ABSTRACT
A 63-year-old man with ankylosing spondylitis (AS) presented with persistent pain in his back after minor trauma. Radiographs revealed no acute pathology. Six weeks later an MRI scan was performed which showed a vertebral fracture at level Tiii with kyphotic deformity. Another 63-year-old male AS patient presented with back pain after minor trauma 10 days before presentation. At plain radiology a vertebral fracture of Tx was discovered. A third patient, an 83-year-old male AS patient complained about back pain after minor trauma; CT imaging revealed a Tx vertebral fracture. All three patients underwent surgical fixation and were discharged without major complications. In principle, an older patient with an established AS complaining of back pain must be regarded as having a fracture of the vertebral column until the contrary is proven, even in the absence of any recent history of trauma. This strategy can prevent major complication in these patients.
Subject(s)
Back Pain/etiology , Spinal Fractures/diagnosis , Spondylitis, Ankylosing/complications , Thoracic Vertebrae/injuries , Aged, 80 and over , Back Pain/diagnosis , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Spinal Fractures/etiology , Spondylitis, Ankylosing/diagnosis , Tomography, X-Ray ComputedABSTRACT
One 23-year-old and two 24- year-old athletes were diagnosed with ankylosing spondylitis. Because of their wish to compete in sport at the highest level, we considered the feasible extent and intensity of physical sports-load regarding the short-, middle- and long-term effects in this particular subgroup of ankylosing spondylitis patients. We could not find any published articles regarding the physical capacities of highly motivated athletes with ankylosing spondylitis. To give 'tailor made' advice to each athlete, we analysed these patients by using a standardized questionnaire, followed by analysis of the case history and a thorough physical examination. As a result we obtained an idea of the maximum individual feasible sports-load in relation to individual capacity for each athlete. Individual and disease characteristics, as well as the sport-specific physical load, can influence the physical capacity of the athlete. To register the effects of maximum sports-load in the middle and long term, and to work towards offering the best possible advice to athletes with ankylosing spondylitis, follow-up research in these 3 patients is advisable.
Subject(s)
Athletic Performance/physiology , Spondylitis, Ankylosing/physiopathology , Sports , Humans , Male , Young AdultABSTRACT
OBJECTIVE: To evaluate the association between clinical, demographic, and psychological factors and the functional Health Assessment Questionnaire (HAQ) and psychological HAQ (PSHAQ) in patients with rheumatoid arthritis (RA). METHODS: After a mean followup time of 7 years after diagnosis, 112 patients with RA were asked to fill out the HAQ and the PSHAQ. Several clinical variables [erythrocyte sedimentation rate (ESR), visual analog scale (VAS) pain, VAS general well-being, Thompson joint score, and morning stiffness] had been assessed at diagnosis and at followup. In addition, the Impact of Rheumatic diseases on General health and Lifestyle questionnaire, comprising different domains of psychological distress, was assessed at diagnosis. Spearman correlations were calculated to determine associations between functional HAQ and clinical and psychological variables at baseline and to determine the associations between clinical variables and the HAQ and PSHAQ score at followup. Univariate logistic regression analyses were performed to identify possible predictors at diagnosis for a worse HAQ score and PSHAQ score (score > 1) at followup. RESULTS: At followup the functional HAQ score was associated with all clinical variables, whereas the PSHAQ was only associated with more subjective patient related variables (VAS pain, VAS general well-being, and morning stiffness). The final model of the multivariate regression analyses to predict a worse HAQ score at followup only included worse functional ability [odds ratio (OR) 2.63, 95% confidence interval (CI) 1.30-5.32, p = 0.007]. Anxiety (OR 1.13, 95% CI 1.03-1.24, p = 0.007) and a lower ESR value (OR 0.98, 95% CI 0.96-1.00, p = 0.05) assessed at diagnosis were included into the final model as predictors for a high PSHAQ score. CONCLUSION: Overall, the HAQ score, reflecting limitations of daily functioning, is a good representation of disease activity at diagnosis and after a mean disease duration of 7 years, whereas PSHAQ is not.
