HE OCCURRENCE of the L.E. cell phenomenon has given the clinician T a valuable laboratory tool in the diagnosis of systemic lupus erythematosus.The original work and many subsequent publications have shown that the L.E. cell preparation possesses a high degree of Nevertheless, this phenomenon has been reported in diseases that are not generally considered to have a relationship to systemic lupus. These include myelomatosi~,~ pernicious anemia,8 fungus infections,DJn miliary tuberculosis,ll leukemia,I2 dermatitis herpetiformis,8 cirrho~is,'~ hepatitis,'* ulcerative colitis,I and certain drug reactions, such as those sometimes following hydralizine,16 penicillinI0 and h~dant0in.l~ Other diseases that may bear a more subtle relationship to systemic lupus erythematosus have also been observed to produce these cells. This group includes chronic glomerulonephritis,ls Senear-Usher pemphigus,lB thrombocytopenic purpura,20 acute hemolytic anemia, discoid lupuse and rheumatoid arthriti~.~*-2~ This report is a resume of our experience with the occurrence of L.E. cells in the blood of patients who have rheumatoid arthritis. CLINICAL MATEFUALS AND METHODSTwo years ago 45 patients with clinically active rheumatoid arthritis were surveyed to determine the number demonstrating L.E. cell phenomena in concentrated preparations of bone marrow. These patients, under therapy for rheumatoid arthritis, were taken at random. They represented the first 45 who consented to sternal puncture. Ages in the groiip ranged from 29 to 87, with an average age of 45.2 years and a median age of 45. The duration of the disease vaned from 6 months in the earliest case treated to over 35 years. Two patients were in Stage I or early disease, one advanced from Stage 111 to Stage IV during the two year period, and the remaining patients were in Stage I1 and 111.

N WORDING this topic, the Editor has invited a nice distinction. There I is no definitive therapy for rheumatoid arthritis, if indeed this polymorph disease proved to be a single entity. But we are usually agreed on what constitutes a rheumatoid patient, and we firmly think that we can help most of them though we cannot promise or prove it. Within these limits, what are the goals we may reasonably pursue in their management? AIMSOne predictable result over the long stretch is a fair capacity for useful work and social function. Hence our first and abiding concern should be the maintenance of the patient's socio-economic integrity by the prevention of crippling deformities and the adjustment of occupational problems. As a corollary, the correction of existing handicaps is a goal of high order because the majority of all disabled patients, even of those in Class IV, can be advanced by one or more functional classes.Next in feasibility is the arrest or moderation of rheumatoid disease in specific joints or other organs. Anatomically limited lesions do cause general disability and are usually amenable to protective, suppressive or corrective therapy. Yes, we should manage the total patient but we should not overlook the potential of topical treatment to some joints or areas whose involvement impairs general function more than do ordinary degrees of systemic virulence.The most desirable aim, but the least certain, is the defervescence of rheumatoid arthritis as a general disease of connective tissue. Evidently, rheumatoid arthritis may become arrested or inactive. Of a group of patients in all stages who have currently active disease and whose arthritis has a mean duration of 5 years, between one-fifth and one-third will experience a remission. Although this experience stems entirely from patients receiving various types of treatment, there is no proof that it is due to treatment. Presumably, the natural course of early, subdiagnostic rheumatoid disease has an even higher rate of remission, unrelated to medical management. But the lack of an agent which will reliably cause rhemuatoid disease to abate and the lack of proof for any medical management to modify its long-term course do not invalidate therapeutic attempts at control by safe means. BASIC MODALITIES

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