Main focus of this issue is the high risk of spinal fractures associated with ankylosing spondylitis as a consequence of osteoporosis and stiffness. 

 As opening article, we have adapted a review article by Dr. U. LANGE on osteoporosis and ankylosing spondylitis originally published in the scientific  journal “Aktuelle Rheumatologie”. He describes the mechanisms contributing to osteoporosis, the possibilities to assess the degree of osteoporosis, and possible therapies. Regrettably, our knowledge on long-term drug effects on osteoporosis in AS is rather poor. Whether an anti-TNF-alpha therapy has an effect of preventing osteoporosis, is still unknown. 

Basis of the article by Dr. H. FARHOUD and his colleagues on undetected cervical spine fractures in ankylosing spondylitis were two posters presented at the International Congress on Spondyloarthropathies in Ghent in 2000 and in 2002. Misdiagnoses were due to insufficient radiographs taken and difficulties of their interpretation. The fractures were often unstable, leading to a high mortality. Surgical stabilisation was the treatment most chosen. Dr. H. BÖHM, expert for spinal surgery and medical advisor of DVMB, contributed a comment supporting the importance of this article. 

The case report by Dr. J. ZACHER and Dr. A. GURSCHE on an AS patient with a fracture in the lumbar spine has been adapted from the Zeitschrift für Rheumatologie. Because of the risk of developing a pseudarthrosis after a fracture in the thoracal or lumbar spine, a surgical stabilisation is often unavoidable in such a case. 

The article by Dr. H ALARANTA and colleagues from Helsinki, Finland, on spinal cord injuries as complications to ankylosing spondylitis has been translated from the journal Clinical and Experimental Rheumatology. Among 1103 patients with spinal cord injuries seen in their specialized rehabilitation centre within 20 years, there were 19 AS patients, 11 times more than expected according to the prevalence of AS. Cause for the trauma was often slipping. Proposals for preventing spinal injuries comprise the installation of handrails beside staircases and night-lights in bedrooms and bathrooms, avoiding loose carpets on the floor, the use of a seat belt, a head rest and a panorama mirror when driving a car, avoiding excessive use of alcohol and of risk behavior such as contact sports and other violent activities.

The article on “to tell or not to tell” by Sarah DUNLAP has been translated from “Spondylitis Plus”, the newsletter of the Spondylitis Association of America. She discusses in which situations it may be better to tell others about the disease, and in which situations it may be better to do not.

An article on the Colon Hydro-Therapy has been translated from Bechterewer’n, the newsletter of the Oslo Bechterew-forening in Norway.

For the year 2002, I have again summarized 128 articles on ankylosing spondylitis relevant for patients which had appeared in scientific journals during that year. I regularly observe 15 rheumatology journals available in a large scientific library in Munich. I have meanwhile accumulated more than 1400 references in my personal computer, most of them with my personal remarks on the contents.

DVMB News:
A German version of "Car driving with ankylosing spondylitis" by Dr. Jon ERLENDSSON from Denmark which appeared already in Danish, English, Portuguese, Japanese, and Czech, has now appeared in German language as booklet No. 10 in the DVMB booklet series, together with a collection of articles and letters-to-the-editor on this subject published in former  issues.

This issue No. 93 will be the last one appearing under the title  in the small A5 format. No. 94 will carry the title “Morbus-Bechterew-Journal” and will be published in colour in the A4 format. A working group preparing this change has looked for cost reducing possibilities, and has decided that it is not reasonable to distribute the list of branch addresses and a “Brief in English” with every issue to 17,000 German-speaking DVMB members.