The intrafamilial transmission of rheumatoid arthritis: an unusual study.

THE SET of seven papers which follow constitutes a report which in its design complements the more common type of clinical investigation. The study sets out specifically to examine a pair of hypotheses: that rheumatoid arthritis is in part determined by a genetic mechanism and is in part determined by social effects within the family. The study uses a carefully validated and thrice repeated interview to classify people with regard to rheumatoid arthritis. This interview technique is essential for it would be quite impossible to examine the widely distributed relatives of a national sample of arthritics. The experimental design compares the frequency of rheumatoid arthritis in first degree relatives, who share one half of their genes with the key persons with arthritis, with the frequency in second degree relatives, who share one eighth of their genes, and with the frequency in unrelated persons, who share only a negligible percentage of their genes. The study also tackles the psychological side of rheumatoid arthritis with quantitative measuring instruments. The results of the studies support the findings in the clinical literature which are well summarized in a book not widely enough known [l]. Only those working at the boundary between medicine and social science will find what follows a fully familiar territory. Others may find much of the material is hard and slow reading. Also, measurement in social psychology has not yet reached the stage where crucial variables have been identified and adequate operationalizations agreed upon. Under such circumstances, it is desirable to take multiple bearings on a single variable and to try expecially hard to rule out the possibility that the relationships uncovered may be spurious. The reader who persists will find: (1) No evidence to support a genetic hypothesis, plus a discussion of the ways we may have been misled into believing that this was a familial disease. (2) A pattern of associations in women which suggests that possibly the following sequence of events might contribute to rheumatoid disease: parental status stress (i.e. discrepancy between the several status indicators of mother and father), to mother’s arbitrary treatment of daughter, to daughter’s resentment as child and chronic anger as adult, to daughter’s rheumatoid arthritis. The associations are not strong enough to suggest that this pattern is necessarily a major contributing factor for the disease; on the other hand, the time relationships in the above sequence are so suggestive that alternate interpretations-such as that the daughter’s arthritis