No abstract

Peripheral venous plasma concentrations of interleukin-6 were studied in 21 patients with active Crohn's disease, 20 patients with ulcerative colitis, and 16 control subjects. Interleukin-6 was detected in the plasma of 18 of 21 patients with Crohn's disease (median 47 (range <20-250) pg/ml) but in only two with ulcerative colitis and two control subjects. In the patients with Crohn's disease there was a significant negative correlation between the plasma interleukin-6 and the serum albumin concentrations. In eight patients with Crohn's disease and five patients with ulcerative colitis undergoing resection plasma from peripheral circulation and mesenteric vein draining diseased intestine was studied. Interleukin-6 was detected in seven of eight peripheral and mesenteric samples from the patients with Crohn's disease but was not detected in any of the samples from the patients with ulcerative colitis. There was no significant difference between mesenteric and peripheral samples in the concentrations of interleukin-6.

Introduction Despite vertebral fracture being a significant risk factor for further fracture, vertebral fractures are often unrecognised. A study was therefore conducted to determine the proportion of patients presenting with a nonvertebral fracture who also have an unrecognised vertebral fracture. Methods Prospective study of patients presenting with a non-vertebral fracture in South Glasgow who underwent DXA evaluation with vertebral morphometry (MXA) from DV5/6 to LV4/5. Vertebral deformities (consistent with fracture) were identified by direct visualisation using the Genant semi-quantitative grading scale. Results Data were available for 337 patients presenting with low trauma non-vertebral fracture; 261 were female. Of all patients, 10.4% were aged 50-64 years, 53.2% were aged 65-74 years and 36.2% were aged 75 years or over. According to WHO definitions, 35.0% of patients had normal lumbar spine BMD (T-score j1 or above), 37.4% were osteopenic (T-score j1.1 to j2.4) and 27.6% osteoporotic (Tscore j2.5 or lower). Humerus (n=103, 31%), radius-ulna (n=90, 27%) and hand/foot (n=53, 16%) were the most common fractures. For 72% of patients (n=241) the presenting fracture was the first low trauma fracture to come to clinical attention. The overall prevalence of vertebral deformity established by MXA was 25% (n=83); 45% (n=37) of patients with vertebral deformity had deformities of more than one vertebra. Of the patients with vertebral deformity and readable scans for grading, 72.5% (58/80) had deformities of grade 2 or 3. Patients presenting with hip fracture, or spine T-score ej2.5, or low BMI, or with more than one prior non-vertebral fracture were all significantly more likely to have evidence of a prevalent vertebral deformity (p<0.05). However, 19.8% of patients with an osteopenic T-score had a vertebral deformity (48% of which were multiple), and 16.1% of patients with a normal T-score had a vertebral deformity (26.3% of which were multiple). Following non-vertebral fracture, some guidelines suggest that anti-resorptive therapy should be reserved for patients with DXA-proven osteoporosis. However, patients who have one or more prior vertebral fractures (prevalent at the time of their non-vertebral fracture) would also become candidates for anti-resorptive therapy-which would have not been the case had their vertebral fracture status not been known. Overall in this study, 8.9% of patients are likely to have had a change in management by virtue of their underlying vertebral deformity status. In other words, 11 patients who present with a non-vertebral fracture would need to undergo vertebral morphometry in order to identify one patient who ought to be managed differently. Conclusions Our results support the recommendation to perform vertebral morphometry in patients who are

Interleukin 113 in biopsy specimens from inflamed colonic mucosa of patients with active inflammatory bowel disease was studied. Compared with normal colonic mucosal biopsy specimens, a significantly greater amount of interleukin ,13 was present in rectal mucosa before (median (range) 4*3 (2-0-11.8) v 119-2 (30.1-286.8) pg/mg; p<001) and produced during organ culture (39.1 (9.4-106-8) Interleukin 1 has been shown to be a mediator of a number of inflammatory and immunological responses." The precise mechanisms leading to inflammation in inflammatory bowel disease remain to be determined, however, and the mode of action of the therapeutically active drug 5-aminosalicylic acid is not clear. There are good reasons to believe that interleukin may be implicated in the pathogenesis of inflammatory bowel disease.' Its functional properties include T lymphocyte activation,4 enhanced antibody synthesis by B lymphocytes,5 and increased fibroblast proliferation.6 It induces adhesion molecules on endothelial cells which facilitate migration of polymorphonuclear leucocytes and mononuclear cells to sites of inflammation.7 It is also an endogenous pyrogen and induces synthesis of acute phase proteins by hepatocytes.2Enhanced production of interleukin 113 by mononuclear cells isolated from colonic mucosa with active inflammatory bowel disease has been shown.8 In the present study, we investigated whether the therapeutically active drug 5-aminosalicylic acid could inhibit interleukin 113 production by biopsy specimens from inflamed colons, and compared it with sulphapyridine (the therapeutically inactive moiety of sulphasalazine) and dexamethasone, whose effects on interleukin ,13 synthesis by monocytes have previously been characterised.9 We also evaluated the relation of interleukin 13 and thromboxane B2 and studied the effect of 5-aminosalicylic acid on basal synthesis of eicosanoids. Methods PATIENTSTwenty four patients with active ulcerative colitis (14 women, six men; median age 48 5 years (range 20-79)), two with active Crohn's disease (both women, aged 20 and 32 years), and 12 patients with normal colons (five women, seven men; median age 52 5 (range 27-81)) were studied. Biopsy specimens were obtained while these patients were undergoing colonoscopy for clinical reasons. The control group with normal colonic mucosa (confirmed on routine histology) were patients who were undergoing investigations for gastrointestinal symptoms and in whom no abnormality of the gastrointestinal tract was found.Eight patients with inflammatory bowel disease were being treated with sulphasalazine, seven with mesalazine, six with oral prednisolone, four with steroid enemas, and four with azathioprme.

This study confirms almost universal vitamin D inadequacy among 548 elderly patients admitted to hospital with hip fracture, regardless of whether a threshold of 50 nmol/L or 70 nmol/L was used. However, among a prospective subset of 50 patients with clinical fragility fractures, especially those with non-hip fractures, the prevalence of inadequacy was substantially lower. It may be that vitamin D represents a correctable risk factor for fragility fracture in the elderly, possibly specifically for the hip.