PATIENT SCENARIO
A 28 yr old male patient has been having some blurred vision, pain, and erythema (red) in the eyes (specifically around the iris). They also complain about lower back pain stiffness. He says that the back pain seems to worsen after resting for long periods. He also has a lot of sleep disturbances related to his pain. He says that exercise actually seems to relieve some of his symptoms. Getting up in the morning is when his symptoms are the worst.
FAMILY hx: They think their uncle had similar symptoms but the patient can’t remember the diagnosis
LABS: HLA-B27 positive
IMAGING/TESTS: Pelvic X-ray reveals sacroilitis, adenovirus eye test- negative, fluorescein eye stain tests negative for corneal abrasion
PHYSICAL EXAM: Mild kyphosis, tender sacroiliac joint, loss of lumbar lordosis
ANSWER
Ankylosing Spondylitis
WHAT IT IS: It is an inflammatory disease where the spine becomes less flexible. The vertebrae (the bony part that actually protects the spinal cord) can actually fuse together. Often people develop a “hunched forward” posture (1). It most often affects the spine & sacroiliac joint (2)
LABS: HLA-B27 present (usually in 90% people with AS)-epocrates
S/S: Back pain ongoing 3+ months. Insomnia common. Early morning stiffness, exercise helps with the stiffness and other sx. Back pain worsens with resting long periods. Sometimes will see uveitis/iritis (inflammation around the eye. Up to 40% patients who have AS can develops this). (2)
PHYSICAL EXAM: Often seen : mild kyphosis, tender sacroiliac joint, loss of lumbar lordosis, possible erythema (redness) of the eye (2)
GENDER: More often males than females
NICKNAMES: Bamboo Spine
COMPLICATIONS: Uveitis/iritis, compression fractures, inflamed/enlarged aorta
TREATMENT: Main goal is to alleviate the pain and treat the stiffness. Also important to prevent spinal deformities. NSAIDs, physical therapy, and sometimes TNF blockers
LIFESTYLE: Sleep difficulties- symptoms worse in am. Exercise improves symptoms-can actually help with this diagnosis-including the pain, flexibility, posture
DISCLAIMER: The information posted is not intended to be medical advice. Check with your primary care provider regarding questions about your health. This post and all other posts are for educational purposes only. This information is intended for medical professionals & students. This is not intended to guide in medical decisions or treatment in any way. As always, medical professionals should call the on call provider if any clarifications are needed. State and hospital protocols should always be followed accordingly. Med Made Ez (MME) disclaims any liability for the decisions you make based on this information. |
