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Lecture 39 March 9th-MSK

Lecture 39 March 9th-MSK

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1DDX: LECTURE 39 \u2013 MARCH 9th, 2007
Seronegative means that they don\u2019t contain Rheumatoid factor. Polyarthrides
Pathologies will be presented as \u201cwhat is different\u201d from what has come before. Lots of similarities, learn to DDX.
Patients have psoriasis and arthritis
\u201c42%\u201d should read \u201c10%\u201d
Need to know the 3 different types and what differentiates them from each other.
MC is Asymmetric inflammatory arthritis (47%)
Symmetric starts to look like RA
Psoriatic spondylitis starts to look like ankylosing spondylitis
Men and women get more often (RA: female m/c)
People have psoriasis for years first.
PIPs and DIPs are affected (RA doesn\u2019t affect DIP)
Pitting of the nails (not present in RA)
Non-symmetrical (DDX RA)
Eyes are affected.

Arthritis mulitans: very destructive: bone starts to be eaten away.
Subcutaneous nodules not present (in 20-30% of RA patients: can look at this, but the absence doesn\u2019t rule out RA)
\u00bc of patients have + rheumatoid factor


Primary symptom: \u00bd have spondylitis and \u00bd have sacroiliitis
Not as bad as AS
Small percentage develop arthritis mutilans
Ensethopathy: irritation to soft tissue components that attach to bone.

Always think about PsA when you see pt. With psoriasis and arthritis.
**know that they have a high frequency of HLA-B27.
No specific age group, but usually middle-age.
Lab findings:
See notes
Will see high ESR and C-reactive protein with all inflammatory conditions. Can use this to track progress of
Pencil in a cup: narrowing of one bone into another.
Opera glass deformity:

Skin is what we show the world. What isn\u2019t meshing with a patient with a skin pathology?
Skin pathologies: always irritating patient, always in their face.

DDX LECTURE 39, MARCH 9th, 2007 \u2013 PAGE 1

Combination of 3 different paths in one. Arthritis, UTI, eye inflammation (conjunctivitis). \u201cCan\u2019t see, can\u2019t pee, can\u2019t dance
with me\u201d
Look at patient\u2019s history. Sexual practices? Travel to location where they may have contracted dysentery.l

Can linger, person can get reinfected if they lead life that puts them at risk.
These conditions will interfere with blood vessel\ue000 aortic regurgitation.
What are you keeping a blind eye to, not looking at in your life? How does this tie in to the rest of their life?

Dr. Loken had a patient with arthritic symptoms, but his main concern was that he was developing so many floaters that he was losing peripheral vision and general vision. Patient convinced that he had STI. Had no partners before 20 year marriage, his wife had no partners. Why does he think he had an STI?


Talk with patient, look at history, there were blanked out areas in his memory. Skipped age 9-16. Had blocked out
this part of his life. Had been molested by his older brother when he was about 10. From this incident, thought that
he had an STI. He thought he would get an STI from ANY anal sex: not just with an infected person. Decided that he
needed to talk to his brother. Second appointment, felt 50% better. Didn\u2019t see patient again.

People don\u2019t just get symptoms for no reason!
Body will say: you don\u2019t have to look at it: closing off vision.
Nurture: what do we use to nurture ourselves? Look for imbalances within this. Often an imbalance in sex.
Do they describe a common sensation in the eyes, urinary tract, joints? Is there pain everywhere? Restriction?
Constant? Try to link this to their emotional life.
Inflammation is yin in nature. If there is inflammation, look for imbalances within yin.

Correlation between IBS and the onset of AS.
Will start to get inflammation in SI joint: this may be the first thing that they notice.
Spine will fuse over time. Will lock, and will havev to use muscles to keep themselves upright.
Spine becomes rigid: bamboo spine
Youngest of arthritides: 15-35 years old. White male disease.
90% have HLA-B27

Main symptom is bilateral sacroiliitis.
Will have limited expansion through ribs.
Affects CV and lungs: chest isn\u2019t expanding the way that it is supposed to. Pressure systems that rely on the space that
they have for proper functioning.

Grading of ROM 1-4. 4=complete ankylosis. 1=normal
Hyperchromic anemia: There is a lot of HB in the cell, but not enough of cells overall. This is a B12 deficiency, not an iron
Can fuse within a few years.
Care: treatment is physiotherapy.

Getting frozen in your body. Can\u2019t move into next phase of life? High school, college time frame. Lots of change in this
Core issues?
SI joint is a transition between earth and water.
What is PARALYZING them from moving forward? Fear?

One of the most painful conditions: some patients can\u2019t stand the feeling of sheets on their toes.
DDX LECTURE 39, MARCH 9th, 2007 \u2013 PAGE 2

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