Aggressive treatment of severe LN and the use of CyA as a steroid-sparing agent may have protective effects against premature atherosclerosis.

DESCRIPTIONThe patient was a 74-year-old gentleman with underlying palmoplantar psoriasis ( fi gure 1 ). He was electively admitted for left below knee amputation for cutaneous squamous cell carcinoma at his left heel with locoregional spread. He was incidentally found to have symmetrical shortening of his fi ngers. On further questioning, we discovered that this had occurred over a period of 5 years. He had no joint pain, symptoms of Raynaud phenomenon or traumatic hand injury. On examination, there was symmetrical shortening of the distal phalanges with loss of nails in most of the digits ( fi gure 2 ). Connective tissue screening was negative for antinuclear antibodies, rheumatoid factor and anti topoisomerase I. Radiograph of the hands showed terminal resorption of the distal phalanges that is, acroosteolysis. There were no erosions of the articular surfaces ( fi gure 3 ). The radiographs of his feet were normal. Acroosteolysis is a recognised radiological fi nding in psoriatic arthropathy; which may precede psoriasis by years. 1 The other wellestablished aetiologies of acroosteolysis are scleroderma, frostbite and hyperparathyroidism. This case highlights the occurrence of psoriatic acroosteolysis in the absence of psoriatic arthropathy. To the best of our knowledge, this is the second reported case of its kind. 2 In 1959, Buckley et al reported a case of psoriasis with progressive osteolysis following trauma. This was thought to be linked to Koebner phenomenon which is known to occur following physical stimuli. 3 This case differs from that as there were no identifi able triggers. Till today, the pathogenesis involved in the osteolytic process remains unknown.

Prevalence of diastolic dysfunction in the rheumatoid arthritis group (47.2%) was not different from controls (50.9%). LV diastolic function had no significant correlation with RA disease severity and duration of disease.

More lupus specific factors were independently associated with thickened CIMT, suggesting that a multi-targeted approach of treatment addressing both the lupus and traditional cardiovascular risks are very important. Larger prospective studies of these special risk factors are indicated.

Manifestasi ekstra artikular rheumatoid arthritis (RA) adalah penyakit paru-paru interstisial (ILD). RA berkaitan ILD (RA-ILD) dikaitkan dengan morbiditi dan mortaliti yang ketara. Objektif utama kajian ini adalah untuk menentukan korelasi antara serotype faktor rheumatoid (RF) dan keterukan RA-ILD berdasarkan penemuan tomografi komputer (CT). Kami telah mendapatkan sejumlah 100 pesakit RA yang diuji untuk IgA RF, IgG RF dan IgM RF dan melalui imbasan CT dada resolusi tinggi. Tujuh puluh dua pesakit mempunyai perubahan ILD pada HRCT dada dan dimasukkan ke dalam kajian ini. Kami mendapati bahawa skor CT bagi "ground glass" menunjukkan korelasi positif yang signifikan dengan tempoh penyakit dan paras IgA manakala skor fibrosis mempunyai hubungan yang signifikan dengan kovariat-kovariat; usia, tempoh penyakit, tahap IgA, tahap IgG dan tahap anti-CCP. Pada analisis multivariat, hanya tahap IgA sahaja yang ketara (p<0.05, pekali beta standard = 0.604) yang dikaitkan dengan skor "ground glass". Bagi skor fibrosis, tahap dan umur IgA adalah prediktor bebas berdasarkan analisis multivariat, dengan skor <0.05 dan 0.02, masing-masing. Sebagai kesimpulan, IgA RF adalah satu-satunya serotype yang secara bebas dikaitkan dengan keterukan RA-ILD.