338 Letters to the editor 1 Edlund E, Johnsson U, Lidgren L, et al. to be most unusual.' Cricothyroid arthritis in and blood of patients with B27 associated Palmoplantar pustulosis and sternocostoclavi- the course of familial Mediterranean fever has peripheral arthritis following trauma, in an cular arthro-osteitis. Ann Rheum Dis 1988; 47: 809-15. not been previously described. attempt to understand the pathogenetic mech- Ann Rheum Dis: first published as 10.1136/ard.49.5.338-c on 1 May 1990. Downloaded from 2 Fallet G H, Arroyo J, Vischer T L. Sternocosto- The presentation with migratory polyarti- anisms. We appreciate the comments of clavicular hyperostosis. Case report with a 31- cular arthritis, the involvement of the inter- Professor Panayi and thank him for drawing year followup. Arthritis Rheum 1983; 26: 784-90. phalangeal joints, and the long period before attention to this topic ofseronegative spondylo- 3 Sonozaki H, Mitsui H, Miyanaga Y, et al. the appearance of the classical manifestations arthropathy. Clinical features of 53 cases with pustulotic of familial Mediterranean fever are other arthro-osteitis. Ann Rheum Dis 1981; 40: unusual features in this case. IGNAZIO OLIVIERI* 547-53. GABRIELE GEMIGNANI 4 Gerster J C, Lagier R, Nicod L. Sternocosto- FAISAL A KHUFFASH GIAMPIERO PASERO clavicular hyperostosis (SCCH). Skeletal Radiol HASSAN A MAJEED Rheumatic Disease Unit 1985; 14: 53-60. Department ofPaediatrics Institute ofMedical Pathology I 5 Sartory D J, Schreiman J S, Kerr E, Resnik C S, Faulty ofMedicine Universiy of Pisa Resnick D. Sternocostoclavicular hyperostosis: Kutvait Universi Pisa, Italy a review and report of 11 cases. Radiology 1986; PO Box 24923 158: 125-8. 13110 Safat, Kuwait *Correspondence to: Dr Ignazio Olivieri, Istituto di 6 Chamot A M, Benhamou C L, Kahn M F, Patologia Medica 1, Servizio di Reumatologia, Via Roma 67, 56100 Pisa, Beranek L, Kaplan G, Prost A. Le syndrome I Heller H, Gafni J, Michaeli D, et al. The arthritis Italy. acne pustulose hyperostose osteite (SAPHO). offamilial Mediterranean fever (FMF). Arthritis Resultats d'une enquete nationale. 85 obser- Rheun 1966; 9: 1-17. 1 Panayi G S. Trauma and seronegative spondylo- vations. Rev Rhum Mal Osteoartic 1987; 54: 2 Majeed H A, Barakat M. Familial Mediterranean arthropathy. Ann Rheum Dis 1989; 48: 879. 187-96. fever (recurrent hereditary polyserositis) in 2 Olivieri I, Gemignani G, Christou C, Pasero G. 7 Karagevrekis Ch, Failet G H, Lagier R. Spinal children: analysis of 88 cases. Eur J Pediatr Trauma and seronegative spondyloarthropathy: changes in association with sternocostoclavicular 1989; 148: 636-41. report of two more cases of peripheral arthritis hyperostosis. JBR-BTR, in press. 3 Sneh E, Pras M, Michaeli D, Shahin N, Gafni J. precipitated by physical injury. Ann Rheum Dis 8 Lagier R, Arroyo J, Fallet G H. Sternocosto- Protracted arthritis in familial Mediterranean 1989; 48: 520-1. clavicular hyperostosis. Radiological and patho- fever. Rheumatology and Rehabilitation 1977; 3 Wisnieski J J. Trauma and Reiter's syndrome: logical study of a specimen with ununited 16: 102-6. development of 'reactive arthropathy' in two clavicular fracture. Pathol Res Pract 1986; 181: 4 Simon G, Marbach J J. Familial Mediterranean patients following musculoskeletal injury. Ann 596-603. fever with temporomandibular joint involve- Rhewn Dis 1984; 43: 829-32. ment. Pediatrics 1976; 57: 810-2. 4 Masson G, Thomas P, Bontoux D, Alcalay M. Influence of trauma on initiation of Reiter's Cricothyroid arthritis in a child with familial syndrome and ankylosing spondylitis. Ann Mediterranean fever Rheun Dis 1985; 44: 860-1. Trauma and seroneptive 5 Jacobs J C, Berdon W E, Johnston A D. HLA- B27-associated spondyloarthritis and entheso- Sir: We describe for the first time the occur- spondyloarthropathy pathy in childhood: clinical, pathologic, and rence of cricothyroid arthritis in a girl who radiographic observations in 58 patients. J first presented with migratory polyarticular Sir: We would like to offer what we believe to Pediatr 1982; 100: 521-8. developed the classical be a necessary reply to Professor Panayi's 6 Olivieri I, Gherardi S, Bini C, Trippi D, Ciompi arthritis but eventually M L, Pasero G. Trauma and seronegative features of familial Mediterranean fever. letter published in the Annals.' Professor spondyloarthropathy: rapid joint destruction in A 9 year old Palestinian Arab girl was Panayi considers that in the two B27 positive peripheral arthritis triggered by physical injury. admitted in January 1979 with fever and patients we described, who developed peri- Ann Rhewn Dis 1988; 47: 73-6. 