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Arthritis & Rheumatism
Official Journal of the American College of Rheumatology
William P. Arend, MD
University of Colorado Health
Sciences Center, Box B-117
4200 East Ninth Avenue
Denver, CO 80262
Clinical Associate Editor
Sterling G. West, MD, Denver
Associate Editors
J. Woodruff Emlen, MD, Denver
Richard Hamman, MD, DrPH, Denver
V. Michael Holers, MD, Denver
J. Roger Hollister, MD, Denver
Halsted R. Holman, MD, Palo Alto
Ray Kilcoyne, MD, Denver
Brian L. Kotzin, MD, Denver
Jerome Wiedel, MD, Denver
Advisory Editors
Steven B. Abramson, MD, New York
Carlos A. Agudelo, MD, Atlanta
Paul J. Anderson, MD, PhD, Boston
Balu H. Athreya, MD, Philadelphia
Robert M. Bennett, MD, Portland
Ferdinand C. Breedveld, MD, Leiden
Peter Brooks, MD, FRACP, Sydney
Jill P. Buyon, MD, New York
Steven E. Carsons, MD, Mineola
Thomas R. Cupps, MD, Washington
Lawren H. Daltroy, DrPH, Boston
Maxime Dougados, MD, Pans
Marc Feldmann, MB, BS, PhD, London
Gary S . Firestein, MD, Sun Diego
Jorg J. Goronzy, MD, PhD, Rochester
Arthur P. Hall, MD, Boston
David A. Horwitz, MD, Los Angeles
Osvaldo Hubscher, MD, Buenos Aires
Consultant Biostatistician
Anna E. B a r h , PhD, Denver
Committee for the Publication of A&R
David A. Fox, MD, Chair, Ann Arbor
Ellen M. Gravallese, MD, Boston
Nancy J. Olsen, MD, Nashville
Joel M. Kremer, MD, Albany
Paul H. Plotz, MD, Bethesda
Carolyn L. Yancey, MD, Landover
Editorial Staff
Jane S. Diamond, MPH, Managing Editor, Atlanta
Patricia K. Higgins, Assistant Managing Editor, Atlanta
Lesley W. Allen, Manuscript Editor, Atlanta
Angela M. Wiens, Editorial Assistant, Atlanta
Virginia A. Frazer, Assistant Editor, Denver
Elisa C. Schulz, Production Editor, Philadelphia
Gunnar Husby, MD, Oslo
Joachim R. Kalden, MD, Erlangen
Jeffrey N. Katz, MD, Boston
Klaus E. Kuettner, PhD, Chicago
Edward V. Lally, MD, Providence
Pierre Miossec, MD, PhD, Lyon
Roland W. Moskowitz, MD, Cleveland
Haralampos M. Moutsopoulos, MD, Zoannina
Jacob B. Natvig, MD, Oslo
Gerald T. Nepom, MD, PhD, Seattle
Kusuki Nishioka, MD, Kawasaki
Nancy J. Olsen, MD, Nashville
Gabriel S. Panayi, MD, MRCP, London
Christine Parker, MD, Boston
Jean-Pierre Pelletier, MD, Montreal
Michelle Petri, MD, Baltimore
Rosalind Ramsey-Goldman, MD, DrPH, Chicago
Thomas J. Schnitzer, MD, PhD, Chicago
Yuichi-Y Shiokawa, MD, Tokyo
Leonard H. Sigal, MD, New Brunswick
Alan J. Silman, MD, Manchester
Josef S. Smolen, MD, Vienna
Leon Sokoloff, MD, Stony Brook
Alan M. Solinger, MD, Sun Diego
Virginia D. Steen, MD, Pittsburgh
Robert Terkeltaub, MD, Sun Diego
Daniel E. Tracey, PhD, Cambridge
L.B.A. van de Putte, MD, Nijmegen
Wim B. van den Berg, PhD, Nijmegen
Michael H. Weisrnan, MD, Sun Diego
Cornelia M. Weyand, MD, PhD, Rochester
Patience H. White, MD, Washington
H. James Williams, MD, Salt Luke City
Frederick Wolfe, MD, Wchita
Moms Ziff, PhD, MD, Dallas
Arthur L. Weaver, MD, Lincoln, President
William J. Koopman, MD, Birmingham, First Vice-president and President-Elect
Ronald L. Kaufman, MD, MBA, Los Angeles, Secretary-Treasurer
Mark Andrejeski, Atlanta, Executive Vice-President
Published for the College by Lippincott-Raven Publishers
Arthritis & Rheumatkm (ISSN 0004-3591) is published monthly for the American College of Rheumatolo by Lippincott-Raven Publishers, at 12107
Insurance Way, Hagerstown, MD 21740. Business offices are located at 227 East Washington Square, PhiladelpKa, PA 19106. Printed in the USA. Copyright
0 1996 by the American College of Rheumatology, Atlanta, Georgia. Printed on acid-free paper effectivewith volume 32, number 11. Periodicals postage paid
at Hagerstown, Maryland, and additional mailing offices.
Subscription information, orders, or nonmember changes of address: (except Japan) 12107 Insurance Way, Hagerstown, MD 21740, or call 1-800-638-3030.
In Japan, contact Igaku-Shoin, Ltd, 1-28-36 Hon 0,Bunkyo-ku, 113 Tokyo, Japan. Members’ changes of address, American College of Rheumatology, 60
Executive Park South, Suite 150, Atlanta, GA 30!29.
Annual subscription rates: US.: $135.00 individual, $210.00 institution;special residenthtudent rate $65.00. Canada and Mexico: $190.00 individual, $235.00
institution; special residenthtudent rate $93.00. The Canadian GST tax of 7% will be added to the subscription price of all orders shipped to Canada.
Lippincott-Raven Publishers’ GST identification number is 130876246. All other countries (except Japan): $215.00 individual, $260.00 institution; special
residenthtudent rate $118.00 (prices include $25.00 air freight delivery; air freight delivery occurs within 7-21 days worldwide). Single copies $21.00, except
for special issues. (Rates are subject to change.) Copies will be replaced without charge if the publisher receives a request.within 90 days of the mailin date,
both in the U.S. and worldwide. International subscriptions must be prepaid. In Japan, contact Igaku-Shoin, Ltd., 1-28-36 Hongo, Bunkyo-ku, 113 gokyo,
Japan. The views and recommendations expressed in articles, letters, and other communications ublished in Arthritis & Rheumatism are those of the authors
and do not necessarily reflect the opinions of the editors, publisher, or American College of Ifheumatology. The publisher and the American Colle e of
Rheumatology do not investigate the information contained in the classified advertisements in this journal and assume no responsibility concerning tiem.
Further, the publisher and the American College of Rheumatology do not arantee, warrant, or endorse an product or service advertised in this journal.
POSTMASTER Send address changes to ARTHRITIS & RHEUMATISzP.0. Box 1550, Hagerstown, MA 21741.
8 Text printed on acid-free paper.
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