Radiologic changes of ischial tuberosity in ankylosing spondylitis.

The objective of the paper was to emphasize the meaning of involvement of ischial tuberosity in ankylosing spondylitis, enriching the clinical picture of the disease and pointing to ankylosing spondylitis, especially when sacroiliitis is absent or less developed. Radiologic examination of ischial tuberosity was performed in 68 patients with different developmental stages of ankylosing spondylitis. There were 66 (97%) men and two (3%) women, aged 30 to 56 years. Anteroposterior radiographs of the pelvis were performed in all patients and independently assessed by two radiologists. The radiologic changes of ischial tuberosity were classified into four stages: 1) stage of minimal changes, 2) stage of destructive changes, 3) stage of reconstructive changes, and 4) stage of ossification of tendon fibers in the form of rumpled tufts. Radiologic changes of enthesitis were found on ischial tuberosity in 31 patients (45.5%, p < 0.01). Stage 1 or minimal changes were found in two (6.5%); stage 2 or destructive changes in 13 (42.0%); stage 3 or reconstructive changes in 11 (35.5%) and stage 4 or "tufts phenomenon" in five (16.0%) patients. The classification of changes is useful for the assessment of disease range and progression as well as for the diagnosis when sacroiliitis is obscurely developed and other radiologic signs are not present.

Primary hypertrophic osteoarthropathy: clinical, radiologic, and scintigraphic characteristics.

BACKGROUND: Our aim was to establish clinical and imaging characteristics of primary hypertrophic osteoarthropathy (PHO). METHODS: A group of 76 patients (71 men and 5 women) with primary hypertrophic osteoarthropathy was examined. Extensive history and status of the locomotor system were determined in all patients. Radiologic and scintigraphic examinations of the bones, thermography, capillaroscopy, gastroscopy, and histologic analysis were also performed. RESULTS: Family history was positive in all 55 patients (100%) summoned for a check-up. Finger clubbing of the hands and feet as well as positive Schamroth test were found in all patients, while hyperhydrosis was found in 65 (85.5%), seborrhea in 39 (51%), and involvement of the joints in 52 (68.5%) patients. Histologic analysis in 18 (23.7%) patients predominantly showed periarticular edema and moderate cellular activity. Periostosis of the long bones was also found in all patients, while scintigraphy, performed in 44 patients, was positive in 18 (33.5%) patients in the active phase of the disease. Thermography, performed in 10 patients, ranged from hypothermia to thermal amputation of feet and hands. Capillaroscopy of hands and feet in 47 (61.8%) patients showed changes in small blood vessels. Gastroscopy indicated abnormalities (ulcer and hypertrophic gastritis) in 21 patients (27.6%). CONCLUSIONS: PHO has special clinical and radiographic manifestations (finger clubbing and periostosis of the long bones) that are associated with some minor manifestations. Development of the disease is gradual (to 20 years) and requires a special diagnostic assessment.

Reactivation of primary hypertrophic osteoarthropathy by bronchogenic carcinoma.

This paper reports 2 cases of primary hypertrophic osteoarthopathy (PHO) which evolved into secondary hypertrophic osteoarthopathy (SHO) under the influence of bronchogenic carcinoma. The patients had a clinical picture of primary hypertrophic osteoarthropathy but without any signs of disease activity until in the last several months when a malignant bronchopulmonary condition developed. This activated all the symptoms: joint swelling; enlarged fingers and distal forearms and legs; moist palms and soles; unpleasant odour of perspiration; and deeper folds of the forehead and nasolabial furrow. A bone scan showed increased accumulation of the radioisotope in specific regions of the skeleton. To our knowledge, no similar cases have been described in the literature.

[Work capacity evaluation in patients with ankylosing spondylitis]. / Radna sposobnost bolesnika s ankilozantnim spondilitisom.

The aim of the study was to establish the employment and working ability for patients with ankylosing spondylitis. The study was performed using a questionnaire mailed to 185 patients with verified diagnosis of ankylosing spondylitis who were treated at the Department of Rheumatology of the University Hospital "Sestre milosrdnice" in Zagreb in the last 5 years. The questionnaire included a few categories of questions and here we analysed those referring the working abilities. The answers were obtained from 92 patients. We took in account the data for 79 patients who fall into the age group of working population (men to 65 yrs, women to 60 yrs.). In that group there were 50 men and 29 women. Twenty-six patients have a full time job, 7 patients have a part-time job, one changed the job and 45 of them are retired. The difference of working abilities was observed regarding to the physical requirement for the job (P < 0.05) and the duration of the disease (P < 0.05). Among the patients who are retired majority stated that ankylosing spondylitis was the cause of their retirement. As for the patients who still work (N = 34), 14 of them were not on sick-leave the last year at all, 2 of them were absent up to one week, 10 patients were absent from 1 to 4 weeks, 3 patients were on sick-leave from 1 to 3 months, and 5 of them more than 3 months. Statistically significant difference was observed in sick-leave rate regarding to the physical requirements for the job (P < 0.01), but not regarding to the duration of the disease (P > 0.05). The results of our study suggest that ankylosing spondylitis reduce the working ability especially for patients who have a hard job. There is an imperative to maintain the working abilities of patients with ankylosing spondylitis as long as possible.

[Clinical features of ankylosing spondylitis--epidemiologic study]. / Neka klinicka obiljezja ankilozantnog spondilitisa--epidemiolosko istrazivanje.

The aim of the study was to establish some clinical features of ankylosing spondylitis in an epidemiological study using a mailed questionnaire. The questionnaire was sent to 185 patients with ankylosing spondylitis who were treated at the Department for Physical Medicine, Rehabilitation and Rheumatology. The answers were obtained from 92 patients (49.7%). In the studied cohort there were 60 men and 32 women. The average age of all patients were 51.6 +/- 11.8 yrs. In most of the patients (69 or 75%) the duration of ankylosing spondylitis is more than 15 years. The diagnosis of ankylosing spondylitis was established on average 6.5 years after the beginning of symptoms. Patients suffering from ankylosing spondylitis more than 15 years reported that the worst period of the disease was the starting 10 years. The main symptoms of the disease are stiffness and pain. The aggravation of pain occurs with enhanced physical activity as well as with prolonged rest--Painful swelling of one or more joints of 3 weeks duration had 63.7%, and more than 3 weeks duration 40.7% patients. There was no difference in occurrence of painful swelling extravertebral joints regarding to duration of the disease (P > 0.05). The most often affected joints were hips and shoulders. Eyes inflammation was reported by 63 patients, and unspecified enterocolitis had 16 patients.