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Background. Polyarteritis nodosa (PAN) is a medium vessel vasculitis which causes significant morbidity and mortality. Usually, it presents with constitutional symptoms with angiographic evidence of aneurysms or segmental stenosis of arteries of mesenteric or renal vasculature. It is exceedingly uncommon for PAN to present with symptomatic progressive intermittent claudication. Case Presentation. We describe a 60-year-old male who presented with rapidly progressive intermittent claudication of his right leg. He did not have any significant atherosclerotic risk factors. He had recent onset hypertension and loss of weight. He also had mononeuropathy of right common peroneal nerve and livedo reticularis rash. With negative autoimmune markers and suggestive histology in deep punch skin biopsy and angiographic evidence of segmental stenosis of femoral and renal arteries, we diagnosed PAN. We treated him with aggressive immunosuppressants and vascular bypass surgery of right femoral vessels; he showed a good response. Conclusion. Rapidly progressive unilateral intermittent claudication could be a very rare, but noteworthy presentation of PAN. With suggestive histology and exclusion of other comorbidities aggressive immunosuppressants should be instituted. Vascular bypass surgery for critical ischaemia of the limbs is an option that could be considered for limb-threatening disease.

Objective: This study was designed to estimate the prevalence of osteoporosis among postmenopausal women selected from seven provinces in Sri Lanka. Method: The study was a community-based cross-sectional survey of a group of 1642 community-dwelling postmenopausal women in seven provinces, except the North and East, in Sri Lanka. Phalangeal bone mineral density (BMD) was measured in all subjects using an AccuDEXA. In a subgroup of 150 women BMDs in the spine from L2–L4 and proximal femur were measured using a Norland Eclipse central DXA machine. In this subgroup, the diagnosis of osteoporosis was made according to the WHO criteria based on T-scores of the spine or femoral neck. The sensitivity, specificity, positive predictive value and negative predictive value of different phalangeal BMD levels were examined and the prevalence of osteoporosis was calculated using the most acceptable cut-off value. Results: A sharp decline in phalangeal BMD (0.006 g/cm2/year) was seen during the postmenopausal period. Phalangeal T-score of −2.00, which had sensitivity, specificity, positive predictive value and negative predictive value of 78%, 85%, 91% and 68% respectively, was selected as the most suitable value to predict osteoporosis: 357 women had phalangeal T-scores either equal to or lower than −2.00. When the positive predictive value and negative predictive value of this cut-off value were applied, 736 women (44.9%) in our sample were likely to have osteoporosis. Conclusions: Osteoporosis is a prevalent disease among postmenopausal women in Sri Lanka. Similar prevalence figures have been reported from other Asian countries.

Summary This study, based on phalangeal bone mineral density (BMD) of 1,174 community dwelling male volunteers aged 50 years or more from seven provinces in Sri Lanka, shows 5.8% prevalence of osteoporosis among them. Advancing age, less physical activity, and low body weight were associated with low BMD. Men with larger families were more likely to have a lower bone mineral density. Purpose The prevalence of osteoporosis among Sri Lankans is not well-known. We wished to estimate the prevalence and determinants of osteoporosis among older men in Sri Lanka. Methods One thousand one hundred seventy-four healthy, community dwelling male volunteers, aged 50 years or more from seven out of nine provinces in Sri Lanka underwent phalangeal bone mineral density estimation using an AccuDXA® scanner. We calculated T scores using the local reference data, and subjects with T score equal or less than −2.5 was considered to have osteoporosis. Results Sixty-six men (5.8%) were detected to have osteoporosis. In contrast to men in the highest tertile of bone mineral density, men in the lowest tertile were older (60.0 versus 55.8 years, p

There is paucity of studies related to parity and bone mineral density in South Asian countries. We recruited 713 healthy, community dwelling post-menopausal women from seven provinces in Sri Lanka for this survey. The number of pregnancies, including miscarriages beyond 20 weeks of gestation, was recorded. Women with diseases and those who have taken drugs that can affect bone mineral density (BMD) were excluded (n = 15). Phalangeal BMD and bone mineral content (BMC) were measured using AccuDEXA in 713 women. Mean (SE) BMD of nulliparous women (n = 32), women with one to two pregnancies (n = 284), three to four pregnancies (n = 290) and more than four pregnancies (n = 107) were 0.437(0.014), 0.454(0.005), 0.455(0.005) and 0.417(0.006) g/cm(2), respectively (P < 0.001). Corresponding mean (SE) BMCs were 1.30(0.063), 1.41(0.021), 1.43(0.022) and 1.32(0.033) g, respectively (P < 0.001). Women with more than four pregnancies were older and lighter when compared with other groups. When results were adjusted for current age and current weight, differences in mean BMD and BMC between groups became non-significant. BMD of nulliparous women remained low in all analyses. We report a significant difference in unadjusted phalangeal BMD in women categorized according to their parity. Women with one to four pregnancies had the highest phalangeal BMD and BMC, while multi-parous (more than four pregnancies) and nulliparous women had lower values. However, in an adjusted analysis, the differences in BMD and BMC were partially explained by the differences of age and body weight between the groups and the unique effect of parity was difficult to determine. Women with lower BMD may have a higher risk of future fractures.