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Mediastinal fibrosis.

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LETTERS
3. Willkens RF, Watson MA, Paxson CS: t o w dose pulse methotrexate in rheumatoid arthritis. J Rheumatol 7501-505, 1980
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Mediastinal fibrosis
To the Editor:
Goldbach et a1 report two sisters with mediastinal
fibrosis associated with seronegative spondylarthropathy, an
interestihg clinical observation which has genetic implications because of the consanguinity of their parents (Goldbach P, Mohsenifar Z, Salick AI: Familial mediastinal fibrosis associated with seronegative spondylarthropathy.
Arthritis Rheum 26:221-225, 1983). There is no indication,
however, that these authors considered the association
between mediastinal fibrosis and healed primary histoplasmosis and tuberculosis (Goodwin RA, Nickell JA, Des Prez
RM; Mediastinal fibrosis complicating healed primary histoplasmosis ahd tuberculosis. Medicine 51 :227-246, 1972).
Only one of the sisters had a skin test for histoplasmosis, which produced negative results. No serologic tests
for histoplasmosis were performed, No special stains or
cultures for fungi were reported. Negative tuberculin skin
test findings in both women reduce the chances that healed
primary tuberculosis was the cause, but special stains and
cultures of all biopsy specimens for Mycobacteriurn tuberculosis would have provided useful additional information.
I am surprised that neither healed primary tuberculosis nor, especially, healed primary histoplasmosis, was considered further by the authors in their clinical approach or in
the discussion of their interesting results.
Burton C. West, MD
Louisiana State University Medical Center
Shreveport, LA
Arthritis in beta-thalassemia minor
To the Editor:
During the past years, some authors have suggested
an association between thalassemia minor and rheumatic
diseases. Rheumatoid arthritis (l), osteonecrosis (2,3), and
more recently, a chronic seronegative arthritis (43) have
been considered clinical entities produced by the hematologic disorder. The limited number of publications concerning
osteoarticular manifestations in beta-thalassemia minor has
motivated us to study 34 thalassemic patients: 20 females
and 14 males, ages 2-73 years (mean of 30). All were
asymptomatic at the time of evaluation, none demonstrated
abnormal hemoglobins by electrophoresis, and the blood
smear findings and hematologic parameters (Coulter “S”
counter) were consistent with the hematologic disease. The
quantification of hemoglabin A2, on cellulose acetate aad
hemoglobin F, by the method of Betke (6), gave values
greater than 3.5% (3.5-8.6%) and less than 4.5%, respectively. A control group of 34 normal volunteers, matched by age
and sex, was also studied.
Seventeen patients from the thalassemic group and
11 from the control group had musculoskeletal complaints;
the locomotor abnormalities found are detailed in Table 1.
The main abnormality in the first group was osteoarthrosis in
8 patients (33 to 73 years old), followed by soft tissue
abnormalities and osteoporosis more evident in the vertebral
column. In the control group, osteoarthrosis again was the
leading abnormality, with 9 cases in patients 40 to 73 years
old.
We did not find in any case evidence of the pauciarticular, chronic, seronegative arthritis reported by Schlumpf
(4) and Dorwart and Schumacher (9,or any of the other
rheumatic abnormalities apparently related to the hematologic disorder. The systemic lupus erythematosus and the
ankylosing spondylitis, diagnosed in a 24-year-old woman
and a 33-year-old man, respectively, are found in young
populations with a certain frequency, and we considered
Table 1. Locomotor abnormalities in patients with thalassemia
minor
No. of cases
Thalassemic
Soft tissue abnormality
Osteoarthrosis
group
5
3
Osteoarthrosis/osteoporosis
3
Osteoporosis
2
Osteoarthrosis/scoliosis
1
Osteoarthrosis/osteoporosis/
osteitis condensans ilii
Systemic lupus
1
erythematosus
Ankylosing spondylitis
Total
1
1
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