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Spondylitic Aortitis


Presentation

  • The present day trainees entering radiology are no longer trained by radiologists who cover and are well informed on most aspects of their specialty as was the case with previous generations.[books.google.de]
  • Psoriatic arthritis affects 30% of patients with psoriasis In 60% psoriasis precedes the arthritis In 15% the sx occur simultaneously In 25% the arthritis appears first Typical presentations Often intermittent Sx ‘A 45 y/o female presents to her GP with[slideserve.com]
  • […] in 95% of AS patients but only 6% of normal population A seronegative arthritis which usually presents as an inflammatory, peripheral mono- or oligo- arthritis (wrists or knees) Rarely presents with polyarthritis or spinal disease A rare destructive[brainscape.com]
  • Probable AS is present if 3 clinical criteria are present or if one of the radiologic criteria is present without any signs or symptoms satisfying the clinical criteria. From van der Linden S, et al.[hss.edu]
Physician
  • Both aortitis (with conduction system alterations) and periaortitis should be kept in mind by the physicians because they can significantly influence the prognosis of ankylosing spondylitis patients and they can need a rapid treatment.[moh-it.pure.elsevier.com]
  • 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.[jrheum.org]
  • Ask our physicians about the latest in ankylosing spondylitis research and new therapeutic techniques! Surgery – Surgery is done if pain or joint damage is severe. Only about 6% of people with Ankylosing Spondylitis need to have a hip replaced.[arthritisconsult.com]
  • […] in past or present inflammatory bowel disease - past or present Crohn's disease or ulcerative colitis diagnosed by physician and confirmed by radiography or endoscopy nongonococcal urethritis or cervicitis or acute diarrhea within 1 month before arthritis[enotes.tripod.com]
Plethora
  • It is our experience that this plethora of experts each with his own individual approach is bewildering and intimidating to the novice radiologist.[books.google.de]
Acute Abdomen
  • Abdomen 433 Infection Miscellaneous 633 The Lower Urinary Tract 670 Obstetric Ultrasound 687 Methods Congenital Lesions 715 Vascular Lesions 751 Trauma 771 The Spine and Spinal Cord 791 Orbital Imaging 823 The Paranasal Sinuses 839 Urheberrecht Häufige[books.google.de]
  • Work, Accidental Death, Accidental Exposure, Accidental Overdose, Acholia, Acidosis Hyperchloraemic, Acne, Acrochordon, Acromegaly, Acrophobia, Actinic Keratosis, Activated Partial Thromboplastin Time Prolonged, Activities of Daily Living Impaired, Acute[bonkersinstitute.org]
Heart Disease
  • Inhalt Janet Murfitt 431 447 Liver and Spleen 463 Janet Murfitt 485 Salivary Glands Oropharynx and Esophagus 517 The Small Intestine 533 GENITOURINARY SYSTEM 575 The Colon 586 Congenital Lesions 605 Acquired Heart Disease 157 P Wilde and G G Hartnell[books.google.de]
  • According to a growing body of evidence, it also increases your risk for heart disease.[everydayhealth.com]
  • Ischemic Heart Disease Ischemic hearts disease is characterized by reduced blood supply to the heart muscle, usually due to coronary artery disease.[spondylitis.org]
  • You can also take these important steps to counter traditional risk factors for heart disease: Quit smoking. “ Smoking is a risk factor for developing a number of autoimmune diseases, as well as heart disease,” Matteson says.[everydayhealth.com]
  • , myocardial, congenital, and thoracic/aortic heart disease.[books.google.it]
Heart Murmur
  • IBD Urethral dc, sexual hx CP, SOB, dry cough, palps, ankle swelling PMH (psoriasis, IBD, heart murmur, lung fibrosis, kidney problems), Fx (psoriasis, IBD, joints/back problems), Dx (including treatments tried), Sx IMPACT on life/work EXAMINE (3 mins[medicaleducationleeds.com]
Diastolic Murmur
  • In fact, a diastolic murmur can be audible for several years before dyspnea develops.” (p. 452) “Transesophageal echocardiography is a better imaging technique to visualize the internal structures of the heart.”[healthyresearcherblog.wordpress.com]
Cutaneous Manifestation
  • Cutaneous Manifestations  assessment of less conspicuous areas including  gluteal cleft  scalp  scalp line  groin  posterior auricular regions should be performed. 24.[slideshare.net]
  • manifestations Chief Concern (CC): mucocutaneous lesions, joint stiffness, myalgia, low back pain worse with rest; occasionally heel pain, red eyes, low grade fever; rarely high fever, weight loss, severe malaise, fatigue History of Present Illness ([enotes.tripod.com]
