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Thalassemia minor land aseptic necrosis a coincidence.

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Thalassemia Minor and Aseptic Necrosis, a
Coincidence?
To the Editor:
The syndrome of thalassemia minor and arthritis
was described in a recently published paper (1). Furthermore we have a series of patients with pauciarticular,
nonerosive, seronegative arthritis, and thalassemia minor under followup observation. There is a predilection
for middle-sized joints such as ankles, wrists, and elbows. The course of this type of arthritis shows chronicity and mild persistent synovitis without joint effusions.
X-ray revealed juxtaarticular osteoporosis of the affected joints, characterized by diminution of the number
of trabeculae (hypertrophic atrophy) combined with
broadening of the singular trabecula. Laboratory investigations including ESR, routine immunological tests,
blood chemistry, and HLA-tissue typing, were all normal.
One patient in our examined group showed periarthritis of one shoulder joint and an aseptic necrosis of
the head of the humerus. Another carrier of thalassemia
minor showed a cyst of the hip. The affected joint in the
second patient was surgically explored and revealed a
cyst wit$ granulomatous tissue in the region of inajor
trochanter. Other known causes of seronegative arthritis
had been excluded.
In the case described by Abou Rizk et a1 (2) the
patient showed typical x-ray hair-on-end-appearance of
the skull, osteoporosis of the lumbar spine, and simultaneously the aseptic necrosis of both femoral heads. The
skull and lumbar spine were radiologically investigated
in 5 5 healthy young carriers of the thalassemia trait (3).
Twenty-nine Greek carriers of thalassemia trait showed
a varying degree of bone rarefaction at different parts of
the skeleton-predominantly at the skull and to a lesser
extent at the humerus and the lumbar spine. These authors have not found a correlation between the degree of
the hematological and biochemical findings on one hand
and radiological changes on the other.
We assume that the long-standing medullary hyperplasia may be responsible for different osseous lesions in carriers of thalassemia minor and perhaps for
the synovitis also. The combination of the peculiar arthropathy with thalassemia minor appears to be worthy
of note and requires a further search among the forms
of arthritis of unknown origin.
U. SCHLUMPF,
M.D.
Universitatsrheumaklinik Zurich
Gloriastrasse 25, CH-8091 Zurich
REFER EN CES
1 . Schlumpf U, Gerber N , Biinzli H, Elsasser U, Pestalozzi
A, Biini A: Arthritiden bei Thalassaemia minor. Schweiz
Med Wschr 107;1156-1162, 1977
2. Abou Rizk N N , Nasr FW, Frayha RA: Aseptic necrosis in
thalassemia minor. Arthritis Rheum 2 0 1 147, 1977
3. Sfikakis P, Stamatoyannopoulos G : Bone changes in thalassaemia trait. Acta Haemat 29: 193-201, 1963
Intrapericardial Steroids in Rheumatoid
Disease
To the Editor:
We read with interest the letter by Zeman and
Scovern ( I ) , in which a patient with seropositive, nodular rheumatoid disease had pericardial tamponade controlled by pericardiocentesis and intrapericardial steroids. We previously reported (2) a patient with
rheumatoid arthritis who presented signs of pericardial
effusion that cleared promptly after pericardiocentesis
and intrapericardial steroids. During 4 years of subsequent followup this patient showed no evidence of
pericardial effusion or constriction.
Zeman and Scovern (1) question whether pericardial resection is mandatory therapy for rheumatoid
pericardial tamponade. The natural history in our case
(2) suggests that it may not be required. However, several years ago we encountered a patient with rheumatoid
pericardial tamponade resembling their patient. In this
case cardiac tamponade was initially controlled by pericardiocentesis and pericardial steroids. Within several
months however, intractable congestive heart failure necessitated pericardiectomy and epicardiectomy.
DUNCAN
A. GORDON,
M.D.
ANTHONY
J. RICHARDS,
M.B.
BARRYE. KOEHLER,
M.D.
IRVIN BRODER,M.D.
University of Toronto Rheumatic Disease Unit
Toronto Western Hospital and
The Gage Research Institute
Toronto M5 T 2S8 Canada
REFERENCES
1. Zeman RK, Scovern H: Intrapericardial steroids in treat-
ment of rheumatoid pericardial tamponade. Arthritis
Rheum 20: 1289- 1290, 1977
2. Richards AJ, Koehler BE, Broder I, Gordon DA: Rheumatoid pericarditis: comparison of Immunologic Characteristics of pericardial fluid, synovial fluid and serum. J
Rheumatol 3:273-282, 1976
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necrosis, land, coincidence, aseptic, thalassemia, minor
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