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Ankylosing spondylitis? Or other morning stiffness dx?

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So I am a first year medical student and every once and a while one of the disorders we learn about I get to see while shadowing a primary care doctor. Unfortunately we learned about ankylosing spondylitis after I saw a curious patient being treat by one of the primary's physician assistants. He had some type of chest surgery that I did not find out what it was for, but it had left a scar and was his chief complaint. He then brought up that recently he got a job in a freezer which he wears a protective suit and gloves in but says he gets finger stiffness that is alleviated with hand exercises during and after work. He also stated that he has really bad back pain in the morning and it takes him around half an hour to get out of bed since he is so stiff he can hardly move at all. He also stated a week or so prior to the appointment he had stood up too fast and hit his head on the stairs without any bleeding, vision issues, passing out, and the PA did not find anything in her exam of the patient except tenderness over the area where he hit his head.He was in his mid twenties, possibly early thirties at most, African American, and did not seem to be in any other pain and had full mobility at this afternoon visit. He also stated he was experiencing premature ejaculations without any ED of getting an erection, maintaining it, or having one for longer than expected. The PA didn't know what was the cause, and I sure as heck don't seeing as I've only learned a handful of diseases. Just thought his age and gender being closely associated with A.S. and his morning stiffness was very interesting in retrospect after learning about the disease and wanted to pick anyone's brain about this to see if it is possibly a cause or something else. Thanks in advance!
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replied February 27th, 2012
Especially eHealthy
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.
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replied December 13th, 2012
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!!!
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replied December 13th, 2012
Active User, very eHealthy
They is a drug called remicade that is a very good tretment for AS
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