RSI — a psychogenic disorder?

It is with some interest that this reviewer, a clinical and investigative rheumatologist who is too young to have experienced the height of the repetitive strain injury (RSI) epidemic, finds himself being asked by the Medical Journal of Australia to report on independent medical examiner and forensic psychiatrist Yolande Lucire’s popularisation of her 1996 PhD thesis. Dr Lucire was a significant critic during the 1980s epidemic and still believes that the Medical Journal of Australia should have withdrawn several of the articles it published, and through which it irresponsibly contributed to the epidemic.

It is clear that attitudes remain acrimonious and polarised on these matters. Dr Lucire continues in her view, even in the “endemic” period of recent years, that RSI is entirely a psychogenic disorder due to somatisation of psychosocial distress. As evidence, she relates the results of her PhD. This was a retrospective case study review of 100 (out of 319) randomly selected RSI patients who had been referred to her for an opinion between 1984 and 1991. She used census statistics for controls, and found that virtually all the patients had one or more personal problems or disruptive life events close to the time of seeking compensation. She also impressively reviews the historical forces of the time, highlighting the lack of correlation between workload and symptoms, and the persistent absence of objective abnormalities.

Hers may have indeed been the most robust investigation of the RSI phenomenon possible for the epidemic, but it is tragic that no serious follow-up study of RSI sufferers has ever been performed. Moreover, a diligent Medline search will reveal more recent contrary epidemiological data and growing evidence for peripheral and central neural changes, at least some of which might not be reversible. The jury remains out as to whether RSI is just somatisation.

Richard A KwiatekRheumatologist Queen Elizabeth HospitalAdelaide, SA