In order to analyse the clinical characteristics and the principal causes of osteoporosis in men, 81 osteoporotic males from an out-patient rheumatology department were studied. Bone mass assessment, automated biochemical profile and biochemical markers of bone turnover were performed in all patients, and hormonal measurements were taken when a specific aetiology was not readily apparent. Sixty-three men (78%) had secondary osteoporosis and 18 (22%) primary osteoporosis. Secondary causes of osteoporosis included hypogonadism (12 patients), corticosteroid therapy (10 patients) and alcoholism (10 patients); the remaining patients had various causes of osteoporosis. Eighteen patients had primary osteoporosis, eight of them with associated hypercalciuria. Normocalciuric patients showed lower 25-hydroxyvitamin D and 1-25-hydroxyvitamin D levels than the control group, whereas hypercalciuric patients had lower parathyroid hormone and renal threshold for phosphate excretion. In 69 patients (85%), back pain was the chief complaint. Forty-five of these 69 patients (65%) had chronic back pain and 24 (35%) had subacute episodes. Fifty per cent of the patients with chronic back pain had vertebral fractures. Both patients with and without chronic back pain were found to have a similar number of vertebral fractures. In conclusion, male osteoporosis is frequently associated with major risk factors. Patients with primary osteoporosis may have associated hypercalciuria or decreased vitamin D levels. However, not all the patients for whom back pain was the chief complaint were found to have vertebral fractures.

In August 2003, an outbreak of scombroid fish poisoning occurred at a retreat centre in California, USA. In a retrospective cohort study, 42 (75%) of the 56 dinner attendees who ate escolar fish (Lepidocybium flavobrunneum) met the case definition. Individuals who ate at least 2 oz of fish were 1.5 times more likely to develop symptoms than those who ate less (relative risk 1.5, 95% confidence interval 0.9-2.6), and to develop more symptoms (median 7 vs. 3 symptoms, P = 0.03). Patients who took medicine had a longer duration of symptoms than those who did not (median 4 vs. 1.5 h, P = 0.05), and experienced a greater number of symptoms (median 8 vs. 3 symptoms, P = 0.0002). Samples of fish contained markedly elevated histamine levels (from 2000 to 3800 ppm). This is one of the largest reported outbreaks of scombroid fish poisoning in the United States and was associated with a rare vehicle for scombroid fish poisoning, escolar.

The authors examined sexual behaviors, the seroprevalence of human immunodeficiency virus type 1 (HIV-1), and condom use among 2,314 homosexual and bisexual men tested during 1988-1989 at the AIDS (acquired immunodeficiency syndrome) National Center in Mexico City. Bisexuals constituted 24% of the sample; the seroprevalence rate was lower for bisexuals than homosexuals (21 vs. 34%). In logistic regressions, HIV-1 seropositivity was independently related to age, education, pattern of insertive/receptive behavior in anal sex, lifetime number of male sex partners, having sex with someone with AIDS, homosexual versus bisexual behavior, and a history of condyloma. The same logistic regressions were found to fit bisexuals and homosexuals. The rate of HIV-1 was reduced in individuals who indicated always requiring their partners to use a condom when practicing receptive anal sex (1% of the total). The most common practice for both homosexuals and bisexuals was "mixed" behavior (i.e., both insertive and receptive anal sex); this was also the practice with the highest risk. Bisexuals practiced both vaginal and anal sex with women and reported little condom use. The substantial seroprevalence among bisexuals, their frequent sexual contact with women, and their low rate of condom use imply a continuing role as a bridge of infection to females. Whether this risk will lead to a sustained heterosexual epidemic remains to be determined.

Background Over the past decade, the off-label use of biologic agents such as TNF-a antagonists has improved the treatment armamentarium for refractory immune-mediated uveitis, with particular success in Behçet’s disease associated uveitis. Objectives To assess the long-term efficacy and safety of TNF-a antagonists (infliximab, [IFX]; adalimumab, [ADA]; and golimumab [GLM]) for the treatment of patients with Behçet’s disease (BD) and uveitis who failed to respond or did not tolerate conventional immunosuppressive (IS) treatment. Methods Retrospective study of patients with Behçet’s uveitis treated with anti-TNF therapy in four tertiary referral hospitals of Spain. Data analyzed were the following: demographic characteristics, disease duration and type of uveitis; best-corrected visual acuity (BCVA); previous treatments; type, regime and duration of each biological agent used; outcomes (remission, loss of efficacy, number of uveitis attacks). Results We included 59 eyes of 32 patients (16 males; mean age, 39±11.9 years old) with BD and refractory uveitis. Mean disease duration was 6.4±4.8 years. 18 patients (56.3%) were HLA-B51 positive. 66% of patients had panuveitis, 25% posterior, 6% anterior, and 3% intermediate uveitis. 84% of patients had bilateral ocular involvement. All patients received oral corticosteroids, and 63% had received ≥2 IS drugs at baseline. 25 patients (78%) were treated with IFX and 7 (22%) with ADA as initial therapy. 11/25 patients treated initially with IFX were switched to another anti-TNF agent due to adverse events (3 patients), loss of efficacy (3), patient’s choice (1), or uveitis relapse after IFX withdrawal (4): 9/11 were switched to ADA and 3/11 to GLM. Globally, 16/32 patients were treated with ADA and 3 with GLM. IFX was infused for a mean of 16.6 months (range, 2-48), ADA was administered for a mean of 30.2 months (range, 3-52), and GLM was given for a mean of 4 months (range, 3-6). Mean follow-up was 77.3 months (range, 8-276). 28 (87%) achieved uveitis remission. 12/32 patients were able to discontinue all systemic IS and CS. BCVA remained stable or improved in 53/59 eyes. Mean BCVA improved from 0.2±0.6 to 0.5±0.2 (p<0.05), and ocular attacks per year dropped from 37 in the year before therapy to 5 at final follow-up visit (p<0.05). 3 serious adverse events requiring IFX withdrawal were reported: 1 severe infusion reaction, 1 disseminated tuberculosis, and 1 prostatitis. Conclusions Anti-TNF agents are effective biological drugs for the treatment of Behçet’s uveitis. Treatments were generally well tolerated and only 3 patients required withdrawal. Disclosure of Interest: None Declared

Secondary amyloidosis is a well recognised complication of rheumatic diseases, but the association with systemic lupus erythematosus is very unusual. We report the case of a patient with systemic lupus erythematosus who developed proteinuria due to renal amyloidosis. We also review the cases previously reported and the hypothesis on the pathogenic mechanisms.