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Tender point count.

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LETTERS
479
Table 1. Response of peripheral blood mononuclear cells (PBMC)
to heat- and formalin-killed Yersinia enterocolitica serotype 3 (Ye3)
22
7
0 R.A. Patients
20
Counts per minute of
cultured cells from:
Antigen
Cells used
Reiter’s
Datients
Ye3 formalin
Ye3 formalin
Ye3 heat
PBMC
T-enriched PBMC
T-enriched PBMC
28,531
27,409
21,888
B27+
controls
29,943
5,414
15,383
A 0 . A Patients
W All Other Patients
4
to both heat- and formalin-killed Ye3 antigens, with a
significant elevation of cpm.
However, when lymphocytes depleted of non-T cells
were studied, Reiter’s patients maintained their response to
formalin-killed Yrrsinia, while the response of the controls
was reduced by the procedure. This emphasis is different
from that of Brenner et al.
The change in response in the B27 positive control
subjects remains an interesting finding, but may have more
to do with qualities of antigen-presenting cells in the 2
groups. We agree that the response is likely to reflect
exposure to a cross-reacting antigen on a locally prevalent
organism, but we remain unconvinced that the evidence
clearly demonstrates a difference in sensitivity between the 2
groups of subjects to a specific Yrrsinia antigen.
Stephen Aaron, FRCP(C)
University of Alberta
Edmonton, Alberta
Canuciu
2
NUMBER OF TENDER POINTS
Figure 1. The tender point count in 980 consecutive rheumatic
disease patients. RA = rheumatoid arthritis; OA = osteoarthritis.
peripheral joint osteoarthritis (69.2%). Four or more tender
points were found in 19-21s of patients, and only 11-12rlO
had 7 or more tender points. A tender point count of 12 or
greater was unusual (Figure I). There was no statistically
significant difference in the proportion or distribution of
tender points among the disease groups, as shown in Figure
I . These data suggest that, except in fibrositis patients, a
high number of tender points is uncommon. Thus, the identification of multiple tender points in patients with musculoskeletal pain suggests the possibility of the diagnosis offibrositis.
Frederick Wolfe, MD
University uf Kansas School of’ Mr.dic,ini.
Wichitcr, KS
Tender point count
To the Editor:
Since Smythe first proposed it as a diagnostic sign in
1972 ( I ) , the “tender point count” has been an essential
criterion for fibrositis diagnosis in studies published on the
disorder (2-6). Although Smythe originally required 12 of 14
possible tender areas for diagnosis, other investigators have
required less; as few as 4 tender points have been accepted
as meeting the tender point criterion (2,3).
Although the presence of tender points is uncommon
in a healthy, young population ( 2 ) , there are no published
data concerning the frequency of tender points in patients
with rheumatic disease in whom joint disease could be
associated with musculoskeletal tenderness.
To investigate the frequency of tender points in a
rheumatic disease population, 980 consecutive patients attending a private practice rheumatic disease clinic were
examined by the same physician for tenderness in the 14
areas suggested by Smythe, using his methodology (7).
Sixty-eight percent (669 of 980) had no tender points. This
group included 165 of 248 patients with definite or classic
rheumatoid arthritis (66.6%) and 128 of 185 patients with
1. Smythe HA: Nonarticular rheumatism and fibrositis, Arthritis
and Allied Conditions. Edited by DJ McCarty. Philadelphia, Lea
& Febiger, 1972, pp 874-884
2. Yunus M , Masi AT, Calabro J J , Miller K A , Feigenbaum SL:
Primary fibromyalgia (fibrositis): clinical study of 50 patients
with matched normal controls. Semin Arthritis Rheum 1 I : 151171, 1981
3. Payne TC, Leavitt F, Garron DC, Katz RS. Golden HE, Glick-
man PB, Vanderplate C: Fibrositis and psychogenic disturbance.
Arthritis Rheum 25:213-217, 1982
4. Campbell SM, Clark S, Tindall EA, Forehand ME. Bennett RM:
Clinical characteristics of fibrositis. Arthritis Rheum 26317-824.
I983
5. Wolfe F, Cathey M: Prevalence of primary and secondary
fibrositis. J Rheumatol 10:965-968, 1983
6 . Wolfe F, Cathey M, Kleinheksel S, Amos S , Hoffman R , Young
D, Hawley D: Psychological status in primary fibrositis and
fibrcisitis associated with rheumatoid arthritis. J Rheumatol
I I :SOO-SOS, 1984
7. Smythe HA: Fibrositis and other diffuse musculoskeletal syndromes, Textbook of Rheumatology. Edited by WN Kelley, ED
Harris Jr, S Ruddy. CB Sledge. Philadelphia. WB Saunders.
1980, 485-493
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