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SummaryOsteoporosis is a well recognized complication of ankylosing spondylitis (AS). This study indicates that increased bone turnover, inflammation, and low vitamin D levels are important in the pathophysiology of AS-related osteoporosis, and that bone turnover markers (BTM) are valuable markers to detect bone loss in AS.IntroductionThe aim of this study was to elucidate the pathophysiology of AS-related osteoporosis by investigating the relation between bone mineral density (BMD), BTM, vitamin D, and clinical assessments of disease activity and physical function, as well as to identify parameters that are related to low BMD (osteopenia or osteoporosis) in AS patients with active disease.MethodsOne hundred twenty-eight consecutive Dutch AS outpatients were included in this cross-sectional study. Bath AS Disease Activity Index (BASDAI), erythrocyte sedimentation rate (ESR), C-reactive protein, ASAS-endorsed disease activity score (ASDAS), Bath AS Functional Index (BASFI), bone formation markers procollagen type 1 N-terminal peptide (PINP) and osteocalcin (OC), bone resorption marker serum C-telopeptides of type I collagen (sCTX), 25-hydroxyvitamin D (25OHvitD), lumbar spine and hip BMD, and vertebral fractures were assessed. Z-scores of BTM were calculated using matched 10-year cohorts of a Dutch reference group to correct for the normal influence that age and gender have on bone turnover.ResultssCTX Z-score, OC Z-score, BASDAI, age, and gender were independently related to low BMD. In addition, PINP Z-score, ESR, 25OHvitD, age, and gender were independently related to sCTX and/or OC Z-score.ConclusionsThis study indicates that increased bone turnover, inflammation, and low vitamin D levels are important in the pathophysiology of AS-related osteoporosis. Furthermore, sCTX and OC Z-scores seem to be valuable markers to detect bone loss in AS patients in daily clinical practice where BMD of the lumbar spine, measured by DXA, may be overestimated due to osteoproliferation in patients with advanced AS.

We report the case of a 62-yr-old man who presented with Lyme pericarditis leading to cardiac tamponade shortly followed by an arthritis. IgM and IgG antibodies to Borrelia burgdorferi were demonstrated in serum by indirect immunofluorescence. Borrelia burgdorferi was demonstrated and identified in pericardial fluid by indirect immunofluorescence using serum from a patient with proven Lyme disease and by a monoclonal antibody immuno-gold silver stain. Spirochetes were also found in synovial biopsies using a silver stain. The tamponade was treated with pericardiocentesis; the arthritis was treated with intravenous ceftriaxone (2 g once daily) for 14 days. The patient recovered completely within days of commencing treatment. This case report demonstrates that borrelial infection may lead to pericarditis and cardiac tamponade.

clinics at Leeds General Infirmary over a two-week period were included in this observational study. Information recorded on a standard case report form included patient details, injection site, indication for injection and whether patients received a standard or an US-guided injection. Results Overall, 91 patients received 127 soft tissue and intraarticular corticosteroid injections. 17 patients (19%) were referred for an US-guided procedure and these patients received 26 injections (20% of total injections). The sites injected using US were small joints of the hands and feet (8), tendon sheaths (8), shoulder (4), hip (3), wrist (2) and sternoclavicular joint (1). Seven patients referred for US-guided corticosteroid injection (41%) reported a poor response to a previous standard injection. US was used to confirm the local diagnosis in 6 patients (35%) before a guided injection was performed. Conclusion The use of US to guide corticosteroid injections is increasing, especially in patients who have failed to respond to a standard injection. US is particularly useful when clinical diagnosis is uncertain or injection is technically difficult. As US becomes increasingly used in rheumatological practise, more rheumatologists may wish to learn the technique of US-guided injection which will require training. Further work is required to determine whether US-guided corticosteroid injection is of additional benefit to patients. REFERENCES 1 Karim Z, Wakefield RJ, Lawson C, et al. The impact of ultrasonography on the diagnosis and management of patients with musculoskeletal conditions. Arthritis Rheum. 2000;43:S299 2 Cicak N, Matasovic T, Bajraktarevic T. Ultrasonographic guidance of needle placement for shoulder arthrography.

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