Enteropathic arthritis is a form of arthritis associated with the chronic inflammatory bowel diseases, ulcerative colitis, and Crohn's disease. This form of arthritis is classified as one of the group of seronegative spondyloarthropathies, which also includes psoriatic arthritis, reactive arthritis, and idiopathic ankylosing spondylitis. Joint involvement also occurs with other gastrointestinal diseases such as Whipple's disease, celiac disease, and following intestinal bypass surgery for morbid obesity. In these conditions, abnormal bowel permeability and immunologic and genetic influences are probably involved in the pathogenesis of the joint disease, although the exact mechanisms remain uncertain.

Chronic recurrent multifocal osteomyelitis is a rare inflammatory form of osteomyelitis of unknown etiology. It affects children and adolescents, and signs and symptoms include recurrent episodes of bone pain, tenderness, possible constitutional upset, and increased inflammatory markers. We present 2 patients with cases of chronic recurrent multifocal osteomyelitis affecting the sacrum who responded dramatically to treatment with corticosteroids.

Objectives To examine doctors' (Experiment 1) and doctors' and lay people's (Experiment 2) interpretations of two sets of recommended verbal labels for conveying information about side effects incidence rates. Method Both studies used a controlled empirical methodology in which participants were presented with a hypothetical, but realistic, scenario involving a prescribed medication that was said to be associated with either mild or severe side effects. The probability of each side effect was described using one of the five descriptors advocated by the European Union (Experiment 1) or one of the six descriptors advocated in Calman's risk scale (Experiment 2), and study participants were required to estimate (numerically) the probability of each side effect occurring. Key findings Experiment 1 showed that the doctors significantly overestimated the risk of side effects occurring when interpreting the five EU descriptors, compared with the assigned probability ranges. Experiment 2 showed that both groups significantly overestimated risk when given the six Calman descriptors, although the degree of overestimation was not as great for the doctors as for the lay people. Conclusion On the basis of our findings, we argue that we are still a long way from achieving a standardised language of risk for use by both professionals and the general public, although there might be more potential for use of standardised terms among professionals. In the meantime, the EU and other regulatory bodies and health professionals should be very cautious about advocating the use of particular verbal labels for describing medication side effects.

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W e present a case of recurrent auricular chondritis, which developed after two injections of a luteinising hormone-releasing hormone (LH-RH) analogue buserelin combined with oral treatment of a pure antiandrogen bicalutamide (Casodex). The patient was treated successfully with a continuous moderate dose of corticosteroids together with azathioprine and methotrexate. Complete repair of the deformed ear followed 7 months after starting the treatment.Relapsing polychondritis (RP) is a chronic autoimmune cartilaginous inflammation. Auricular chondritis is a presenting sign in over 85% of patients, in which patients' ears become red, swollen, and tender. We observed a painless form of recurrent auricular chondritis complicated by severe cartilage damage. CASE REPORTA 69 year old man had a history of old myocardial infarction and prostatic adenocarcinoma (Gleason score VI, stage T2B NO MO). He underwent two injections of an LH-RH analogue buserelin (Suprefact Depot, Aventis Pharma), combined with a pure antiandrogen bicalutamide (Casodex; AstraZeneca).Five months after starting treatment he presented with a painless redness and swelling of his right ear, which spared the lobe. This inflammation, showing inflammatory mononuclear infiltrate, progressed to include dropping and deformity of the upper part of the ear, and resolved spontaneously after 3 months (figs 1A and 2). The patient was then referred to the rheumatologist.Besides the dropped pinna, no systemic manifestations were found on physical examination and the patient's neurological status was unremarkable, including normal pain perception. Retinal screening showed no vasculitic changes. Routine laboratory investigation was normal except for raised inflammatory markers: erythrocyte sedimentation rate and C reactive protein. Serum immunoelectrophoresis, antinuclear antibodies, antineutrophil cytoplasmic antibodies, rheumatoid factor, prostate-specific antigen were normal. Viral serology, tuberculin test, and Venereal Disease research Laboratory test were negative. Ultrasound of large vessels and echocardiography were normal. A chest x ray examination and computed tomography (CT), abdominal CT, and bone scan were unremarkable.Owing to serious coronary disease, the lack of active auricular inflammation and systemic disease, and because buserelin treatment had been stopped, it was decided to observe the patient without treatment. However, painless auricular chondritis of the opposite side occurred 3 months later, supporting an initial suspicion of relapsing polychondritis. Prednisone 40 mg/day and azathioprine 100 mg/day were given. Corticosteroids were tapered to 20 mg/day for 1 month after reduction of inflammation in the opposite ear. Azathioprine treatment was stopped when the liver enzyme level was significantly raised after 2 months of treatment. A daily dose of prednisone 20 mg/day was continued, and oral methotrexate 7.5 mg/week was started after the liver function returned to normal. Partial repair of the auricular cartilage was noted 2 months later and f...