Diffuse idiopathic skeletal hyperostosis in elderly Icelanders and its association with the metabolic syndrome: the AGES-Reykjavik Study

Objective: To describe the prevalence of diffuse idiopathic skeletal hyperostosis (DISH) in a large population-based study of elderly Icelanders, with particular reference to weight-related factors and the metabolic syndrome.Method: The study population comprised 5321 participants aged 68-96 years (2276 males, mean ± sd age 76 ± 5 , and 3045 females, age 77 ± 6) from the AGES-Reykjavik Study. DISH diagnosis was based on computed tomography (CT) scans, and interpreted strictly by the Resnick criteria and additional suggestions for CT interpretation by Oudkerk et al. Radiology readings were taken by a radiology resident and sample readings by two experienced radiologists.Results: A diagnosis of DISH was made in 13.7% of males and 2.8% of females. There was no association with age, but a strong association was seen with the metabolic syndrome [odds ratio (OR) 2.12, 95% confidence interval (CI) 1.69-2.64, p = 3.9 × 10^-11]. Among the components of the metabolic syndrome, the association with DISH was significant for the insulin resistance criterion (OR 1.66, 95% CI 1.32-2.01, p < 0.001) and the body mass index (BMI) criterion (OR 2.16, 95% CI 1.70-2.74, p < 0.001). Other weight-related variables (midlife BMI, weight, and abdominal circumference) showed similar associations.Conclusions: This study, which to our knowledge is the largest published study on the prevalence of DISH, shows an association with the metabolic syndrome, particularly with the insulin resistance and BMI criteria. This is analogous with previous reports linking DISH with metabolic causes. In this age category, we did not observe any increase in prevalence with age.

Scintigraphic hand osteoarthritis (OA)--prevalence, joint distribution, and association with OA at other sites

OBJECTIVE

To assess the information available from routine bone scans on prevalence and joint distribution of osteoarthritis (OA), particularly of the hand.

METHODS

Consecutive whole body bone scans of 414 patients, including a special hand projection, were analyzed for evidence of OA related uptake. After exclusions for various reasons, 297 scans were considered "representative" with regard to hand OA (108 male and 189 female patients). Kappa values for interreader agreement ranged from 0.61 to 0.82 for hand joints and was slightly lower for other joints.

RESULTS

The prevalence of positive hand joints was low before the age of 40, but increased rapidly in the 5th and 6th decade to reach a plateau. Women had a higher prevalence of uptake than men in the carpometacarpal-1 (CMC1) joint and patella. Uptake was similar on the dominant and non-dominant sides in all joints with the exception of the shoulder. Subchondral knee uptake prevalence tended to decrease in the oldest age groups, but other joint sites showed a steadily increasing prevalence throughout life. Hand symptoms were related to distal interphalangeal (DIP) and CMC1 uptake, thumb symptoms with first metacarpophalangeal joint (MCP1) CMC1 uptake, and knee symptoms with the subchondral knee uptake pattern. Affected hand joint distribution was characterized by a strong bilateral concordance within rows, and an association was seen between subchondral knee uptake and hand involvement, particularly in the DIP joints, but to a lesser degree also with CMC1 and proximal interphalangeal (PIP) uptake. Association between spinal sites and between the forefoot and the knee was also observed.

CONCLUSION

Bone scintigraphy is valuable method in epidemiological studies of OA, with acceptable interreader reproducibility and relation to joint symptoms. Although much of the current findings seem comparable with previous radiologic studies, they provide new ideas about age related patterns and joint subsets, possibly indicating a difference in pathogenetic mechanisms among joints in OA.

A case of calciphylaxis. Case report

A young woman on hemodialysis with hyperparathyroidism suddenly developed areas of skin necrosis caused by arterial calcification. Parathyroidectomy apparently arrested this process. Seven months after cadaver kidney transplantation, following reparation of a graft artery stenosis, necrosis spread anew from the wound gradually extending to large areas. The patient died and autopsy revealed calcification in many internal organs. The case fits the description of systemic calciphylaxis a syndrome now described in humans but originally experimentally induced in rats.

Left bundle branch block: prevalence, incidence, follow-up and outcome

In a randomly selected population screening study of 8450 men and 9039 women 33 to 71 years of age conducted in Iceland in 1967-1977, 27 men and 17 women were found to have left bundle branch bock (LBBB). The prevalence of LBBB at that time was 0.43% for men and 0.28% for women. The incidence of LBBB was 3.2 per 10,000 per year for men and 3.7 per 10,000 per year for women. All except one of 37 alive patients with LBBB were examined in 1984 including chest X-ray, echocardiography and exercise testing (Bruce protocol). Eight men had had myocardial infarction (P less than 0.05), 12 had angina pectoris, 15 had hypertension, 7 had cardiomyopathy, 13 had primary conduction disease, and 3 had pacemakers. Five men and two women had died in comparison with 18 men and 1 woman in an age-matched control group of 176 people (P : ns). Three of 5 decreased LBBB men had cardiomyopathy at autopsy. Three men died suddenly. The two women died of noncardiac causes. Only one patient in the control group had cardiomyopathy (P less than 0.01). There was no significant difference in other cardiac diagnoses between the groups. Eleven LBBB women out of thirteen had a normal exercise duration (greater than or equal to 6 min) and 11/17 men exercised normally (less than or equal to 7 min). In comparison with the control group, the LBBB patients had an increased LV diameter 2.85 +/- 0.38 vs 2.58 +/- 0.38 cm m-2 body surface area (P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)