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Old 08-30-2012
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Question Can't grip the cup in the morning!

A 32-Year old Caucasian male complains of inability to grip his cup of coffee and hold a pen in the morning. He says that he is 'fully functional' in the afternoon. His ESR is 45 mm/hr. Which of the following is most likely to be affected by this patient's disease?

A. Sacral spine
B. Sacroiliac joints
C. Lumbar spine
D. Thoracic spine
E. Cervical spine
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Old 08-30-2012
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answer is cervical spine

its a very silly question.. sounds more like Ankylosing spondylitis with improvement in jt symptoms with use. but the trick is the raised ESR! Rheumatoid arthritis has systemic signs symptoms and elevated acute phase reactants. so that make C1-C2 sublaxation as a most likely cause which is seen in RA!
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Old 08-30-2012
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Quote:
Originally Posted by shyangel18 View Post
anser is cervical spine

its a v silly question.. sounds more like Ankylosing spondyltis with imrprovemnt in jt symptoms with use. but hte trick is the raised ESR! Rheumatoid arthristis has systemic signs symptoms and elvated acute phase reactants. so that make C1-C2 sublaxation as a most likely cause which is seen in RA!
But ESR and CRP is raised during acute episode of ankylosing spondylitis too
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Old 08-31-2012
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Originally Posted by step_enhancer View Post
But ESR and CRP is raised during acute episode of ankylosing spondylitis too
TRUTH!
But, You see in C/O AS, predominant joints involved are the sacro illiac joints and rarely will you ever see cervical spine getting involved!
Whereas, In R.A. Cervical spine (Esp. Atlanto-axial joint) Most commonly involved when it comes to involvement of Spine in C/O R.A.
And once 'that' joint goes, it's simply a matter of neuropathy

For discussion sake, AS has fusion of joints(broadly speaking) and hence no sublaxation at atlanto-axial..... less chances of neuropathy (Will give some points to impingement, but not that much)
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Originally Posted by rocketprinciple View Post
TRUTH!
But, You see in C/O AS, predominant joints involved are the sacro illiac joints and rarely will you ever see cervical spine getting involved!
Whereas, In R.A. Cervical spine (Esp. Atlanto-axial joint) Most commonly involved when it comes to involvement of Spine in C/O R.A.
And once 'that' joint goes, it's simply a matter of neuropathy

For discussion sake, AS has fusion of joints(broadly speaking) and hence no sublaxation at atlanto-axial..... less chances of neuropathy (Will give some points to impingement, but not that much)
Thanks I got it .

So in Ankylosing spondylitis involvement is of axial skeleton (Primary symptoms like back pain and stiffness ) rather than the peripheral joints as in this patient "inability to hold the cup" .
Peripheral joints are involved in RA .
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