Unknown 96
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Unknown # 96
Case presentation •
•
A 31 year old Georgetown graduate student went to his primary care doctor complaining of lower back pain for 4 months which he attributed to many hours of studying. He reports he wakes up quite stiff in the morning, which resolves after showering, and his back pain improves when he exercises
•
•
He also recently was seen by an eye doctor because of blurry vision in the left eye that he thought was possibly due to his contact lens. His eye exam showed the following:
•
Radiographs taken by his primary care physician show the following:
Questions 1) 2) a) b) c) d) e)
What is the diagnosis? This condition is associated with which of the following? RF + ANA + HLA-B27 + C-ANCA Anti CCP
Answers
• •
Ankylosing spondylitis HLA B 27
Ankylosing Spondylitis •
•
It is a chronic inflammatory skeletal condition causing fibrous and bony bridging of the joints of unknown etiology Peak age 20-30
Pathophysiology •
Enthesitis (where the ligaments attach to the bone) with adjacent edema, erosive lesions that undergo ossification
•
Patients often complain with symptoms of inflammatory back pain: • Prior to age 40 • Lasts at least 3 months • Morning stiffness • Improves with exercise
Extra-articular manifestations • • • •
Anterior Uveitis- 25-40% of patients – most common Atlanto-axial subluxation Inflammatory bowel disease Aortic insufficiency
Diagnosis •
Physical / history • Inflammatory back pain • Limited motion of the lumbar spine • Limited chest expansion • Definite sacroillitis on radiograph • Schober test -
•
Labs • HLA B27 + • anemia
•
Imaging • X-rays showing sacroiliitis • “bamboo spine”
Case presentation •
•
A 31 year old Georgetown graduate student went to his primary care doctor complaining of lower back pain for 4 months which he attributed to many hours of studying. He reports he wakes up quite stiff in the morning, which resolves after showering, and his back pain improves when he exercises
•
•
He also recently was seen by an eye doctor because of blurry vision in the left eye that he thought was possibly due to his contact lens. His eye exam showed the following:
•
Radiographs taken by his primary care physician show the following:
Questions 1) 2) a) b) c) d) e)
What is the diagnosis? This condition is associated with which of the following? RF + ANA + HLA-B27 + C-ANCA Anti CCP
Answers
• •
Ankylosing spondylitis HLA B 27
Ankylosing Spondylitis •
•
It is a chronic inflammatory skeletal condition causing fibrous and bony bridging of the joints of unknown etiology Peak age 20-30
Pathophysiology •
Enthesitis (where the ligaments attach to the bone) with adjacent edema, erosive lesions that undergo ossification
•
Patients often complain with symptoms of inflammatory back pain: • Prior to age 40 • Lasts at least 3 months • Morning stiffness • Improves with exercise
Extra-articular manifestations • • • •
Anterior Uveitis- 25-40% of patients – most common Atlanto-axial subluxation Inflammatory bowel disease Aortic insufficiency
Diagnosis •
Physical / history • Inflammatory back pain • Limited motion of the lumbar spine • Limited chest expansion • Definite sacroillitis on radiograph • Schober test -
•
Labs • HLA B27 + • anemia
•
Imaging • X-rays showing sacroiliitis • “bamboo spine”
