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Many rheumatic diseases are influenced by both genetic and environmental factors. Studies of families help to understand the genetic aspects of these multifactorial disorders. Some are inherited as an autosomal dominant trait, such that an individual who inherits the gene carrying the trait will have the disease. Other rheumatic disorders such as ankylosing spondylitis (spinal arthritis which ends in spinal fusion and rigidity) tend to cluster in families, but will not occur uniformly. Spondylitis is related to the presence of a particular HLA (human leukocyte antigen) subtype. These subtypes are groups of cell-surface proteins which distinguish self cells from nonself cells and are important in defense against foreign organisms and rejection of grafted tissues. Spondylitis, similar spondylarthropathies (arthritis of the spine), and rheumatoid arthritis have not previously been found to inherited as an autosomal dominant trait. The occurrence of an arthropathy (joint disease) running within a French family is described. The study was begun after finding two sisters and a brother with a polyarthritis (involvement of many joints) without positive blood tests. Five generations and 83 family members were studied. Medical symptoms and X-ray evidence of arthritis were found in 16 subjects. Eye inflammation, intestinal disease, and psoriasis were not present. Three consecutive generations were affected, every affected subject in the second to fourth generations had an affected parent, transmission was autosomal rather than sex-linked (as male-to-male transmission was found), and 61 percent of children of affected subjects inherited the disease, all suggestive of an autosomal dominant inheritance pattern. Joint symptoms began between 18 and 32 years. The wrist, foot, or shoulder were usually the first joints involved, and the disease usually occurred as intermittent episodes of one to three months. Mechanical factors influenced the joints affected, as right-handed subjects had right-sided symptoms, and manual workers had inflamed wrists. Painless stiffness gradually developed, and the neck, low back, and sacroiliac joints were involved, but not prominently. X-rays showed bone erosions and proliferation. Joint symptoms did not resemble rheumatoid arthritis or ankylosing spondylitis. Ossification (bony changes) of soft tissues occurred. The study suggests this is a novel type of inherited arthritis, and research is needed to identify the target of the genetic change. (Consumer Summary produced by Reliance Medical Information, Inc.)

Brucellosis is a bacterial infection that causes fever in animals and can also affect humans. The disease is a major health problem in many areas of the world. A recent surge of brucellosis in Saudi Arabia has been attributed to widespread animal farming and a common habit of consuming raw milk products. Diseases of the bones and joints are thought to be the most common complication associated with brucellosis, but the incidence may vary according to the patient, environment, or strain of bacteria involved. The occurrence of joint involvement in brucellosis has mostly been studied in adults. The medical findings associated with joint and bone disease in 40 (24 female) of 106 children with brucellosis were evaluated. Twenty-four children were school-aged. Single joints were involved in 28, while 12 had disease in multiple joints. Hip and knee joints were most frequently affected. Most patients with arthritis also had pain in joints that were not arthritic. Severe joint destruction was rare, as arthritis usually involved only soft tissue swelling and fluid accumulation in joints. Bone scans were more helpful than X-rays in identifying infections deep in bones. The arthritis as well as the infection responded well to antibiotic therapy. Three patients had relapses which responded to antibiotics, and only one had permanent joint dysfunction. The authors state that diagnosis of brucellosis should be considered whenever fever accompanies rheumatic complaints. (Consumer Summary produced by Reliance Medical Information, Inc.)

Magnetic resonance imaging (MRI), which allows the visualization of internal body parts by the absorbance of radiowaves, is a sensitive method for examining the muscles and bones. A common site for the occurrence of rheumatoid arthritis (RA) is the shoulder. RA can involve the joints, the clavicle or collar bone, the bursae, the tendons known as rotator cuff tendons, and the surrounding muscles. MRI was used to detect abnormalities in the shoulders of 18 patients. The MRI procedure was able to detect bony abnormalities and soft tissue lesions; the latter included joint effusion and muscular atrophy or wasting. The soft tissue lesions were not visible with conventional radiography (X-ray imaging). However, conventional radiography is more useful than MRI for examining the acromioclavicular joint, the joint between the scapula and clavicle, two of the bones forming the shoulder. Early detection of shoulder involvement in RA is important so that physiotherapy can be initiated to prevent further, irreversible damage. MRI is a sensitive method of diagnosis which allows identification and grading of abnormalities in the shoulder joint of patients with RA. (Consumer Summary produced by Reliance Medical Information, Inc.)