Ankylosing spondylitis? Or other morning stiffness dx?

soontobedr,

You have picked up on one of the hallmarks of a systemic inflammatory disorder, which is morning stiffness that takes around 30-45 minutes of activity to resolve (usually right after the morning shower). Which goes along with patients with an inflammatory arthropathy will note that their joints get stiff with rest and better with activity. (The opposite is true for osteoarthritis, they get worse with activity.)


Unfortunately, AS would not be the first spondyloarthropathy to pick in this patient, as he is black. As noted in the abstract below, AS is three times less common in blacks than in whites. That is not to say that he could not have it, but you may want to consider one of the other spondyloarthropathies, and there are several of them.

You might want to read up on the more common spondyloarthropathies. You will probably see several cases of Reiter's in your time as a physician. They can also be caused by certain infections (enteric and STD).


But, AS was a good thought for the age and gender, race was just off.


Good luck in your future studies.







Race-Related Differences in HLA Association with Ankylosing Spondylitis and Reiter's Disease in American Blacks and Whites
Muhammad A. Khan

J Natl Med Assoc. 1978 January; 70(1): 41-42.

Abstract
Ankylosing spondylitis is three times less common in American blacks than in whites. It is extremely rare in African blacks of unmixed ancestry. A histocompatibility antigen HLA-B27, which does not exist in African blacks of unmixed ancestry, and is present in eight percent of white and two to four percent of the American black population, is strongly associated with ankylosing spondylitis and Reiter's disease. B27 is present in more than 80 percent of white patients with ankylosing spondylitis or Reiter's disease but in less than 60 percent of American black patients. Other genetic and environmental factors may be of major importance in the genesis of these diseases in American blacks. For diagnostic purposes the absence of B27 is of less importance in excluding these diseases in blacks than in whites.

I have AS. I am a white FEMALE. PLEASE, PLEASE, PLEASE remember AS! Women get it too! So many with AS suffer for 10, 20, 30 years before diagnosis! Usually by that time their back is almost completely fused & the pain unbearable. I am a former RN & had only faintly heard of Ankylosing Spondylitis before I was diagnosed with it. Delay in diagnosis or MISDIAGNOSIS, like I had, is the number one problem with treating AS. My 16 year old daughter has also been diagnosed with this horrible disease. This is a white person disease & women get it too!!!

They is a drug called remicade that is a very good tretment for AS