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Avascular necrosis of bone while on alendronate: report of a case: Authors' Reply
Avascular necrosis of bone while on alendronate: report of a case
Correspondence
127
Dear Editor, In a recent issue of the journal, Aneja et al. have presented the results of their study on peripheral neuropathy in RA.1 This study is possibly the largest such study from our country. It highlights the fact that much of neuropathy, especially autonomic neuropathy, in RA is subclinical. With the exception of autonomic neuropathy, which is largely detectable only with special autonomic function tests, patients with other forms of neuropathy were shown to have findings on historical review and examination. The key questions to be answered are: How much of additional information is obtained by performing nerve conduction studies and, should nerve conduction studies be limited only to symptomatic patients? These data would help clinicians to decide
the utility of nerve conduction studies in the care of RA patient.
AUTHORS’ REPLY
clinically with neuropathy and in the other 56% it was NCV that detected the subclinical neuropathy. As per the results of this study more than 50% patients had subclinical neuropathy that was not detectable clinically; it seems that NCV would be an important investigation to detect these subclinical cases that are not otherwise apparent and by restricting NCV in only symptomatic patients we would be missing out on these subclinical cases.
Lt. Col. K. Shanmuganandan has raised a pertinent question whether NCV should be restricted to only symptomatic patients. In the present study, out of total 66 patients, 21 had clinical features of neuropathy and of those only 11 had abnormal nerve conduction study. Of these 21 patients having some clinical features of neuropathy only 11 were demonstrated to have neuropathy by NCV. This shows that in many patients the subjectivity plays a role that may interfere with the clinical interpretation. Of 25 patients with neuropathy as detected by the NCV only 11 had features of clinical neuropathy. That means only about 44% patients manifested
Dear Editor, I would like to congratulate you for bringing out a wonderful series of articles on vasculitis.1,2 In addition to in-depth knowledge of the subject, Professor Konttinen has a flair for explaining complex topics in a lucid and easily understandable manner. Vasculitides are an uncommon, yet important part of rheumatological practice. It is imperative for the wellread rheumatologist to have a strong grasp of these disorders. Professor Kontinnen has used the apt analogy of roadmaps and road signs to highlight the practical aspects of this condition. I look forward to reading the remaining articles in the series. May I suggest that such series on various important topics be made a regular part of the journal as they enhance the journal’s value for readers, especially postgraduates and trainees. Yours sincerely, Dr. (Brig) Chander Mohan Adya
Yours sincerely, Lt. Col. K. Shanmuganandan Department of Internal Medicine Armed Forces Medical College, Pune, India
REFERENCE 1.
Aneja R, Singh MB, Shankar S, Dhir V, Grover R, Gupta R, et al. Prevalence of peripheral neuropathy in patients with newly diagnosed rheumatoid arthritis. Ind J Rheumatol 2007; 2: 47–50.
Dr. Ritu Aneja Department of Medicine, Sohar Hospital, Sohar Ministry of Health, Sultanate of Oman Email: [email protected]
Department of Medicine & Rheumatology Gian Sagar Medical College, Ramnagar, Banur Dist., Patiala Email: [email protected]
REFERENCES 1.
2.
Konttinen YT, Pettersson T, Matucci-Cerinic M, Dadoniene J, Poduval P. Roadmap to vasculitis: a rheumatological treasure hunt. Part I. Stop sign, red flags, triggering factors, patient history and physical examination. Ind J Rheumatol 2007; 2: 11–6. Konttinen YT, Pettersson T, Matucci-Cerinic M, Dadoniene J, Poduval P. Roadmap to vasculitis: a rheumatological treasure hunt. Part II. Classification, features of individual vasculitides and differential diagnosis against pseudovasculitis. Ind J Rheumatol 2007; 2: 55–64.
Correspondence
127
Dear Editor, In a recent issue of the journal, Aneja et al. have presented the results of their study on peripheral neuropathy in RA.1 This study is possibly the largest such study from our country. It highlights the fact that much of neuropathy, especially autonomic neuropathy, in RA is subclinical. With the exception of autonomic neuropathy, which is largely detectable only with special autonomic function tests, patients with other forms of neuropathy were shown to have findings on historical review and examination. The key questions to be answered are: How much of additional information is obtained by performing nerve conduction studies and, should nerve conduction studies be limited only to symptomatic patients? These data would help clinicians to decide
the utility of nerve conduction studies in the care of RA patient.
AUTHORS’ REPLY
clinically with neuropathy and in the other 56% it was NCV that detected the subclinical neuropathy. As per the results of this study more than 50% patients had subclinical neuropathy that was not detectable clinically; it seems that NCV would be an important investigation to detect these subclinical cases that are not otherwise apparent and by restricting NCV in only symptomatic patients we would be missing out on these subclinical cases.
Lt. Col. K. Shanmuganandan has raised a pertinent question whether NCV should be restricted to only symptomatic patients. In the present study, out of total 66 patients, 21 had clinical features of neuropathy and of those only 11 had abnormal nerve conduction study. Of these 21 patients having some clinical features of neuropathy only 11 were demonstrated to have neuropathy by NCV. This shows that in many patients the subjectivity plays a role that may interfere with the clinical interpretation. Of 25 patients with neuropathy as detected by the NCV only 11 had features of clinical neuropathy. That means only about 44% patients manifested
Dear Editor, I would like to congratulate you for bringing out a wonderful series of articles on vasculitis.1,2 In addition to in-depth knowledge of the subject, Professor Konttinen has a flair for explaining complex topics in a lucid and easily understandable manner. Vasculitides are an uncommon, yet important part of rheumatological practice. It is imperative for the wellread rheumatologist to have a strong grasp of these disorders. Professor Kontinnen has used the apt analogy of roadmaps and road signs to highlight the practical aspects of this condition. I look forward to reading the remaining articles in the series. May I suggest that such series on various important topics be made a regular part of the journal as they enhance the journal’s value for readers, especially postgraduates and trainees. Yours sincerely, Dr. (Brig) Chander Mohan Adya
Yours sincerely, Lt. Col. K. Shanmuganandan Department of Internal Medicine Armed Forces Medical College, Pune, India
REFERENCE 1.
Aneja R, Singh MB, Shankar S, Dhir V, Grover R, Gupta R, et al. Prevalence of peripheral neuropathy in patients with newly diagnosed rheumatoid arthritis. Ind J Rheumatol 2007; 2: 47–50.
Dr. Ritu Aneja Department of Medicine, Sohar Hospital, Sohar Ministry of Health, Sultanate of Oman Email: [email protected]
Department of Medicine & Rheumatology Gian Sagar Medical College, Ramnagar, Banur Dist., Patiala Email: [email protected]
REFERENCES 1.
2.
Konttinen YT, Pettersson T, Matucci-Cerinic M, Dadoniene J, Poduval P. Roadmap to vasculitis: a rheumatological treasure hunt. Part I. Stop sign, red flags, triggering factors, patient history and physical examination. Ind J Rheumatol 2007; 2: 11–6. Konttinen YT, Pettersson T, Matucci-Cerinic M, Dadoniene J, Poduval P. Roadmap to vasculitis: a rheumatological treasure hunt. Part II. Classification, features of individual vasculitides and differential diagnosis against pseudovasculitis. Ind J Rheumatol 2007; 2: 55–64.