In a group of 30 black and 30 white healthy workers, matched for age, sex and body weight, serum creatine kinase was significantly higher in black males than in white males (P less than 0.01). Seventeen blacks but only four whites had levels above the accepted upper limit of normal of 195 IU/l. There was no correlation with lean body mass. Elevation of serum creatine kinase need not signify disease in blacks, for whom a separate reference range should be established. Two cases are reported of physically healthy black men subjected to unnecessary investigation on the basis of persistently elevated serum creatine kinase.

SUMMARY We describe a case of systemic sclerosis with sympathetic and parasympathetic neuropathy and detail autonomic testing in six further patients. Of these six patients, three showed early parasympathetic damage. None of the patients had evidence of peripheral neuropathy, and there was no correlation between the presence of autonomic dysfunction and the severity of Raynaud's phenomenon.Autonomic neuropathy has not previously been reported in systemic sclerosis to our knowledge. Autonomic neuropathy has been described in rheumatoid arthritis1 2 and systemic lupus erythematosus,3 and impotence was recently described in systemic sclerosis4 but without formal studies of autonomic function. Other neurological manifestations of systemic sclerosis have been described but are rare. A mild peripheral neuropathy has been reported.5 6 as has trigeminal neuralgia.7-9Subacute combined degeneration of the cord following vitamin B12 deficiency secondary to sclerodermatous involvement of the small intestine has also been recorded.10We describe a patient with systemic sclerosis and autonomic neuropathy and detail our investigation of the autonomic nervous system in six other patients with scleroderma and eight control patients.

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SUMMARY The incidence of erosive arthropathy of the sternoclavicular joints in 25 consecutive cases of polymyalgia rheumatica was studied by means of sternoclavicular tomography. Definite erosions were found in 11 patients. Erosions were most likely to be found in patients whose symptoms had been present for more than 6 months. The occurrence of an erosive arthropathy in PMR is even more controversial. Only 2 authors have reported a significant incidence of radiographic erosions. Andrews' found sclerosis and/or erosions of the sacroiliac joints in 11 of 27 patients with PMR. Bruk3 found radiological erosions in 17 of 80 patients with PMR. The joints most commonly involved were the pubic symphysis and the sacroiliac joints. Sternoclavicular erosions were found in 5 cases, but attention was drawn to the difficulty of interpreting plain radiographs of these joints. Despite these 2 studies the occurrence of an erosive arthropathy in PMR has not been generally accepted.10 11

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