Background/Objective: Detection of anti-nucleosome antibodies in patients with systemic lupus erythematosus (SLE) has been well established and it is claimed that their presence is associated with disease activity. The objec- tive of this study is to determine the diagnostic value of anti-nucleosome antibodies in the assessment of lupus nephritis and clinically active SLE. Methods: The anti-nucleosome antibodies were evaluated in the serum of 200 Tunisian SLE patients at disease onset by a sensitive immunodot assay. Serum samples from each patient were also tested for ANA and anti-dsDNA antibody by IIF on Hep 2 cells and Crithidia luciliae respectively. During the follow-up, the patients were regularly monitored for clinical parameters. Global SLE activity was measured by the European Consensus Lupus Activity Measurement (ECLAM). Results: The prevalence of anti-nucleosome and anti-dsDNA antibodies was 69% and 63.5% respectively. Anti- nucleosome antibodies were found to be 30.1% positive in SLE patients lacking anti-dsDNA antibody. 79.5% patients had active SLE at the first clinical examination. Anti-nucleosome antibodies were more sensitive than anti- dsDNA antibodies to detect active SLE (78% vs. 71.7%, P = 0.19). 52.5% of SLE patients had renal involvement. Among these patients, the rate of anti-nucleosome positivity and anti-dsDNA were 77.1% and 67.6% respectively. The positivity of anti-nucleosome antibodies was significantly higher in patients with renal disease than the subjects without renal disease (P = 0.009). Anti-nucleosome and anti-ds DNA antibodies were significantly correlated with disease activity (P < 0.001 and P < 0.001 respectively). Conclusion: Anti-nucleosome antibody reactivity may be a useful marker in the diagnosis and assessment of active SLE.

Objective: To assess the efficacy of pulse Pamidronate therapy in NSAID refractory ankylosing spondylitis (AS). Patients: Fifty two patients of ankylosing spondylitis (fulfilling modified New York criteria), refractory to NSAID and having active disease were enrolled. Active disease was defined as BASDAI ≥ 4 and/or early morning stiffness ≥ 45 minutes despite NSAID therapy. Intervention: Monthly intravenous Pamidronate infusions (60 mg) for a period of 6 months along with current NSAID. Primary outcome measure was improvement in BASDAI at the end of therapy. Secondary outcome mea- sures included improvement in BASDAI ≥ 25%, BASFI, metrology parameters, visual analogue scales for pain and global assessment of disease, ESR, CRP, MMP-3 and quality of life domains. Results: Out of 52 patients enrolled [47 men; mean age 36.2 years (range 22-53 years) and mean disease duration 7.2 years (3-25 years)], 47 patients completed the study. At 6 months, there were significant improvement in BAS- DAI (P < 0.005), BASFI (P < 0.005), pain (P < 0.005) and patient global assessment of disease (P < 0.005) and lateral flexion (P < 0.05). However, BASDAI ≥ 25% reduction was seen in 29.6% patients only. In addition, quality of life, HAQ and serological markers MMP-3, ESR and CRP were not significantly altered. Most common adverse effects included arthralgias and myalgias, 22.5% each, following initial infusions. There were five withdrawals; two defaults and one for hip joint replacement and two for asymptomatic rise in serum creatinine. Conclusion: Pamidronate has modest efficacy in improving the patient reported outcome variables in NSAID refractory AS.

Objective: To examine the adequacy of primary prophylaxis for glucocorticoid-induced osteoporosis (GIOP) in patients taking long-term steroids. Methods: We conducted a retrospective audit in our hospital to determine physician's awareness and preventive measure during treatment against GIOP. Hospital records of patients receiving ≥ 7.5 mg/day of oral steroids for ≥ 3 months were studied and relevant data was collected. Primary preventive measures instituted against GIOP were noted and analysed. Results: One hundred and fifty one patients, 87 females and 64 males, fulfilling the inclusion criteria were included in this study. Of the 151 patients, 44 did not receive any prophylaxis, 73 received inadequate prophylaxis and only 34 were given appropriate prophylaxis. Conclusions: The practice of instituting primary preventive measures against GIOP is not satisfactory among pre- scribing doctors. There is an urgent need to increase awareness and knowledge of GIOP management.

Objective: To prospectively evaluate consecutive patients with knee osteoarthritis who presented to a Canadian community rheumatology clinic and determine the prevalence of varus deformities of the knees and the incidence of forefoot overpronation in three ethnically different populations-a Canadian-born population, Indian-born population and Portuguese-born population. Use of different therapies for knee osteoarthritis in the clinic was also evaluated. Methods: Data were collected on patient age, sex, body mass index (BMI), visual analog scale (VAS) pain, ethnic background, valgus/varus deformity at the knee and overpronation of the forefoot. Kellgren-Lawrence scores were assigned to plain radiographs. Charts were subsequently reviewed to evaluate rates of intra-articular steroid injec- tion, hyaluronic injection, surgical referral and surgical referral in the first year after being seen in the clinic. Results: Eight patients who were Portuguese-born, 26 who were Indian-born and 33 who were Canadian-born were identified. Age was not significantly different. Women had more valgus changes than men (P = 0.04), and VAS pain was not significantly different between men and women. Significantly more varus deformity was noted in the Indian-born group than the Canadian-born group (P = 0.002), and more valgus deformity was noted in the Portuguese-born than Canadian-born group (P = 0.009). There was a trend to lower BMI in the Punjabi-born group and lower VAS pain in the Canadian-born group. There was no significant correlation between BMI and VAS pain, nor age and VAS pain (r = −0.192 and −0.050 respectively). There was no significant association with either BMI or age and forefoot overpronation. No ethnicity differences in treatment such as use of intra-articular steroid/hyualuronic acid use, surgical referral or surgery were observed. Conclusions: Patient populations differed significantly in terms of varus and valgus deformities at the knee.

Neck pain is a fairly common condition. Although majority of cases have benign mechanical causes it has got a wide dif- ferential diagnosis and encompasses serious albeit less common causes like malignancies, infections, etc. A detailed clinical evaluation can differentiate causes that can be managed conservatively from the ones requiring more aggressive approach. Laboratory tests, imaging studies and neurophysiologic testing is not required for majority of cases. Presence of systemic, neurologic features or red flag signs requires further evaluation. In this review we discuss a clinical approach to diagnosis and management of neck pain. The various causes of neck pain and the red flag signs are discussed.