SUMMARYThis is the first controlled study of the frequency of back pain in a European Caucasian population with diffuse idiopathic skeletal hyperostosis (DISH).Elderly patients admitted to hospital for reasons other than back pain were assessed for the presence of spinal DISH using the routine lateral chest radiograph films. A total of 106 probands (82 males, 24 females) with a mean age of 70 years fulfilled the criteria for DISH as defined previously. One hundred and seventyeight patients (117 males, 61 females) not meeting these criteria were used as controls. The prevalence of back pain was assessed by a blinded interviewer using a structured questionnaire. Our primary hypothesis was that spinal DISH positive probands had not had back pain more often than controls. This controlled study showed no statistically significant difference in pain frequency between spinal DISH positive probands and controls at any spinal level.We conclude that back pain does not occur more often in radiographically defined DISH positive probands than in controls. The radiological finding of spinal DISH, as far as it does not lead to stenosis of the spinal canal or dysphagia, thus seems to be a finding without clinical relevance.

SUMMARYElbow pain is a common complaint and elbow hyperostosis a frequent radiological condition. However, little is known about the association between the clinical and radiological findings. To evaluate the relationship between spinal and extraspinal hyperostotic features and the clinical relevance of elbow hyperostosis we have performed the first controlled, double-blinded study of 85 hospitalized probands, 33 with and 52 without thoracospinal hyperostosis on lateral chest X-ray. Elbow and shoulder hyperostosis were graded on bilateral standard radiographs. Elbow pain was assessed by an interviewer using a standardized questionnaire and extraskeletal causes of elbow pain were recorded. The prevalence of elbow hyperostosis was increased in cases with thoracospinal hyperostosis compared to controls (82% versus 58%, X 2 = 5.32, P<0.025, n = 85, odds ratio (OR) 3.30 (95% CI 1.16-9.35)). Similarly, the prevalence of elbow hyperostosis was increased in cases with shoulder hyperostosis compared to controls (83% versus 60%, x 2 = 4.51, F<0.05, n = 84, OR = 3.20 (95% CI 1.06-9.66)), emphasizing the multifocal nature of hyperostotic features. Elbow pain was only slightly more prevalent incases with elbow hyperostosis compared to controls (21% versus 13%, x 2 = 0.75, NS, OR = 1.84(95% CI 0.46-7.44)). We conclude that elbow hyperostosis is a radiological finding of doubtful clinical relevance.

Clinical suspicion, positive gram stains and cultures of the synovial fluid are the fundamental criteria for the diagnosis of bacterial arthritis. Bacterial arthritis may, however, show an oligosymptomatic clinical course and thus lead to a delay in diagnosis. The case records of 43 patients with bacterial arthritis were reviewed retrospectively. Rigors (20.9%), fever (40.5%), blood leucocytosis (41.8%) and a shift to the left of blood leucocytes (35%) were found in less than half of all examined patients. Positive cultures of the synovial fluid (71.4%) were far more frequent than positive blood cultures (23.5%). We conclude, that the absence of fever, rigors, blood leucocytosis and positive blood cultures does not rule out the possibility of bacterial arthritis.