Brief in English from Bechterew-Brief No. 76

In the first article of this issue, Dr. Thomas HÖHLER from the University of Mainz, winner of the DVMB research prize in 1998, describes his results on antibodies and cytotoxic T-cells in twin siblings with and without ankylosing spondylitis whom he found in our membership with the help of two announcements in our newsletter. Dr. Höhler found no significant difference in the concentration of antibodies against several bacteria species (Escherichia coli, Proteus mirabilis and Klebsiella pneumoniae) between twin siblings with and without AS. He also found that all twin siblings with AS had significantly less T-cells against Klebsiella, Candida, and Streptococcus in their blood than their healty twin partners. This proves that Klebsiella is unlikely an essential trigger of the disease.

As a further result of our large survey on the situation of spondyloarthritis sufferers, I have investigated some possible predictors for the long-term outcome of the disease. An early disease onset increases the probability only of hip surgery. There is no increase in the frequency of peripheral joint involvement nor in any other outcome parameters. In patients with a family history of AS, a hip or knee involvement is significantly more frequent than in other spondyloarthritis patients. In all other parameters, there is again no significant difference between patients with and without relatives with AS. Most meaningful for the long-term outcome are the symptoms in the first years of the disease: Patients with early uveitis or peripheral arthritis or with pain in several regions of the body at the time of diagnosis, experience in average a less favourable long-term disease outcome than those without these early signs.

The extended article on psoriatic spondyloarthritis by Dr. Wolfgang MIEHLE has been assembled from chapters of two of his books on this subject. Dr. Miehle describes the skin symptoms in psoriatic spondyloarthritis as well as the spine and peripheral-joint symptoms. He mentions the value of several diagnostic methods and considers the value of all the different kinds of treatment for these symptoms.

Professor Monika ØSTENSEN from Trondheim (Norway) gives an overview over the antirheumatic drug therapy during pregnancy and nursing. She describes the risks for the baby or for the mother connected with some antirheumatic drugs. Whereas cytostatic drugs have to be avoided already before the possibility of a pregnancy, some NSAIDs are now regarded to be harmless. Also prednisone or prednisolone may be taken, if necessary. Future NSAIDs inhibiting selectively only the enzyme COX-2, avoid the risk for the stomach mucous membrane. They may, however, be not at all harmless for the unborn child and have to be avoided during pregnancy, because severe deformities have been observed in animal trials.

Dr. Klaus-Peter STOCK in his article on crunching, creaking, snapping regards the different noises which a joint in motion may create. He explains the possible origins of these noises and their diagnostic meaning. The character of the sound may be used to distinguish between a normal and an unhealthy state of the joint.

An international symposium "Radon and Health" took place in September 1998 in Bad Hofgastein (Austria). Speakers from many countries described the therapeutic effect of the radioactive noble gas radon in rheumatic diseases. New results clearly show that small doses of radiation also help the body to prevent cancers and are not at all harmfull as is always claimed.

DVMB News:
Three new members of the DVMB board have been elected by the delegates in October 1998 and are presented in this issue together with their re-elected fellow board members.

For September 2nd to 5th 1999, DVMB invites the delegates from other ankylosing spondylitis societies to the 5th ASIF Council meeting which will take place in the rehabilitation clinic Saarschleife in Mettlach-Orscholz near the French-German-Luxembourg borders.

E. Feldtkeller