Ankylosis
  • Ankylosing spondylitis (less commonly known as Bechterew disease and Marie Strümpell disease ) is a seronegative spondyloarthropathy , which results in fusion (ankylosis) of the spine and sacroiliac (SI) joints, although involvement is also seen in large[radiopaedia.org]
  • […] portion of SI joint is involved Inferior and anterior portion of joint Other enthesopathies like DISH can cause bridging of upper, non-synovial part of joint Usually site of initial involvement Bilaterally symmetric Widened with erosions at first Then ankylosis[learningradiology.com]
  • This process tends to be slow, but when it progresses can ultimately lead to complete spinal fusion or ankylosis (i.e. the so-called “bamboo spine”).[hopkinsarthritis.org]
  • X-rays may show erosive changes or new bone formation and bony ankylosis in 30% of those people who develop peripheral arthiritis. New bone formation or ankylosis does not occur in rheumatoid arthritis (4).[whatdotheyknow.com]
  • Distinctive features of the disease are the striking tendency towards ossification and ankylosis of the spine and involvement of entheses.[hss.edu]
Loss of Lumbar Lordosis
  • […] of lumbar lordosis Flexion at hips and knees On palpation- Reduced lateral flexion Reduced forward flexion- Schober’s test Reduced chest expansion Tenderness over sacro-illiac joints Differential Diagnosis What other conditions would have similar symptoms[slideserve.com]
  • In chronic progressive disease there is loss of lumbar lordosis with increased thoracic and cervical kyphosis which become fixed as a result of fibrosis and bony ankylosis. 1.1 Aetiology The disease shows a strong association with HLA-B27.[whatdotheyknow.com]
  • In the advanced stages, patients develop loss of lumbar lordosis, buttock atrophy, and an exaggerated thoracic kyphosis with a stooped forward neck sometimes referred to as a 'question mark posture'.[patient.info]
  • Advanced stage(ankylosis)  Constant low back pain  Ankylosis, decreased ROM  Muscle wasting in shoulder and pelvic girdle  Loss of lumbar lordosis  Marked dorsocervical kyphosis  Ultimately in 3 to 5 years – SI joints are fused, spine, hips ankylosed[slideshare.net]
Confusion
  • Instead they encounter a confusing array of subspecialists divided both by systems and by techniques.[books.google.de]
  • There may be considerable systemic disturbance with fever, weight loss and vasomotor changes in the feet. 28 Asymmetric oligoarthritis in lower limbs, usually of acute onset Acute monoarthritis, confused with septic arthritis Sacroiliitis, can be acute[slideplayer.com]
  • Antibodies to cardiolipin - High Ig levels - Effusion - Other autoantibodies: RBC, platelets, and anti-phospholipid are known -- Along with ANA -- Develop immune complexes - LE cell: Macrophages or neutrophils phagocytose Ab-coated nuclei - Possible confusion[flashcardmachine.com]
  • There is some confusion between diagnostic and classification criteria for SpA. As of now, all criteria that have been developed are classification criteria, although they are sometimes used as diagnostic criteria[ 54 ].[wjgnet.com]
Myelopathy
  • Infarction, Cerebral Ischaemia, Cerebral Perfusion Pressure Decreased, Cerebral Thrombosis, Cerebrovascular Accident, Cerebrovascular Disorder, Cerebrovascular Insufficiency, Cerebrovascular Spasm, Cerumen Impaction, Cervical Incompetence, Cervical Myelopathy[bonkersinstitute.org]
  • .: Atlanto-axial subluxation and cervical myelopathy in rheumatoid ar- thritis. Q J Med 60: 159, 391, 1971. Swinson DR, Hamilton EBD, Mathews JA, Yates DAH: Ver- tical subluxation of the axis in rheumatoid arthritis. Ann Rheum Dis 31: 5, 359, 1972.[docslide.com.br]
  • Also, patients with AS are prone to atlanto-axial subluxation, which may lead to cervical myelopathy. Cauda equina syndrome may occur in patients with severe long-standing disease.[patient.info]
  • .  Progressive myelopathy - develops from cord compression leading to motor/sensory disturbance.  Cauda equina syndrome – late complication Initial deficit is loss of sensation on the lower extremity 55.  Spinal stenosis – rare ; Result of bony overgrowth[slideshare.net]
Seizure
  • Aseptic Necrosis Bone, Asocial Behaviour, Aspartate Aminotransferase Abnormal, Aspartate Aminotransferase Increased, Asphyxia, Aspiration, Asterixis, Asthenia, Asthenopia, Asthma, Asthmatic Crisis, Astigmatism, Ataxia, Atelectasis, Atherosclerosis, Atonic Seizures[bonkersinstitute.org]

