Question

Rick is a 27-year-old who works in an accounting firm. He had started to experience lower back pain and stiffness that he thought were a result of the long hours he spent at his desk. More recently, however, he began to have sleep difficulties. He found that he often woke up during the night feeling hot and sometimes sweaty. Furthermore, his back pain disrupted his sleep, particularly when it radiated around his pelvis and into his thighs. When his lack of sleep began to interfere with his work, he went to an osteopath to see what was wrong. She listened to his case history carefully. Upon physical examination, she noted a slight decrease in his lumbar lordosis and a reduced range of movement in his lumbar spine. His blood tests revealed the presence of HLA-B27, an elevated ESR, and absence of RH. His radiograph showed evidence of sacroiliitis.

1. What is the likely diagnosis Rick received? What are the common clinical presentation and manifestations of the disease?
2. Why is osteoarthritis of the hips a potential secondary complication of this disease? What are the structural changes that occur in the articular cartilage of an osteoarthritic joint?
3. What is the effect of advanced ankylosing spondylitis on lung function?

Answer 1

Question 1

According to me the likely diagnosis risk presentation is of ankylosing spondylitis . I came to this diagnosis due to following reason

Patient serum values indicate and suggest that there is presence of HLA- B27, He also have increased ESR. And moreover the serum values also indicate absence of RH . On radiological examination we find that there is inflammatory process present which usually involve sacroiliac joints . In a typical case of anklylosing spondylitis the first thing that is affected is sacroiliac joint which further moves to spine . Now this will cause bony ankylosing as soon as it ascend up the vertebrae .

The pain which patient have is due to lumbar spine pain which radiate to thighs and hips

The patient had sweating in the night which is due to fever which is a typical condition in ankylosing spondylitis .

Question 2

Osteoarthritis of hip is a serious complication of ankylosing spondylitis because the hip has abnormal distribution of weight and abnormal weight bearing forces applied in the hip bone because there is effected spine . Now this poor condition generated wear and tear which is the initiation of osteoarthritic changes .

Structural changes which take place in articular cartilage of osteoarthritic joint are as in the starting there is edema of the bone and chondrocyte are present in the tissue . These changes in properties of the cartilage and chances of micro fracture increase . Now the synovial fluid enter these cracks (microfractures) which cause widening of the subcondral bone .

Question 3

With the increase in time with ankylosong spondylitis disease there is usually development of thoracic kyphosis . This kyphosis usually decrease or restrict the movement of thoracic cavity . This sometime constrict the lungs . Ribs expansion is also reduced because costovertebral joints are also involved and effected . As there is no expansion of ribs this effect the lungs which cannot expand . Total capitcy of the lungs is also decreased .

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