Select a Community
Are you sure you want to trigger topic in your Anconeus AI algorithm?
You are done for today with this topic.
Would you like to start learning session with this topic items scheduled for future?
Anti-CCP
0%
0/30
Anti-dsDNA
HLA-B27
43%
13/30
HLA-DR4
47%
14/30
p-ANCA
10%
3/30
Select Answer to see Preferred Response
This patient is suffering from a reactive arthritis given his joint pain, conjunctivitis (red and itchy eyes attributed to allergies), and urethritis (pain with urination and discharge), most likely precipitated by a Chlamydia infection. HLA-B27 positivity increases the risk of developing reactive arthritis. The triad of large joint oligoarthritis, urethritis, and uveitis/conjunctivitis characterizes reactive arthritis. Once arthritic symptoms have manifested, both microbial tests and blood/synovial fluid cultures are often negative, with serum antibodies as the only detectable abnormality. Reactive arthritis is associated with a Chlamydia infection; however, other infections including GI infections (from infectious causes such as Salmonella) can predispose patients to this condition. The diagnosis of reactive arthritis is primarily clinical; however, an elevated CRP and ESR in the setting of an HLA-B27 positive patient strengthens the diagnosis. HLA-B27 is commonly found in the PAIR conditions - psoriasis, ankylosing spondylitis, inflammatory bowel disease, and reactive arthritis. Incorrect Answers: Answers 1 & 4: Anti-CCP is a specific marker in rheumatoid arthritis and HLA-DR4 is associated with rheumatoid arthritis which presents in a middle-aged woman with symmetric joint pain that is worse in the morning. Associated joint deformity and other systemic symptoms can be seen. Answer 2: Anti-dsDNA is a specific marker for systemic lupus erythematosus which presents with a rash (malar or discoid), arthralgias, myalgias, kidney disease, hemolytic anemia, serositis, and many other systemic symptoms depending on the organ system affected. Answer 5: p-ANCA is positive in ulcerative colitis which presents with abdominal pain, fever, and grossly bloody stools with inflammation and symptoms limited to the colon (versus the entire bowel as seen in Crohn disease). Bullet Summary: HLA-B27 is associated with the PAIR diseases - psoriasis, ankylosing spondylitis, inflammatory bowel disease, and reactive arthritis.
4.9
(9)
Please Login to add comment