Prevention and treatment of glucocorticoid-induced osteoporosis in International and Italian scenarios

Osteoporosis (OP) and increased risk of fracture (Fx) associated with chronic glucocorticoid treatment pushed panels of experts and scientific societies to produce recommendations for both prevention and treatment of glucocorticoid-induced OP (GIO). Recently the American College of Rheumatology developed and/or endorsed their updated guidelines and recommendations for the prevention and treatment of GIO. In these recommendations the use of FRAX tool, for the 10-year probability of a major osteoporotic Fx, was integrated with other clinical risk factors to define low-, medium-, and high-risk patients. Updated approaches are delineated for post-menopausal women and men >50 years, pre-menopausal women not of childbearing potential, men 50 years, receiving >5 mg/day prednisone equivalent for >3 months; more recently teriparatide has also been included, only for those patients presenting ≥1 prevalent fragility Fx and receiving >5 mg/day prednisone equivalent for >12 months. Also zoledronic acid has been approved by Italian Agency of the Drug (AIFA, 30/08/10) for "… post-menopausal women and men chronically treated with GC ad high risk of Fx", but the drug is dispensed exclusively at the hospital

Ultrasound in the diagnosis of calcium pyrophosphate dihydrate deposition disease. A systematic literature review and a meta-analysis

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Ultrasound imaging for the rheumatologist IX. Ultrasound imaging in spondyloarthritis

Musculoskeletal ultrasound (US) has an increasingly important role in the assessment of spondyloarthritis (SPA) not only for its ability to detect synovial and tendon involvement but also for the accurate imaging of enthesitis, the clinical hallmark feature of SpA. As already known, most cases of enthesitis are subclinical in SpA and US is an effective technique used to detect them. Also, in cases of dactylitis, US can accurately delineate the underlying pathology. US allows clinicians to guide needle positioning within inflamed joints, tendon sheaths and entheses in order to inject steroids or other drugs. This is particularly important for patients with SpA, because of the frequency of mono or oligoarthritis, tendon and entheseal involvement, who may have great benefit from intrarticular or intralesional therapy. The clinical application of US in SpA extends to the monitoring of therapy efficacy, particularly when coupled with power Doppler imaging. Very slight changes in vascularity are easily detected in joints, entheses or tendons, aiding the rheumatologist in the assessment of the effects of local or systemic therapies. The present review provides an update of the available data and discusses research issues of US imaging in SPA. © Copyright Clinical and Experimental Rheumatology 2007