Impromptu teaching rounds for me this AM. Complex case involving a hispanic female with a pain flare in multiple joints, recent prolonged travel in Mexico complicated by diarrhea, and a history of unexplained iron deficiency anemia. Important turning point in this case was measurement of ESR of >115. XRAY of spine and pelvis revealed fused SI joints and enthesopathic changes of the vertebra consistent with ankylosing spondylitis vs enteropathic arthropathy.
Seronegative spondyloarthropathy: constellation of diseases that include ankylosing spondylitis, reactive arthritis (Reiter's), psoriatic arthritis, enteropathic arthritis, and undifferentiated spondys. These diseases are often associated with HLA-B27. Enteropathic arthritis can be associated with a variety of infections to include traveler's diarrhea and brucellosis. IBD associated spondy can preceed onset of bowel symptoms by months / years. Treatment of these disease ranges from anti-inflammatories, corticosteroids, to TNF alph inhibitors.
Review of topics covered in morning report, M&m, and core conferences with links to supplemental reading material.
Subscribe
Posts
Comments
No comments:
Post a Comment