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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Ankylosing spondylitis can present a difficult diagnostic challenge. Not only is its etiology unknown, but its clinical manifestations are myriad and sometimes precede classic low back pain by years. The foremost aid in diagnosis is an awareness of these manifestations, coupled with a willingness to make a tentative (possible or probable) diagnosis of the disease. HLA-B27 positivity and radiologic evidence of sacroiliitis cannot be considered more than nonspecific findings. The earlier the diagnosis, the earlier therapy can be instituted to prevent or minimize disabling deformities. Patient education is integral to therapy and should stress proper posture and exercise in addition to realistic expectations. Medication, particularly the nonsteroidal antiinflammatory drugs, to relieve pain and timely surgical intervention, such as total hip replacement, to relieve pain and/or improve function may also be necessary.
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PMID:Ankylosing spondylitis: the challenge of early diagnosis. 698 3

Seronegative inflammatory disease was diagnosed in seven patients who had pain, swelling, and redness of the foot and/or ankle. Since the clinical findings mimicked infection, tendinitis, fasciitis, or chronic strain, the initial diagnosis was erroneous and treatment ineffective. In addition to the test for the HLA-B27 antigen, technetium-99m-diphosphonate scintigraphy and magnification roentgenograms have proved valuable tools. Increased isotope uptake was found in all involved extremities, and magnification roentgenograms helped to detect early and subtle lesions of bone. The lesions comprised cortical erosion, increased intracortical absorption of bone, periosteal reactions, and osteoporosis. The response to anti-inflammatory drugs was good in all seven patients. Limited and preliminary follow-up data, including repeat bone scans, suggest that the inflammation may be of a transient nature.
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PMID:Seronegative inflammations of the ankle and foot: diagnostic challenges. 722 8

Twenty-six patients with a pauciarticular arthritis have been studied clinically, radiologically and with histocompatibility typing. An increased frequency of HLA B27 was found (p = 1.87 x 10(-12)). Low back and buttock pain, Achilles tendinitis and dactylitis of the toes were more frequent in HLA-B27 positive patients. It is suggested that histocompatibility testing may be of some value in diagnosis and in the investigation of the possible 'reactive' nature of this type of arthritis.
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PMID:Seronegative pauciarticular arthritis and HLA B27. 741 13

Five pediatric patients who presented with hip contractures are described. There were 3 boys and 2 girls ranging in age from 7 to 14. None had morning stiffness and one complained of no pain at all. Each had undergone several diagnostic procedures and had seen an average of 2.5 doctors before receiving the diagnosis of arthritis. All were antinuclear antibody negative and HLA-B27 positive, and they had excellent responses to treatment with nonsteroidals and physical therapy. HLA-B27 positive arthritis should be considered in the differential diagnosis of otherwise unexplained hip contractures in children.
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PMID:Hip contracture as the presenting sign in children with HLA-B27 arthritis. 769 65

Unclassifiable seronegative spondyloarthropathy (SSA) syndrome is primarily considered to be an affliction of males. In this report from northern India, 25 HLA-B27 antigen positive females with this condition are described and compared with 39 HLA-B27-positive males with the same disease. All these patients presented with typical features of spondyloarthropathy such as predominantly lower limb synovitis, enthesopathy and inflammatory spinal pain. The onset was insidious in 56% of the females and in 64% of the males. The mean age of onset as also the mean duration of symptoms prior to diagnosis were significantly higher in females (26.2 vs 19.4 yr and 8 vs 2 yr, respectively). A mono- or oligo-arthritis was seen in 52% of the females and in 53% of the males, but the average number of joints involved was less in females (4.8 vs 7.7). Lower limb joints alone were involved in 56% of the females and 49% of the males, with the knees, ankles and hips being most commonly involved, often asymmetrically. The mean degree of symmetry was significantly lower in females (62 vs 76). Ninety-two per cent of females and 74% of males had inflammatory spinal pain. Radiographic sacroiliitis was demonstrable in 56% females and 74% males. It is concluded that 'unclassifiable' SSA syndrome is not infrequent in females but is diagnosed late. Fewer joints tend to be involved and there is greater tendency towards asymmetry in females.
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PMID:Profile of HLA-B27-related 'unclassifiable' seronegative spondyloarthropathy in females and its comparison with the profile in males. 862 50

We present the case of a 23 year old patient with Kawasaki syndrome which resolved without sequelae after salicylate treatment. An peculiar finding was that of typical symptoms and signs of bilateral sacroiliitis demonstrated by symmetrically increased articular uptake of technetium 99 diphosphonate. This sacroiliitis disappeared completely after resolution of the syndrome. HLA-B27 ag was negative. Articular affection in Kawasaki syndrome comprises pain and/or swelling of large and small peripheral joints. Acute sacroiliitis is a finding not previously described. We believe this to have been an isolated episode and not the onset of a chronic seronegative spondylarthritis.
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PMID:[Kawasaki's syndrome in the adult and bilateral sacroiliitis]. 880 70

