LETTERS

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Winston EL, Pariser KM, Miller KB, Salem DN, Creager MA: Nifedipine as a therapeutic modality for Raynaud’s phenomenon. Arthritis Rheum 26: 1177-1 180, 1983 Kahan A, Weber S, Amor B, Saporta L , Hodara M, Degeorges M: Etude controlee de la nifedipine dans le traitement du phknomene de Raynaud. Rev Rhum Ma1 Osteoartic 49:337-343, 1982 Smith CD, McKendry RJR: Controlled trial of nifedipine in the treatment of Raynaud’s phenomenon. Lancet 2:1299-1301, 1982 Rodeheffer RJ, Rommer JA, Wigley I-‘, Smith CR: Controlled double-blind trial of nifedipine in the treatment of Raynaud’s phenomenon. N Engl J Med 308:880-883, 1983 Rodnan GP, Myerowitz RL, Justh GO: Morphologic changes in the digital arteries of patients with progressive systemic sclerosis (scleroderma) and Raynaud’s phenomenon. Medicine (Balti- more) 59:393-408, 1980 McGrath MA, Peek R, Penny R: Blood hyperviscosity with reduced skin blood flow in scleroderma. Ann Rheum Dis 36569- 574, 1977 Van der Meulen J , Wouda AA, Mandema E, The TH: Immune complexes in peripheral blood polymorphonuclear leucocytes of patients with Raynaud’s phenomenon. Clin Exp Immunol 3552- 66, 1979 Kahan A, Amor B, Menkes CJ, Weber S: Nifedipine in digital ulceration in scleroderma (letter). Arthritis Rheum 26:809, 1983

Comment on Anderson and Dorwart paper

To the Editor: I read with interest the paper (Anderson RB, Dor-

wart B: Pneumarthrosis in a shoulder infected with Serratia liquefasciens: case report and literature review. Arthritis Rheum 26: 1166-1 168, 1983) which reviewed previously re- ported cases of pneumarthrosis by anaerobic organisms. I would like to add, however, that we (Pate D, Katz A: Clostridia discitis. Arthritis Rheum 22: 1039-1040, 1979) also had previously reported a case of Clostridia discitis where the radiographic gas collection in the disc space led to establishing the correct diagnosis. Unlike the cases reviewed by Anderson and Dorwart, our patient had neither history of antecedent trauma nor surgery, and no active underlying systemic illness.

I appreciated the reemphasis of the need to look for gas production in a joint space where infectious arthritis is suspected.

Arnold L. Katz, MD Tulsa Medical College Tulsa, OK

Flexion contractures and digital sclerosis in adult non-insulin-dependent diabetes

To the Editor: In your November 1982 issue, Seibold ( 1 ) reported a

high prevalence of digital sclerosis and flexion contractures of the interphalangeal joints of the hands in children with insulin-dependent diabetes mellitus. Later, Eversmeyer (2) described similar findings in 2 cases of adult insulin-depen- dent diabetes. We also observed similar features in 4 cases of adult non-insulin-dependent diabetes.

The patients, 3 women and 1 man, aged 66 (patient l ) , 59 (patient 2), 78 (patient 3), and 56 (patient 4), had had diabetes for 15 (patient l), 6 (patient 2), 3 (patient 3), and 10 (patient 4) years. Patients 1, 2, and 4 were treated only with diet, and patient 3 with an oral hypoglycemic drug.

All patients had good glycemic control, but were affected by diabetic retinopathy. All showed symmetric and asymptomatic flexion contractures of the proximal interpha- langeal joints of the hands and 2 of them (patients 2 and 4) had palpably thickened and adherent skin restricted to the proximal interphalangeal joints and distally. These features appeared after onset of diabetes.

None of them exhibited any manifestations of other connective tissue diseases, except osteoarthritis of the spine (patients I , 2, and 3). Our observations suggest that digital sclerosis and flexion contractures can also be found in adults with non-insulin-dependent diabetes.

Furthermore, we agree with previous reports (2-4) that these pathologic manifestations could be due to a derangement of the microvascular circulation which could be independent of blood glucose level.

Paolo Kossi, MD Venceslao Fossaluzza, MD Stefan0 Pirrone, MD Franco Tosato, MD S . Maria della Misericordia General Hospital Udine, Italy

Seibold JR: Digital sclerosis in children with insulin-dependent diabetes mellitus. Arthritis Rheum 25: 1357-1361, 1982 Eversmeyer WH: Digital sclerosis in adult insulin-dependent diabetes (letter). Arthritis Rheum 26:932, 1983 Rosenbloorn AL, Silverstein JH, Lezottc DC, Richardson K, McCullum M: Limited joint mobility in childhood diabetes melli- tus indicates increased risk for microvascular disease. N Engl J Med 305:191-194, 1981 Knowles HB: Joint contractures. waxy skin, and control of diabetes. N Engl J Med 305:217-219, 1981