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RHEUMATOID arthritis is a highly complex, systemic inflammatory disease of unknown etiology [1]. Its pathogenesis is multifactorial, involving mechanisms related to gender, immunogenetics, microvascularity, neurohormonal systems and sex hormones (e.g. pregnancy) [1,2]. Major biological inter-relationships which are being discovered among such regulatory systems of the body [3] promise to elucidate essential biological and clinical characteristics of this mysterious disease. Additionally, analytical epidemiological investigations which are identifying distinguishing patterns of RA within populations may offer clues to its possible host, agent and environmental determinants [1]. In this issue, Symmons et al. [4] describe the incidence of RA in the Norwich Health Authority (NHA), utilizing data derived from a longitudinal population based register. The study represents an important effort to derive reliable incidence rates of RA in a large Anglo-Saxon population (around 485 000). The initial results [4] reveal significant age-sex interaction patterns which may reflect fundamental host determinants of disease. These and other incidence data (see below) may be consistent with a role of androgenic-anabolic (AA) steroid deficiency in the pathogenesis of RA. Incidence of disease is defined epidemiologically as the rate of onset of a specified condition within a defined population during a particular time period. Prevalence of disease is more simply defined as the ratio or proportion of persons affected with the specified condition in a defined population at a particular time [1]. At equilibrium, the incidence (/) times mean duration (D) of disease equals prevalence (P), i.e.

rheumatology

INCIDENCE OF RHEUMATOID ARTHRITIS: DO THE OBSERVED AGE-SEX INTERACTION PATTERNS SUPPORT A ROLE OF ANDROGENIC-ANABOLIC STEROID DEFICIENCY IN ITS PATHOGENESIS?