Although a number of reports have now described an association between polymorphism of the LMP2 gene and disease phenotype in HLA-B27 positive individuals with ankylosing spondylitis (AS), some describe associations with acute anterior uveitis, others with juvenile onset disease, and one report provides no association. A recent study describes yet a further association with disease severity in patients with juvenile rheumatoid arthritis. We therefore hypothesized that the discrepant findings in adult disease may be a reflection of an underlying association with disease severity. Our study population consisted of 100 HLA-B27 positive Caucasians with AS of ten or more years duration. Clinical assessment of disease severity was based on a metrology index scoring five measurements, the modified health assessment questionnaire for the spondyloarthropathies, and a disease activity index consisting of a visual analog scale to score the amount of pain, stiffness and fatigue. LMP2 genotypes were assigned following polymerase chain reaction amplification from genomic DNA and restriction enzyme digestion with CfoI. Despite confirmation of a significantly higher prevalence of the LMP2 BB genotype in AAU positive (66.0%) versus AAU negative (45.2%) patients (P < 0.05), we observed no association between LMP2 genotypes and any of the indices of disease severity. Furthermore, although a significant association was noted between the presence of peripheral synovitis and the functional index score (P < 0.05), a history of AAU was not associated with more severe disease. Our data is thus internally consistent in demonstrating no association between LMP2 genotypes and either disease severity or peripheral arthritis, and supports the notion that polymorphism of LMP2 primarily influences the development of AAU and not some other phenotype of AS.
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PMID:Polymorphism of the LMP2 gene and disease phenotype in ankylosing spondylitis: no association with disease severity. 934 40

The study included 187 patients with positive diagnosis of Reiter's syndrome (RS) examined and treated in the Clinic of Rheumatology of Military Medical Academy in the period of 26 years (1970-1995). There were 176 males and 11 females (16:1) aged from 12 to 65 (average age 28.5) years. The disease diagnosis was made upon the clinical finding of at least two of four RS main features: acute urogenital or enteral infection, arthritis, ophthalmic and mucocutaneous changes. Family disease occurrence was noticed in 5, and juvenile type in 6 patients. HLA-B27 antigen was present in 81.5% patients. In 74.3% patients the urogenital disease type was determined, in 18.2% enterocolitic and in 7.5% initial causative agent was not discovered. Three or two RS main signs were present in approximately same number of patients (42.2% and 42.6%) while all the four disease signs were found in 15% patients. Acute or subacute course was found in 43.8%, recurrent in 34.2% and chronic in 22% patients. Clinically, the disease was revealed in locomotor system, most frequently as the asymmetric oligoartritis localized in lower extremities. Sacroiliac arthritis, partial or more frequently asymmetric mutual, radiologically confirmed, was present in 18.2% patients. Only one patient was with sacroiliitis without peripheral arthritis, pain in heel was present in 31.5%, and dactilitis, more frequently in the feet, in 13.9% patients. Radiological changes were found in 51.8% patients, most frequently in sacroiliac joints and heel bone. Chlamydia trachomatis or genital mycoplasma were isolated in synovial fluid of 33.3% (6/18) patients. The most frequent urogenital change was urethritis (56.7), ophthalmic--conjunctivitis (46.5), and mucocutaneous--balanitis (12.3). Positive damage of heart and kidneys by primary disease was found in 2, i.e. 4 patients, and possible in 7, i.e. 14 patients. No differences in RS clinical demonstration among sexes were observed. Besides conventional therapy, in only 26 (13.9%) patients were applied drugs out of the basic group, so as the radiation synovectomy and surgical methods of treatment.
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PMID:[Reiter's syndrome--analysis of 187 patients]. 947 25

We report a heterosexual patient with HIV infection and a CD4 T-cell count of 0.45 x 10(9)/L who developed mild ulcerative proctitis, sacroileitis and oligoarthiritis. While he was treated with 5-aminosalicylic enemas, the patient rapidly developed severe pancolitis. An emergency colectomy without procetectomy was performed. A few months later, he suffered recurrence of ulcerative proctitis, aggravation of arthritic pain and developed anterior uveitis. All symptoms disappeared after proctectomy. There was no evidence for opportunistic infection or Kaposi's sarcoma. Antineutrophil cytoplasmic antibodies were positive and the HLA-B27 antigen was present. CD4 counts were lower during the phases of active disease than during remission. This case demonstrates that severe ulcerative colitis can occur in the presence of moderate T-cell defects. In view of a recent report of remission of Crohn's disease under comparable circumstances, it is possible that the extent of T-cell involvement in both diseases is radically different.
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PMID:Extensive ulcerative colitis and extraintestinal manifestations in a patient with HIV infection and significant CD4 T-cell lymphopenia. 958 41

Seronegative spondylarthropathies include ankylosing spondylitis, Reiter's syndrome and reactive arthritis, psoriatic arthritis, arthritis associated with ulcerative colitis and Crohn's disease, plus other forms which do not meet the criteria for definite categories and are called undifferentiated. Recently two sets of classification criteria have been proposed for the entire group including undifferentiated forms: the European Spondylarthropathy Study Group and the Amor criteria. The prevalence of spondylarthropathies is directly correlated with the prevalence of the HLA-B27 antigen in the population. The highest prevalence of ankylosing spondylitis (4.5%) has been found in Canadian Haida Indians, where 50% of the population is B27 positive. Among Europeans the frequency of the B27 antigen in the general population ranges from 3 to 13% and the prevalence of ankylosing spondylitis is estimated to be 0.1-0.23%. Seronegative spondylarthropathies have common clinical and radiologic manifestations: inflammatory spinal pain, sacroiliitis, chest wall pain, peripheral arthritis, peripheral enthesitis, dactylitis, lesions of the lung apices, conjunctivitis, uveitis and aortic incompetence together with conduction disturbances. All of these may also occur in isolation.
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PMID:Clinical manifestations of seronegative spondylarthropathies. 965 94


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