How does the rheumatologist respond to the report by Remington et al1 of three patients with Reye syndrome who were treated with aspirin for juvenile rheumatoid arthritis? It is not an easy matter. Although juvenile rheumatoid arthritis is an infrequent disease and Reye syndrome is an unusual complication of salicylate therapy and viral disease, it seemed inevitable that both events would happen in rare patients. Should the report by Remington et al1 cause even more concern because of the possibility that salicylate-treated arthritic children are at increased risk?
If one examines the statistics in the report, one cannot quarrel with the mathematics, provided one can accept the numerator three as being a sample of a greater universe rather than an unusual cluster not representative of the whole. Some clusters have been useful and should not be dismissed. For instance, in Lyme arthritis and legionnaires'