357 LETTERS Response to Goldbach article To the Editor: In reviewing the Case Reports section in the article by Goldbach et al (Goldbach P, Mohsenifar Z, Salick AI: Familial mediastinal fibrosis associated with seronegative spondylarthropathy. Arthritis Rheum 26:221-225, 1983), it appears to me that the patients have radiographic changes suggestive of osteitis condensans ilii in that the sacroiliac joint spaces look well maintained, the sacral margins are sharp and without erosions, and the sclerosis seems to be confined primarily to the iliac side of the sacroiliac joint. The fact that they were HLA-B27 negative might also suggest that these patients did not have spondylarthropathy. although that does not rule out the possibility. Charles W. Sienknecht, MD, FACP Arthritis Associutes Chattcinooga, TN Reply To the Editor: In reference to the possible confusion about the presence of sacroiliitis in the 2 patients reported, please be assured that this was confirmed by sacroiliac computerized axial tomography scan in each case. Allen I. Salick, MD Bever1.y Hills, CA Comment on Sienknecht letter To the Editor: The correspondence from Dr. Sienknecht raises an interesting point. The radiographic abnormalities of the sacroiliac joints in the 2 patients described by Dr. Goldbach and his associates (Goldbach P, Mohsenifar Z, Salick AI: Familial mediastinal fibrosis associated with seronegative spondylarthropathy. Arthritis Rheum 26:221-225, 1983) resemble those seen in osteitis condensans ilii, although the articular surface of the ilium is more irregular and the band of iliac sclerosis is more poorly defined in these patients than in those having typical osteitis condensans ilii. In my experience, true sacroiliitis in women commonly lacks the dramatic alterations that are generally seen on radiographic examination in men. In women with sacroiliitis the subchondral bone in the ilium, the sacrum, or both may not demonstrate the striking erosive alterations observed in men with the disease. Thus, the differentiation of sacroiliitis and osteitis condensans ilii in women can be very difficult, as in the 2 cases described by Goldbach et al. Donald L. Resnick, MD VA Medical Center University of California San Diego, C A Arthritis and Rheumatism, Vol. 27, No. 3 (March 1984) Comment on the report of Athreya et al To the Editor: Athreya et al in their recent report (Athreya BH, Schumacher HR, Getz HD, Norman ME, Borden S IV, Witzleben CL: Arthropathy of Lowe’s [oculocerebrorenal] syndrome. Arthritis Rheum 26:728-735, 1983) fail to refer to Rosenblatt and Holmes’ initial description of arthritis in Lowe’s syndrome (Rosenblatt D, Holmes LB: Development of arthritis in Lowe’s syndrome. J Pediatr 84:924-925, 1974). In that article, the authors reported “acute episodes of painful swelling” in which the involved joints (knees, ankles, elbows, and interphalangeal joints) “were red, warm, swollen and painful for periods of two to three weeks”; this was first noted in a 25-year-old individual who, at that time, was the sole surviving patient ofthe original report of Lowe et al. At autopsy 4 years later, the articular surfaces were noted to be thickened without synovitis, as more elegantly detailed in the recent report. Jerry C. Jacobs, MD College of Physicians and Surgeons Coliimbiu University New York, NY Spoon player’s tibia To the Editor: The hazards of modern recreational activities, such as jogger’s penile frostbite (Hershkowitz M: Penile frostbite: an unforeseen hazard of jogging. N Engl J Med 296:178, 1977) and Pac-Man phalanx (Gibofsky A: Pac-Man phalanx [letter]. Arthritis Rheum 26: 120, 19831, increasingly are being recognized. Nevertheless, more traditional pastimes are not immune to associated disease. Spoon playing commonly was used to accompany more orthodox musical instruments in the late nineteenth and early twentieth centuries, but has now largely died out. However, we have recently seen severe mid-tibia1 pain following a session of spoon playing. A 69-year-old man was seen with increasing midtibia1 pain of 4 weeks’ duration. The pain was exacerbated by exercise, eased by rest, and associated with mid-tibia1 tenderness. His symptoms began 24 hours after a prolonged episode of spoon playing. The patient played the spoons in a sitting position. Two dessert spoons were held by the shafts between the index and middle fingers, and middlc and ring fingers, respectively, of the right hand with their convex surfaces abutting. The “music” was generated by striking the spoons alternately on the right and left knees, while vigorously stamping the floor with the leg being struck. The patient played the spoons in this manner for approximately 90 minutes.