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  #1  
Old 07-14-2011
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Question Back pain + blurry vision + EKG abnormality!

A 45 y old male presents with exertional dysnea and palpitation since few months. He denies smoking and intake of alcohol. Past h/o is significant for pain and stiffnes in the back in morning which improves by doing exercise. He is also thinking of taking eye appointments due to blurry vision. On examination early diastolic murmur is heard. Ecg shows left axis deviation with conduction defect. cxray shows cardiomegaly. RA factor is negative. What is most likely diagnosis?
1. Reactive Arthrities
2. Ankylosing Spondylitis
3. Osteoarthrities
4. Psoriatc arthrities
5. SLE
6. Sjogren's syndrome.
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  #2  
Old 07-14-2011
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Ankylosing Spondylitis (Back pain, uveitis, aortic regurgitation and conduction defects. But peak of onset of disease usually between 20-30 years of age)
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Old 07-14-2011
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2. Ankylosing Spondylitis

as 1) reactive needs a preceeding infection also it wouldnt give a long history of back pain and and stiffness

3)Osteoarthritis doenst present this way usally its in the limbs also more importanty the pain increases on exersize and relived by rest

4. Psoriatc arthrities - they would have to give a history of a rash/ psoriasis

5) SLE - well this guys is a pain he can basically have everything but im sure they would hae mentioned a rash or maybe autoimmune phenomenom hx also i dont remember it having anything to do with a heartblock

6) sjogren - dry eye, dry mouth are practically mandatory
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Old 07-14-2011
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pain and stiffnes in the back in morning which improves by doing exercise +eye problem characteristic for AS so i m with option 2
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Old 07-14-2011
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Quote:
Originally Posted by docnas View Post
2. Ankylosing Spondylitis

as 1) reactive needs a preceeding infection also it wouldnt give a long history of back pain and and stiffness

3)Osteoarthritis doenst present this way usally its in the limbs also more importanty the pain increases on exersize and relived by rest

4. Psoriatc arthrities - they would have to give a history of a rash/ psoriasis

5) SLE - well this guys is a pain he can basically have everything but im sure they would hae mentioned a rash or maybe autoimmune phenomenom hx also i dont remember it having anything to do with a heartblock

6) sjogren - dry eye, dry mouth are practically mandatory

I agree with you. By the way, Neonatal Lupus is associated with heart block, but I didn't find any reference about SLE and heart block.

The only thing that not match with the diagnosis of Ankylosing Spondylitis is the age (>40 years old) but others do match,so it is probably Ankylosing Spondylitis.
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Old 07-14-2011
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2. Ankylosing Spondylitis
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will go with ankylosing spondylitis
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thanks i didnt know that about the neonatal lupus
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Old 07-14-2011
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Ankylosing Spondylitis.
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  #10  
Old 07-15-2011
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Quote:
Originally Posted by confident View Post
A 45 y old male presents with exertional dysnea and palpitation since few months. He denies smoking and intake of alcohol. Past h/o is significant for pain and stiffnes in the back in morning which improves by doing exercise. He is also thinking of taking eye appointments due to blurry vision. On examination early diastolic murmur is heard. Ecg shows left axis deviation with conduction defect. cxray shows cardiomegaly. RA factor is negative. What is most likely diagnosis?
1. Reactive Arthrities
2. Ankylosing Spondylitis
3. Osteoarthrities
4. Psoriatc arthrities
5. SLE
6. Sjogren's syndrome.

Yes the answer is 2. Ankylosing spondyllities. Blurry vision and sacroilitis are hallmark of the diseases.( I think mostly seen with >40 age group...but it may occur at that age)
Seronegative spondyloarthropathies types are : Reiters, IBD associated arthropathies, Ankylosing spondylitis, Psoriatic arthropathy. These have negative RA, HLAB27 positive, mostly presents with sacroilities.

1. Reactive arthrities mostly have HLAB27+, Wt bearing jt, h/o diaarhea, URTI, STD, Pustules erruption on sole of the feet.

3. Osteoarthrities : pain and stiffness usuall presents after doing work or activity and improves with rest.

4. Psoriatic mostly presents with rash and DIP and dactylities seen
5. SLE Extraarticular manifestation and low complement level, dsDNA positive are seen.

6. Sjogrens will be seen in association with RA, SLE, Sclerosis, ANA+,Dry eye, dry mouth
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