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Spoon player's tibia.

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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
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
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