Workup

  • The above X-ray shows the characteristic appearance of the “bamboo spine” that is observed in ankylosing spondylitis ( source ) CLINICAL WORKUP: OTHER HLA Typing: Most all patients who have this condition are HLA-B27 positive.[stepwards.com]
Streptococcus Pneumoniae
  • Infectious Bacterial : Salmonella, Staphylococcus, Streptococcus pneumoniae Syphilis : The typical calcification of the ascending aorta is uncommon. Mycobacterial : Mycobacterium tuberculosis Viral : HIV. References Gornik HL, Creager MA . Aortitis.[roentgenrayreader.blogspot.com]
  • pneumoniae , syphilis , yaws Musculoskeletal/Orthopedic No underlying causes Neurologic No underlying causes Nutritional/Metabolic No underlying causes Obstetric/Gynecologic No underlying causes Oncologic No underlying causes Ophthalmologic No underlying[wikidoc.org]
Mycobacterium Fortuitum
  • "Aortitis caused by Mycobacterium fortuitum". Arch Intern Med . 151 (5): 1010–1. PMID 2025125 . Lopez, FF.; Vaidyan, PB.; Mega, AE.; Schiffman, FJ. (2001). "Aortitis as a manifestation of myelodysplastic syndrome". Postgrad Med J . 77 (904): 116–8.[wikidoc.org]

Treatment

  • Its treatment employs endoscopic and/or surgical procedures and administration of corticosteroids, even in association with immunosuppressive agents.[moh-it.pure.elsevier.com]
  • Is there effective treatment for AS? The most important treatments for AS are daily exercise and anti-inflammatory medications (e.g. Indocid, Naprosyn, Voltaren, Neurofen, Feldene).[austin.org.au]
  • Leflunomide is recommended for the treatment of active peripheral psoriatic arthritis. [ 9 ] Sulfasalazine may be considered as an alternative in the treatment of peripheral psoriatic arthritis. [ 9 ] Methotrexate may be considered in the treatment of[patient.info]
  • Treatment of the arthritis of these other spondyloarthropathies is similar to the treatment of reactive arthritis .[merckmanuals.com]
  • Pathogenesis, symptoms and signs, diagnosis, and treatment differ by etiology. However, the general principle for treatment is to treat the underlying disorder. Resources In This Article[msdmanuals.com]

Prognosis

  • Both aortitis (with conduction system alterations) and periaortitis should be kept in mind by the physicians because they can significantly influence the prognosis of ankylosing spondylitis patients and they can need a rapid treatment.[moh-it.pure.elsevier.com]
  • What is the prognosis? Enteropathic Arthritis Arthritis that accompanies inflammatory bowel disease.[slideserve.com]
  • Whether you are attempting to choose a course of therapy, ascertain the optimal timing for intervention, arrive at a prognosis, or determine the possible need for periodic diagnostic evaluation, this is an essential resource you'll consult time and time[books.google.it]
  • Prognosis The prognosis for many patients with AS will be complete spinal ankylosis, while others will experience intermittent flares between bouts of clinical remission.[hopkinsarthritis.org]

