestations in "erythema exudativum multiforme," published between 1895 and 1903, in which he included 29 case reports, described patients whose conditions unquestionably would fall today into the categories of periarteritis nodosa and disseminated lupus. That Osler was aware of the possibility of remissions
KAMPMEIER RH, SHAPIRO JL. DIFFUSE AND SOMETIMES RECURRENT COURSE OF DIFFUSE ARTERITIS: Observations and Report of a Patient Observed for Twenty-One Years. AMA Arch Intern Med. 1953;92(6):856–879. doi:10.1001/archinte.1953.00240240092007
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