UW + mehlman revision Ankylospondylo 12-24 (1)

Question 1

UW table. Inflammatory back pain. 4? age, elicits, relieves

Answer 1

insidious onset < 40yo
symptoms >3 months
RELIEVED WITH EXERCISE
Nocturnal pain

Question 2

UW table. Inflammatory back pain. CP?

Answer 2

Arthritis (sacroiliitis)
Reduced chest expansion and spinal mobility
Enthesitis
Dactylitis
uveitis

Question 3

UW table. Inflammatory back pain. complications?3

Answer 3

osteoporosis/osteopenia/vertrbral fractures

Aortic regurgitation (ar todel yra murmur?)

Cauda equina

Question 4

UW table. Inflammatory back pain. lab? 2

Answer 4

Elevated CRP and ESR
HLA-B27 assoc

Question 5

UW table. Inflammatory back pain. imaging?

Answer 5

xray of sacroiliac joints
MRI of sacroiliac joints (in early stage if xray show no abnormalities)

Question 6

UW table Tx. nonpharmacologic? 2

Answer 6

Exercise (postural exercise, ROM/stretching exercises)

Physical therapy

Question 7

UW table Tx. pharmacologic?

Answer 7

NSAIDs
COX2

Question 8

UW table Tx. if pharmacologic fails or progresses?

Answer 8

TNF-alfa or IL-17 inhibitors

Question 9

IBD-assoc. arthritis. what about nsaids?

Answer 9

nsaids may relieve arthritis symptoms, but exacerbate underlying bowel disease

Question 10

why increased risk for fracture?

Answer 10

osteoporosis/osteopenia due to chronic inflamation –> inflammatory cytokines and incr. osteoclast activity

spinal rigidity: it incr. risk for fracture from minimal trauma

Question 11

what pulmonary testing results?

Answer 11

restrictive pattern

decr. VC; decr. TLC; normal FEV1/FVC; incr. or norma; FRC, RV.

thoracic hyperkyphosis

Question 12

M. bamboo spine = AS

Answer 12

.

Question 13

M. Dx of AS?

Answer 13

xray of sacroiliac joints

Question 14

M. HLA-B27 assoc. diseases?

Answer 14

PAIN
Psoriasis, AS, IBD, Reactive arthritis

Question 15

M. guy with AS and blood in stools?

Answer 15

IBD (HLA-B27 PAIR)

Question 16

M. lower back pain + psoriasis, Dx?

Answer 16

likely sacroiliitis

usually primarily Sx of AS, just then psoriasis

Question 17

M. Back pain in the morning + relieved by movement + 20-40 yo male = AS

Answer 17

.