1/4. Diagnosing ankylosing spondylitis.This article focuses on the early diagnosis and effective management of ankylosing spondylitis (AS), a disease that is not uncommon and that can cause early retirement and severe functional disability. AS, like most other rheumatologic diseases, has no diagnostic gold standard. Correct diagnosis depends largely on a constellation of clinical symptoms and signs in addition to radiological findings. early diagnosis has become all the more important because effective therapies are available: tumor necrosis factor antagonists that suppress disease activity and improve functional ability in patients with AS refractory to conventional drug therapy. The biologic agents are probably even more effective if given early. inflammation of the sacroiliac joints and the spine is a common, early feature and possibly the most frequent first manifestation of disease. Therefore, its early detection is important, and magnetic resonance imaging has proven useful in this regard. To optimize diagnostic accuracy of early disease, it is crucial to use a comprehensive approach and have a deep understanding of the disease and its clinical picture. The clinician should gather a complete history, paying close attention to all the elements of this multisystem disease, as well as judiciously ordering laboratory testing and imaging. New strategies are being developed to assist primary care physicians in their screening for these patients, which in turn should result in early referral to rheumatologists and early diagnosis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/4. Diagnostic value of HLA-B27 testing ankylosing spondylitis and Reiter's syndrome.Typing for histocompatibility antigen (HLA)-B27 has been suggested as a clinically valuable diagnostic test for ankylosing spondylitis and Reiter's syndrome, although some decry its use for this purpose. Diagnoses can be made in most patients with these diseases on the basis of the history, physical examination, and roentgenographic findings. The B27 test cannot be used to screen an asymptomatic population to detect these diseases and should not be thought of as a routine diagnostic test. We present probability graphs derived from Bayes' theorem, which show that for certain patients the B27 test, when used properly, is of clinical value as an aid to diagnosis. Proper application of the B27 test in clinical medicine is discussed. The test result does not absolutely confirm or exclude the presence of these diseases; it merely provides a probability statement on their existence in the patient. The test is therefore most useful to physicians who understand the use of probability reasoning in clinical decision making.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/4. Socioeconomic effects of ankylosing spondylitis.Subjects with ankylosing spondylitis are frequently required to make many adjustments to their lifestyle. As these occur over many years, accommodation to the disease is usually accomplished adequately. However, it is important that the physician is aware of the functional problems, of which the patient will rarely complain, and should be able to advise and summon help, particularly with regard to employment and sexual activity. The problems of women with the illness need further exploration.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/4. Odontoid fracture and C1-C2 subluxation in psoriatic cervical spondyloarthropathy. A case report.STUDY DESIGN. Case presentation and review of pertinent literature. OBJECTIVES. To present an unusual case and alert other physicians to possible missed diagnoses. SUMMARY OF BACKGROUND DATA. An unusual case is presented of a young man with server psoriatic spondyloarthropathy and fusion of C2-C7 (Type II cervical psoriatic ankylosing disease) who fell at home, sustaining an unrecognized fracture of the odontoid process leading to subluxation of C1-C2 and the transitory tetraplegia. The patient presented with torticollis, and the fracture was unrecognized for a long period of time. methods. Case presentation. RESULTS. This patient became independent in all activities of daily living after surgery and rehabilitation despite persistence of torticollis. CONCLUSIONS. A patient who presents clinically with traumatic torticollis after minor trauma and who also has psoriasis and ankylosis of the cervical spine should be suspected of having a fracture-subluxation until definitely proven otherwise. In the present case, the late diagnosis delayed surgical stabilization.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |