Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Reiter's Syndrome (RS) is not common in children and adolescents. From 1982 to 1987 we have seen 13 pediatric patients (8 male and 5 female) with clinical manifestations that characterized RS. Age of onset was 13 years. Clinical findings have been arthritis (100%) involving the knee and ankle joints, heel pain (84%), lumbosacral pain (38%). One to three weeks before joint involvement, six patients (46%) complained of urethritis, 5 (38%) had enteritis and two patients had both. 46% of the patients had HLA-B27 antigen. Radiologic findings were sacroileitis in five patients and calcaneal spurs. All patients were treated with non-steroidal antiinflammatory therapy and, in general, there was a clinical remission in 1-3 months. Nevertheless, after 4 years of follow up, 2 patients had acute relapsing arthritis and 4 had chronic arthropathy. Three patients have developed secondary ankylosing spondylitis. RS is not all that infrequent in pediatric patients with joint involvements if one looks for urethritis, enteritis, eye involvement and cutaneous manifestations. The clinical course is favorable, but there might be some chronic or relapsing cases. Some patients can developed secondary ankylosing spondylitis. For that reason a prolonged follow up of these patients is necessary.
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PMID:[Reiter's syndrome: considerations on the frequency and mid-term course of its juvenile form]. 323 76

A subacute, oligoarthritic syndrome developed in four patients with human immunodeficiency virus (HIV) infection. Three had true acquired immunodeficiency syndrome (AIDS) and all had lymphocyte abnormalities. The arthritis was characterized by extreme pain and disability in three patients and moderate pain in one. Knees and ankles were affected. Symptoms developed over a one- to six-week interval; response to treatment was rapid, especially to intra-articular corticosteroids. Despite the clinical severity of the arthritis, synovial fluids were non-inflammatory and biopsy specimens revealed only mild chronic synovitis. A definite etiology could not be established. None of the patients had recognized infections predisposing to reactive arthritis, and the three patients who underwent tissue typing were HLA-B27-negative. A viral infection, including HIV, is a possible cause. In distinction to these four patients, arthritides with clearly established etiologies developed during this same time period in four other HIV-infected patients.
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PMID:Acquired immunodeficiency syndrome-associated arthritis. 336 41

A 50-year-old male presented with polyarthritis and pain of the right costovertebral angle in the cervicothoracic area. Radiological findings in a sacroiliac joint, the presence of a syndesmophyte, the HLA B-27 phenotype and negative serological studies prompted the diagnosis of HLA-B27 related seronegative spondyloarthropathy. Conventional and computerized tomograms disclosed an erosive arthritis of the 1st right costovertebral joint that was responsible for the pain in the costovertebral angle. We are unaware of previous CT scan documentation of such lesions.
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PMID:Erosive arthritis of the costovertebral joint in seronegative spondyloarthropathy. 348 53

Two patients with seronegative HLA-B27-connected spondylarthropathy, associated in one case with psoriasis and in the other with Reiter's disease, who had atlanto-axial subluxation (AAS) are reported. The AAS caused muscle weakness and intractable occipito-cervical pain. Both patients were treated operatively with a Gallie type C1-C2 fusion. The symptoms subsided following surgery and the patients remained free of cervical spine discomfort. The report also indicates that the rarer variants of the HLA-B27 associated chronic seronegative spondylarthropathies may cause AAS complicated by neurological symptoms and that the disorder is amenable to surgical intervention.
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PMID:Atlanto-axial subluxation in patients with seronegative spondylarthritis. 349 55

We report 2 independently-conducted family studies of HLA-B27 positive probands with ankylosing spondylitis (AS), both of which support the view that the clinical spectrum of AS is broader than ordinarily assumed, and should include individuals who have symptomatic disease but who do not show radiologic evidence of abnormalities of the sacroiliac joints or the spine. In the Cleveland study of 100 relatives of 30 B27 positive AS probands, 9 relatives did not show radiologic abnormalities of the sacroiliac joints or the spine but had symptoms of chronic inflammatory back pain previously reported to be characteristic of AS. These 9 relatives were all subsequently found to possess B27, in contrast with only 27 of 60 asymptomatic relatives (P less than 0.01). In the Leiden study of 101 relatives of 20 randomly chosen B27 positive AS probands, 13 of 86 relatives without radiographic evidence of sacroiliitis reported "thoracic pain and stiffness," as defined in the Rome criteria for AS. Twelve of these 13 symptomatic relatives were B27 positive. In contrast, among the remaining 73 relatives, only 33 were B27 positive (P less than 0.01). The occurrence of these characteristic spondylitic symptoms in B27 positive, but not B27 negative, relatives of AS probands suggests that the spectrum of the clinical manifestations of AS may include individuals with symptomatic disease, but without radiographic evidence of abnormalities of the sacroiliac joints or the spine. The relatively large number of females we found in this group suggests that women are more likely to manifest this variety of disease than are men.
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PMID:Spondylitic disease without radiologic evidence of sacroiliitis in relatives of HLA-B27 positive ankylosing spondylitis patients. 387 29

Eighteen unrelated children (12 boys and six girls) with Osgood-Schlatter disease (OSD) were evaluated by history, physical examination, and histocompatibility antigen [human leukocyte antigen (HLA)] determination. Four boys and two girls had pain at sites other than the tibial tuberosity. By history, other related individuals with a diagnosis of OSD were found in six of the 18 families. The distributions of HLA antigens (A, B, and DR) were not demonstrably abnormal. The similarity of OSD and enthesitis accompanying HLA-B27-associated arthropathy may cause diagnostic difficulty. The lack of an association between OSD and HLA-B27 may be of assistance in differentiating the two disorders.
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PMID:Histocompatibility antigens in Osgood-Schlatter disease. 387 74

Spondyloarthritis (Sp) is newly defined as arthritis that is clinically, pathologically, and genetically related to and predisposed to ankylosing spondylitis (AS) and Reiter's syndrome (RS) rather than to rheumatoid arthritis (RA). A diagnosis of Sp does not necessarily imply arthritis of the spine and does not depend on the demonstration of roentgenographic sacroiliitis that, in this conceptualization, is recognized not as the essential hallmark, but rather merely as a diagnostic "way station" on a continuum of disease, which may (but need not necessarily) begin with RS or be complicated during its course by AS or RS. Spondyloarthritis is distinctively characterized morphologically and clinically by disproportionate inflammation at the entheses, the sites of attachment of tendons and ligaments to bone. Family history or presence of enthesopathic pain, psoriasis, inflammatory bowel disease, uveitis, recurrent urethritis, prostatitis or cervicitis, keratoderma blennorrhagicum, HLA-B27, and asymmetric pauciarticular lower lower extremity arthritis without rheumatoid factor or rheumatoid nodules suggests a diagnosis of Sp rather than RA.
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PMID:Spondyloarthritis and enthesopathy. Current concepts in rheumatology. 621 89

Although ankylosing spondylitis (AS) has been considered rare in women, we believe that its incidence is underestimated. In our case studies of 12 women with AS the characteristic clinical features of the disease included onset before the age of 30 (12 patients); night pain and morning stiffness (12 patients); intermittent, migratory joint pain (9 patients); and history of uveitis (2 patients). Spine mobility was decreased in all patients. Sacroiliac (SI) (8 patients) and circumthoracic (5 patients) tenderness were common findings. If these pertinent clues are present, further diagnostic studies are indicated. Histocompatibility testing for the HLA-B27 antigen, which is reported to be present in over 90% of patients with AS, is useful in detecting early and mild forms of the disease. We found the antigen in 10 of 11 patients tested. Radioisotope (RI) scanning can show early inflammation of the SI joints long before changes are evident on standard roentgenograms: In 3 cases, SI films were reported as normal but RI scans revealed abnormal uptake and ratios. Early detection of AS prevents inappropriate treatment of patients and mislabeling them as functional complainers.
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PMID:Ankylosing spondylitis in women. 624 28

The clinical manifestations and results of investigations in a series of 221 patients diagnosed as suffering from Reiter's disease are described in detail. Attention is drawn to the very varied natural history of the disease, the relapse rate of 60% and the development of serious complications and disability in young people. The failure to establish the cause of the condition or to unravel its relationship to nonspecific urethritis and bacillary dysentery contrasts with the reported presence of the human leucocyte antigen HLA-B27 in 76% of patients. There is no curative treatment but symptomatic treatment will relieve pain and stiffness and may shorten the duration of individual attacks. Prolonged follow-up of established cases, monitoring of activity of the disease by regular measurements of the erythrocyte sedimentation test and prompt treatment of relapses may prevent the development of serious locomotor disability.
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PMID:Clinical aspects of Reiter's disease. 636 Feb 86

The present study was performed on 61 HLA-B27 positive first-degree relatives and 40 HLA-B27 negative relatives of 20 HLA-B27 positive probands with ankylosing spondylitis (AS). Of 24 HLA-B27 positive relatives 45 years or older, 21% had AS and 38% sacroiliitis. The HLA-B27 negative relatives did not have features of either disease. In the population study of 2,957 individuals 45 years or older, we found 5 cases of HLA-B27 positive sacroiliitis (according to the New York criteria) and 3 of these fulfilled the New York criteria for diagnosis of AS. In 2 of these 3 individuals, the diagnosis was made on clinical grounds. The phenotype frequency of HLA-B27 in this population is 7.8%, or about 230 HLA-B27 positive individuals in this population sample. Since AS was found in only 3 individuals, 1.3% of the HLA-B27 positive individuals in the population at large have AS; therefore, our data show that among individuals 45 years or older, 21% of HLA-B27 positive relatives of HLA-B27 positive AS patients have AS as compared with 1.3% of the HLA-B27 positive individuals in the population at large. Thus, the risk for AS is 16 times greater in the HLA-B27 positive relatives compared with HLA-B27 positive individuals in the population at large. The discriminatory value of the New York criterion of history of pain or the presence of pain at the dorsolumbar junction or in the lumbar spine was analyzed in the population and family studies and was found to be too nonspecific.
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PMID:The risk of developing ankylosing spondylitis in HLA-B27 positive individuals. A comparison of relatives of spondylitis patients with the general population. 660 52


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