Fibromyalgia is a complex problem in which symptoms of anxiety and depression feature prominently. Low levels of vitamin D have been frequently reported in fibromyalgia, but no relationship was demonstrated with anxiety and depression. Seventy-five Caucasian patients who fulfilled the ACR criteria for fibromyalgia had serum vitamin D levels measured and completed the Fibromyalgia Impact Questionnaire (FIQ) and Hospital Anxiety and Depression Score (HADS). Deficient levels of vitamin D was found in 13.3% of the patients, while 56.0% had insufficient levels and 30.7% had normal levels. Patients with vitamin D deficiency (<25 nmol/l) had higher HADS [median, IQR, 31.0 (23.8-36.8] than patients with insufficient levels [25-50 nmol/l; HADS 22.5 (17.0-26.0)] or than patients with normal levels [50 nmol/l or greater; HADS 23.5 (19.0-27.5); Kruskal-Wallis ANOVA on ranks p<0.05]. There was no relationship with global measures of disease impact or musculoskeletal symptoms. Vitamin D deficiency is common in fibromyalgia and occurs more frequently in patients with anxiety and depression. The nature and direction of the causal relationship remains unclear, but there are definite implications for long-term bone health.

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Objective: To investigate the efficacy of corticosteroid injections into the carpometacarpal joint of the thumb (CMCJ) in patients with osteoarthritis. Design: A double blind, randomised controlled trial using 40 hospital referred patients with CMCJ osteoarthritis who received intra-articular injections of 5 mg triamcinolone hexacetonide (0.25 ml) or sterile 0.9% saline (0.25 ml). Injections were given under imaging control. Main outcome measures: The primary outcome was improvement in a pain visual analogue score (VAS) of 20% at 24 weeks. In addition patients were assessed at 4, 12, and 24 weeks for joint stiffness, joint tenderness, and physician and patient global assessments. Hand radiographs were evaluated for the degree of CMC joint space narrowing and marginal osteophytes according to the OARSI atlas. Results: Baseline clinical variables were not significantly different between the two treatment groups. There was no improvement in the VAS of pain at 24 weeks. At each assessment point there was no significant difference between the steroid and placebo groups in median values for joint stiffness, joint tenderness, or patient and physician global assessments. Non-parametric analysis of each group individually revealed statistically significant improvements in patient and physician global assessments at weeks 4, 12, and 24 in the placebo group and at weeks 4 and 12 in the steroid group. Conclusions: No clinical benefit was gained from intra-articular steroid injection to the CMCJ in moderate to severe osteoarthritis compared with placebo injection.T he carpometacarpal joint (CMCJ) of the thumb is commonly targeted by the osteoarthritic process. The condition occurs both as a localised form of osteoarthritis and as part of generalised nodal osteoarthritis. Estimates of the prevalence of the disorder show a female preponderance with a ratio of 1:3 between men and women.1 A recent study showed that 25% of patients with hand osteoarthritis had isolated evidence of CMCJ osteoarthritis, while it was present as part of nodal osteoarthritis in 53% of cases.2 Several factors have been associated with the development of degenerative changes in the CMCJ, including increased thumb base joint laxity 3 and greater grip strength. 4The general principles for management of CMCJ osteoarthritis follow those for peripheral joint osteoarthritis in general. No specific guidelines on the treatment of this form of osteoarthritis exist, but the recommended options include the use of a combination of simple analgesia, muscle strengthening physiotherapy, and a thumb spica splint together with intra-articular injections of corticosteroid.

Objective: To propose e-learning methods that address the fundamental problems related to sonographic training in rheumatology. Methods: The project was designed for rheumatologists with strong motivation to learn ultrasound. A modular approach was constructed, consisting of a basic 3-day residential course, followed by a 6-month period of web-based tutoring, and culminating in a final 2-day residential course with a formal assessment of competency. Results: The website (http://www.e-sonography.com) was accessed by all 60 participants. A mean of 20 (range 10-80) log-on sessions were registered for each participant, and a mean of 250 min (range 60-600 min) of web access was recorded. A total of 163 sonographic images were submitted by 18 (30%) participants. The majority of the images focused on the following anatomical areas: shoulder 49 (30%), hand 34 (21%) and knee 20 (12%). A total time investment of approximately 14 h was made by the US tutors over the 6-month period for interaction with the participants. Conclusions: The e-learning methods described in this report represent the first attempt to adopt a novel technique to circumvent several of the inherent barriers to the many facets of teaching musculoskeletal ultrasound to a wide audience. S onographic training in rheumatology is considered by many to be a virtually endless process, and currently there is no agreement between recognised experts on the best approach to adopt. [1][2][3][4][5][6] In recent years, several proposals have been put forward with the aim of addressing the specific difficulties encountered by rheumatologists training in ultrasonography (US). [7][8][9] Direct supervision by an expert is universally recognised as a core element for appropriate training in US. Unfortunately, this approach is beset with logistical difficulties in terms of the relative lack of recognised tutors together with constraints on time for both tutor and student.The primary aim of this report is to propose methods that directly address these fundamental problems in a web-based approach. As a secondary aim, we endeavoured to provide an overall assessment of clinical US competency. METHODSThe project was designed for rheumatologists with strong motivation to learn US and was advertised in all Italian rheumatology departments. A modular approach to training was constructed, consisting of a basic 3-day residential course, according to the standard provided by The European League Against Rheumatism (EULAR) sonography courses, followed by a 6-month period of web-based tutoring and culminating in a final 2-day residential course with a formal assessment of competency. The basic courseThe introductory basic US course was organised for a total of 60 rheumatologists from all over Italy. The main aim of the introductory course was to convey basic knowledge in clinical US. The programme included lectures and practical sessions with healthy subjects and patients with rheumatic disease. Dedicated presentations were given related to the eight anatomical sites indicated in the p...

Our results provide evidence in favour of the hypothesis that clinical examination is far from optimal for assessing joint inflammation in patients with early RA. Furthermore, this study suggests that US can considerably improve the detection of signs of joint inflammation both in terms of sensitivity and reliability.