7 Williams K A, Scott J T. Influence of trauma on migratory polyarticular arthritis of the large pheral arthritis immediately after trauma,2 the development of chronic inflammatory poly- joints. The heart was normal. The erythrocyte physical injury and the onset of peripheral arthritis. Ann Rheun Dis 1967; 26: 532-7. sedimentation rate was 110 mm/h and the arthritis were only coincidental. The first case 8 Wright V. Psoriatic arthritis. In: Scott J T, ed. 0 titre was 400 Todd units. A represents, in his opinion, a reactive arthritis Copeman's textbook of the rheumatic diseases. 6th antistreptolysin ed. Edinburgh, London, Melbourne, New diagnosis of acute rheumatic fever was made following gastroenteritis, and the second case, York: Churchill Livingstone, 1986: 775-86. and treatment was started with secondary arthritis of the knees begun by chance after prophylaxis. During the following six years the trauma. http://ard.bmj.com/ she had several episodes of arthritis, which If other articles on this subject' are not were interpreted as recurrence of acute rheu- taken into account this may seem to be the Chondroprotective drugs and osteoarthritis matic fever due to irregular prophylaxis, and most logical conclusion, partly because no occasional fever and abdominal pain. evidence of causality may be produced other Sir: I read with interest the leader article by In January 1985 the girl was admitted with than the immediate onset ofperipheral arthritis Doherty on 'Chondroprotection by non- fever and arthritis of both elbows and the right after trauma, and the lack of an infective steroidal anti-inflammatory drugs' published wrist. Next morning she developed arthritis of trigger. Wisnieski3 and Masson et alP have in the Annals.' the cricothyroid joint. The diagnosis was reported other cases of peripheral arthritis in Although I am in general agreement with on September 27, 2021 by guest. Protected copyright. verified by indirect laryngoscopy. She also B27 positive subjects immediately after physi- the views expressed by Dr Doherty, he raised developed arthritis ofthe interphalangeal joints cal injury. In some of these, like our patient some issues which I consider deserve further of both hands. She became better after five 12 there was also urethritis with negative comment. days of aspirin treatment. Two months later urethral smears and culture, in addition to In his article Dr Doherty questions the she had another similar episode of transient arthritis. Our patient also had a diarrhoea relevance of certain laboratory derived data arthritis of the cricothyroid and interphalan- with negative stool culture, which subsided in on non-steroidal anti-inflammatory drugs geal joints. During the following three years two days without any treatment. In 1982 (NSAIDs) to their clinical use in osteoarthritis. the girl had several episodes of fever and Jacobs et al reported that five of their 58 He considers the standard for assessing these abdominal pain, with the frequency progres- patients with juvenile onset B27 positive drugs is the long term symptomatic and sively increasing to one to two attacks a week. spondyloarthropathy had a trauma severe functional improvement in patients 'rather She also developed arthritis of the ankles enough for a doctor to be consulted before the than individual biochemical or structural associated with erysipelas-like erythema. onset of peripheral arthritis.' In 1988 we characteristics'. It should be noted, however, Family history disclosed that her mother, a reported the cases of two B27 positive subjects that most NSAIDs are also powerful analgesics maternal aunt, and two sisters had had similar who had never had pain to peripheral joints and may effectively relieve the symptoms of recurrent episodes. Prophylaxiswith colchicine before, but developed an erosive peripheral osteoarthritis without necessarily influencing was effective in decreasing the frequency of arthritis of the right hip shortly after a severe its progression. Pain relief and improvement febrile and painful episodes; during the past physical injury to the same joint.6 The rapid of joint mobility are thus inadequate criteria 12 months the girl has had only three mild evolution of the destructive process, which is for distinguishing between an NSAID acting abdominal attacks and one episode oftransient not usual in erosive arthritis of seronegative only as an analgesic and an NSAID which is arthritis of the left ankle. spondyloarthropathy, provides further evi- also positively influencing the underlying Thesynovialattackoffamilial Mediterranean dence in favour of the triggering role of osteoarthritic disease. More objective methods fever typically appears as acute monoarthritis trauma. of clinical assessment of patient response to affecting a large joint ofthe lower extremity. ' In conclusion, the articles published on the drug treatment are therefore required before Involvement