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Pathology

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Subchondral bone erosion involving the sacroiliac joints and absence of rheumatoid factor with night bone pains is seen in? (AIIMS May 2013)



A Ankylosing spondylitis

B Degenerative join disease
C Reiter syndrome

D Seronegative rheumatoid arthritis

Ans. A Ankylosing spondylitis

a. The patient's young age, occurrence of pain at night, negativity of rheumatoid factor, and especially, bilateral involvement of sacroiliac joints are consistent with ankylosing spondylitis.

b. This is one of the seronegative spondyloarthropathies, characterized by onset before 40 years of age, absence of circulating autoantibodies, frequent association with HLA-B27 histocompatibility antigen, and common involvement of the spinal column.

i. Ankylosing spondylitis should be suspected in any young person complaining of chronic lower back pain and confirmed by radiographs or CT scans of sacroiliac joints.

The disease usually progresses to involve the whole vertebral column, producing ankylosis and respiratory failure secondary to restrictive lung disease.

Uveitis and aortic insufficiency are additional manifestations.

ii. Degenerative joint disease would be exceptional at such a young age, unless predisposing conditions were present.

Degenerative joint disease is not associated with systemic signs and symptoms.

Radiographs of affected joints show narrowed interarticular spaces, osteophytes, and increased density of subchondral bone. Sacroiliac joints are not involved.

iii. Reiter syndrome is one of the seronegative spondyloarthropathies.

It develops as a sequela of gastrointestinal infections due to Salmonella, Shigella, or Campylobacter, or after sexually transmitted infection caused by Chlamydia or Ureaplasma.

Arthritis of large joints (knee and ankle), conjunctivitis, and skin vesicular eruption are the hallmarks of this condition.

iv. Seronegative rheumatoid arthritis refers to those cases in which a typical picture of rheumatoid arthritis is associated with negative rheumatoid factor.

Rheumatoid arthritis involves small joints, especially those of the hands.

Still disease is a rare systemic form of arthritis with onset before age 17.

It manifests with spiking fever and systemic symptoms that usually antedate arthritis.

Associated manifestations include a morbilliform rash, hepatosplenomegaly, serositis, anemia, and leukocytosis.

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