The prevalence of diffuse idiopathic skeletal hyperostosis in a population-based study in Hungary.

Diffuse idiopathic skeletal hyperostosis (DISH) is a skeletal disease characterized by ligamentous ossification of the antero-lateral side of the spine. The prevalence of DISH was studied in a cross-sectional, population-based study of Hungarian men and women, 50 years and over. The study was based on an analysis of the lateral thoracic and lateral lumbar radiographs of 635 persons recruited from a population register in Budapest, Hungary. Radiographs were taken according to standardised protocol and DISH was classified using the Resnick and modified Resnick criteria. The prevalence of hyperostosis according to the modified Resnick criteria was 27.3% in men and 12.8% in women. There was an increase in the prevalence of DISH with increasing age in men, from 10.0% in the 50-54 year age group to 36.6% in those over 75 years, and in women from 1.9% to 25.9% in the same age groups. According to this radiology survey the disease is more frequent and more severe in men than in women throughout life.

[Prevalence of vertebral deformity in Hungary: the European Vertebral Osteoporosis Study]. / A csigolyadeformitás prevalenciája hazánkban: az Európai Vertebralis Osteoporosis study.

Prevalence and distribution of vertebral deformity regarded as classic marker of osteoporosis are reported on the basis of the results of the first Hungarian cross-sectional population-based survey. The clinical-epidemiological project is conducted by the National Institute of Rheumatology and Physiotherapy in Hungary in the frame of the European Vertebral Osteoporosis Study which comprises 19 countries and 36 centres. A random sample of 324 females and 300 males aged 50 years and over stratified in 5-year age bands was recruited. Lateral spinal X-rays were evaluated centrally by two different morphometric methods. Based on the McCloskey-Kanis criteria the prevalence of all deformities was 16.7% in females and 18.7% in males. These values from Hungary have been considered high compared to the prevalence rates of other European countries, approaching, and in males exceeding, the highest rates gained from Sweden. In females the prevalence increased with age, men aged 50-59 years and women aged 75 years and over had higher prevalence of deformity compared to the other sex. In females vertebra thoracic 11, in males that of lumbar 3 were mostly affected, wedge deformities occurred most frequently. Extrapolating the results we can conclude that vertebral deformity found in both sexes similarly, affects approximately 500,000 individuals in Hungary along with the potential deterioration of quality of life. This enormous burden requires the consistent fulfillment of the National Osteoporosis Program and other preventive-curative strategies.

[Prevalence and risk factors in diffuse idiopathic skeletal hyperostosis in a population sample in Hungary]. / A diffúz idiopathiás skeletalis hyperostosis prevalenciája és rizikótényezöi reprezentatív hazai populációban.

The aim of the study was to get some information on the epidemiology and etiology of DISH which is a frequent, chronic, benign musculoskeletal disease. In order to investigate the epidemiology of DISH the authors planned a population-based cross-sectional study and to investigate the etiology of the disease they planned a case-control study. The prevalence of DISH in Hungary in men over the age of 50 years is 5.8% and in women is 1.3%. In men DISH begins earlier in the lifetime and over the age of 65 years the prevalence increases rapidly in both sexes. In men throughout the life the disease is more common and more severe than in women. In the case-control study the authors investigated the association of the disease with risk factors as obesity, hyperuricemia, hypercholesterinemia, hypertriglyceridemia. Hyperuricemia was significantly more frequently found in DISH than in the control group. In the name of DISH the word "idiopathic" is questionable because apart from the known glucose metabolic imbalance other metabolic abnormalities (uric acid) could be found. There might be a complex metabolic disturbance in the etiology of DISH.

Interleukin 6 levels in synovial fluids of patients with different arthritides: correlation with local IgM rheumatoid factor and systemic acute phase protein production.

Interleukin 6 (IL-6), a multifunctional cytokine particularly active in regulation of the acute phase response, governs the terminal maturation of B lymphocytes and participates in early activation of T cells. IL-6 levels of synovial fluids of 153 patients with different arthritides were measured by a simple sandwich enzyme immunoassay. Highest IL-6 concentrations were detected in patients with rheumatoid arthritis (RA), particularly in those characterized by very active general symptoms and severe joint pain. High IL-6 levels were detected in patients with juvenile RA with polyarticular onset of disease and in gout. Corresponding to the suggested in vivo relevance of IL-6, dose correlation of IL-6 levels with the synovial IgM rheumatoid factor accumulation was demonstrated. The rate of the correlation between synovial IL-6 level and concentration of serum C-reactive protein in RA was inversely proportional to the dose of steroid treatment in patients with RA.

Clinical and family studies in Hungarian patients with gout.

In this study we examined 22 Hungarian male probands with gout and 105 of their first degree relatives. This was the first family study in Hungary in which the characteristics of distribution of gout and hyperuricaemia among patients with gout and their first degree relatives, as well as the possible correlation between the prevalence of the disease and MHC class I antigens was investigated. Our gout patients showed the following characteristics: (1) There was a typical onset after age 40, benign oligoarticular form of arthritis, underexcretion of uric acid, moderate hypertension without evidence of reduced renal function, and a relatively high frequency of hyperostosis. (2) The prevalence of hyperuricaemia and gout exceeded the general population level in the first degree relatives of our gout patients. (3) The distribution of MHC class I antigens among the first degree relatives of our patients with gout showed no characteristic patterns. (4) There was no correlation between HLA B27 antigens and prevalence of gout or hyperostosis in family sibling studies. (5) The high frequency of gout and hyperuricaemia, as well as the lack of characteristic HLA patterns among the first degree relatives of gout patients in our family studies, point to the possible cumulative effect of several genes and environmental factors in the etiopathogenesis of this disease.

Saturnine gout.

The history of saturnine gout is almost as old as civilization itself. Studies carried out in recent decades explain the development of hyperuricaemia and gout, with the inhibiting effect of lead on the tubular urate transport causing decreased urate excretion. In the case of lead intoxication these effects are often associated with renal failure but may occur without clinical features of lead toxicity and renal damage. The clinical features of saturnine gout are essentially similar to those of primary gout; however, acute attacks tend to occur in the knee more frequently than the first metatarsophalangeal joint. Acute attacks in saturnine gout are frequently polyarticular and tophi rarely develop. The diagnosis of saturnine gout rests on the history of exposure to lead, clinical features of lead toxicity, biochemical confirmation of high serum lead levels and other biochemical abnormalities, and the exclusion of other forms of gout. Treatment consists of excluding the patient from further exposure to lead, the use of chelating agents to remove lead, and control of acute gouty arthritis and hyperuricaemia.

[Pathogenesis of gouty arthritis]. / Pathogenese der Gicht-Arthritis.

The urate crystal stands in the centre of the pathogenesis of gouty arthritis. External influences, such as changes of temperature and mechanical loads as well as factors, which lead to a short term change of the level of uric acid in the serum, such as alcohol, meals rich in purine, uricosurics and saluretics are, indeed, able to induce an attack of gout, but they are no obligatory prerequisite. The granulocytes are to be regarded as the second important prerequisite of the crystal arthritis. They become effective either via the process of phagocytosis or their cell membrane produces prostaglandins, the formation of which is evoked by electrostatic forces of the crystals. Mediators, such as kinins, Hageman's factor and complement are mainly responsible for the initial pain reaction, vasodilation and leukotaxis, lysosomal enzymes evoke the secondary changes at the joint.