Etiology

  • Pathogenesis, symptoms and signs, diagnosis, and treatment differ by etiology. However, the general principle for treatment is to treat the underlying disorder. Resources In This Article[msdmanuals.com]
  • Etiology The precise etiology of AS remains mostly unknown, though heritability is frequently cited as a significant contributor. Major histocompatibility alleles, particularly HLA-B27, may account for up to one-third of the genetic effect.[hopkinsarthritis.org]
  • General Considerations Chronic inflammatory disease of unknown etiology primarily affecting spine Most common spondyloarthropathy Age-young adults 15-35 years Mostly male M:F 4:1 Mostly Caucasian Caucasians to Blacks 3:1 Clinical findings Insidious onset[learningradiology.com]
  • Pathology Etiology infectious syphilitic aortitis tuberculous aortitis pyogenic aortitis: especially Salmonella infection aortitis due to HIV infected (mycotic) aortic aneurysm non-infectious giant cell arteritis Takayasu arteritis other rheumatologic[radiopaedia.org]
  • Etiology  Not completely understood  Auto-immune  HLA-B27 : seen in 90 % patients  Autosomal inheritance with 70 % penetration in males  some family history 34.[slideshare.net]

Epidemiology

  • Patient Population: Prevalence and Epidemiology Knee // Shoulder & Elbow // Hip // Spine // Foot & Ankle // Hand & Wrist Fragility Fractures: Diagnosis and Treatment Shoulder & Elbow The Characteristics of Surgeons Performing Total Shoulder Arthroplasty[mdedge.com]
  • Epidemiology of spondyloarthritis in North America. Am J Med Sci 2011;341(4):284-6. Dillon CF, Hirsch R. The United States National Health and Nutrition Examination Surveyand the epidemiology of ankylosing spondylitis.[hopkinsarthritis.org]
  • [ 3, 4 ] The diverse clinical manifestations of this condition have impaired meaningful research on epidemiology.[patient.info]
  • MCP joint destruction with bone resorption and finger shortening (Opera-glass hands) -- this eventually leads to paw like hands with subluxation and loss of function Arthritis effecting up to four joints in the first 6months of the disease classically Epidemiology[brainscape.com]
  • Epidemiology [ 1 ] Prevalence is 0.1-2% of the general population, with the highest prevalence in northern European countries and the lowest in people of Afro-Caribbean descent. Peak onset is between 20-30 years of age. Male:female ratio is 3:1.[patient.info]
Sex distribution
Age distribution

Pathophysiology

  • Focuses on aspects of pathophysiological processes, clinical presentations, screening tests, prognostic implications and novel therapeutic approaches.[books.google.it]
  • These patients are at high risk of anesthesia related mortality from the pathophysiology of the cardiac lesion, exacerbated by the cardiovascular changes of pregnancy and complicated by the hemodynamic aberrations caused by anesthesia.[unboundmedicine.com]
  • Clinical and genetic similarities suggest that they also share similar causes or pathophysiologies. Rheumatoid factor (RF) is usually negative in the spondyloarthropathies (hence, why they are called seronegative spondyloarthropathies).[merckmanuals.com]
  • The pathophysiology probably involves immune-mediated inflammation.[msdmanuals.com]
  • Ankylosing spondylitis Psoriatic arthritis Reactive arthritis (Reiters) Enteropathicarthritis (associated with IBD) HLA-B27 Ankylosing spondylitis Ankylosing Spondylitis primarily involves the axial skeleton (egsacroiliitis & spondylitis) Prevalence- 0.15% Pathophysiology[slideserve.com]

Prevention

  • Can You Prevent AS? Currently, no method of preventing ankylosing spondylitis exists. However, a good stretching and exercise program can delay the normal disease progression.[emedicinehealth.com]
  • When it comes to ankylosing spondylitis and heart disease, it’s all about prevention, Dr. Steinbaum said.[everydayhealth.com]
  • Management of aortitis includes controlling the inflammation with medications, treating complications, and preventing its recurrence.[spondylitis.org]
  • If you pay attention to your posture, exercise regularly and avoid the stoop associated with the condition, you can prevent this from becoming too serious.[arthritisconsult.com]
  • PATIENT MANAGEMENT: PROPHYLACTIC MEASURES COULD THIS HAVE BEEN PREVENTED? ARCHIVE OF STANDARDIZED EXAM QUESTIONS This archive compiles standardized exam questions that relate to this topic. Page Updated: 02.19.2017[stepwards.com]

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