docnikki
Forum Guru
Topics: 93
Posts: 680
|
A 28-year-old man with a history of renal insufficiency comes to your office with the gradual onset of mild lower back pain that has been radiating down to his thighs over the last two months. He also complains of bilateral shoulder and knee pain that improves with exercise. The patient states that his back is slightly stiff in the morning and that this stiffness is worsened by rest and relieved when he walks. He has never had any back pain before. On physical examination, he is afebrile. There is no local lower back tenderness, and he has a minimally decreased range of motion in the lumbar part of the spine. His rheumatoid factor is negative, and the ESR is 40 mm/h. Plain x-rays of the spine and pelvis are normal. Which of the following is the most appropriate management at this time?
(A) Hydroxychloroquine
(B) Prednisone
(C) Indomethacin
(D) Celecoxib
(E) Physical therapy
|
| Korotkoff
Forum Senior
Topics: 15
Posts: 174
|
May be D? Not sure again. Where did you get these questions?
|
| doc_clotaire
Forum Guru
Topics: 159
Posts: 1,245
|
Seems like Ankylosing spondylitis
giveaway---------------morning stiffness relieved with exercise in young man
I would go for behavioral therapy first since even COX-2 inhibitors could still be bad for his kidney . If that does not work , I would look for the appropriate medication
___________________
The elevator to succes is broke ,you must take the stairs
|
| docnikki
Forum Guru
Topics: 93
Posts: 680
|
Yup doc its Physical therapy. kortakoff these are Fisher's questions.
This patient presents with what is most likely ankylosing spondylitis (AS). This is a chronic inflammatory disease of the joints of the axial skeleton, manifested by pain and progressive stiffness of the spine. He has had this pain for only two months, and the MRI will most likely not show any changes in the sacroiliac joints. He has very mild disease and no evidence as of yet of an anatomic abnormality. In fact, he is still missing many of the firm diagnostic criteria for AS, such as >3 months of symptoms, limited thoracic motion, iritis, and radiological evidence of sacroiliitis. Eventually, erosions and sclerosis of sacroiliac joints will become evident on radiographs. The term "bamboo spine" has been used to describe the late radiographic appearance of the spinal column. This patient has a history of renal insufficiency, and NSAIDs or COX-2 inhibitors may worsen his renal function and are thus contraindicated in this case. He now has only mild lower back pain with slight stiffness and will benefit from physical therapy, which might prevent axial skeleton deformity.
The onset of AS is usually gradual with intermittent bouts of back pain that may radiate down the thighs. The disease progresses in a cephalad direction, and back motion becomes progressively more limited. Transient acute arthritis of peripheral joints occurs in approximately 50% of cases, and permanent changes in the peripheral joints are seen in about 25%. This is most common of the hips, shoulders, and knees.
|
|
| |
| | | | |
