Background: Amino-bisphosphonates like Pamidronate, having weak anti-Tumour Necrosis factor (TNF)-alpha property is effective in ankylosing spondylitis (AS). Objective: To assess the efficacy of intravenous pulse Ibandronate, another bisphosphonate, in non-steroidal anti- inflammatory drug (NSAID) refractory/intolerant AS, as it is cheaper, requires less frequent dosing and is easily available. Methods: Thirty-four patients, diagnosed as AS by Modified New York Criteria, having Bath AS Disease Activity Index (BASDAI) ≥ 4 (i.e. active disease) and NSAID refractory/intolerant, received six doses of injection Ibandronate (3 mg) intravenously, three monthly, for 15 months. Patients with peripheral arthritis were given sulfasalazine along with Ibandronate. Outcome assessed comparing baseline and final BASDAI, Bath AS metrology index (BASMI), Bath AS functional index (BASFI), Bath AS global score (BAS-G), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Response defined according to assessments in ankylosing spondylitis (ASAS)-20 and BASDAI-50, and, reduction in tender and swollen joint counts in patients with peripheral arthritis. Results: Twenty-eight patients received all six doses. Twenty-one (75%) and 23 (82%) patients achieved BASDAI-50 and ASAS-20 responses, respectively. Significant reductions in mean BASDAI (48.36%), BASMI (55.08%), BASFI (47.03%), BASG (47.47%), ESR (49.24%) and CRP (66.38%) were noted after 15 months. Ten patients hav- ing peripheral joint involvement had significant decrement in swollen (67.74%) and tender (57.14%) joint counts. Conclusion: Intravenous Ibandronate has reasonable efficacy in the treatment of AS.

Background: Patients of rheumatoid arthritis (RA) have close association with an increased risk of cardiovascular disease. The earliest stage of atherosclerosis is exhibited by endothelial dysfunction, which is an expression of a systemic phenomenon. Objective: To evaluate the effect of inflammation of RA on endothelial function and its correlation with inflammatory markers, in young patients RA with low disease activity and without traditional cardiovascular risk factors by meas- uring endothelial reactivity. Methods: Flow-mediated vasodilatation (FMV), assessed by non-invasive ultrasound on the brachial artery, was evaluated in 50 young to middle aged patients with RA (age between 18 and 55 years) with disease activity score ≤ 3.2, without overt cardiovascular disease, at the age of 50 years, and sex matched healthy controls. Results: Mean FMV was found significantly lower in RA patients than in controls ([4.03 ± 1.9 vs. 8.7 ± 1.7] %; P < 0.001), and it was inversely related to C-reactive protein level (r = −0.415; P < 0.01) expressed at the value measured at the time of ultrasound evaluation. Conclusions: RA patients, young to middle aged, having low disease activity, free from overt cardiovascular dis- ease and cardiovascular risk factors, have an altered endothelial reactivity that seemed to be primarily related to the inflammatory state of the disease.

As practicing rheumatologists we have probably never given thought to how common an ailment, back pain is. Two thirds to almost three fourths of the population would have suffered at least a single episode of back pain in their lifespan. Usually the first episode of back pain occurs in the third or the fourth decade of life and increases with advancing age. Most clinicians approach back pain with an algorithm to classify whether back pain is inflammatory or non inflammatory. Amongst Non inflammatory back pain, we first proceed to rule out a prolapsed disc and then sinister causes such as malignancy and infection. Once the above have been ruled out all the leftover complaints are collectively given the label of "Mechanical back pain". It is precisely this kind of back pain which is more likely to be chronic, unresolved and unrelenting and it is this "Mechanical back pain" that we would like to focus on rather than the whole list of differential diagnosis.