A 26-year-old Italian-American man comes to your office for the evaluation of low back pain. He has had this pain for the last eight months, and it is progressively getting worse. The pain is worse in the morning and gets better as the day progresses. He denies any history of trauma in the past. He works as a chef at a local restaurant. His father and uncles also have "back problems." His physical examination reveals a limited range of motion of his lumbosacral spine and markedly reduced chest expansion. The rest of his physical and musculoskeletal examination is unremarkable. If the initial evaluation shows mild disease, what would you do to monitor the disease activity?

Question

A 26-year-old Italian-American man comes to your office for the evaluation of low back pain.  He has had this pain for the last eight months, and it is progressively getting worse.  The pain is worse in the morning and gets better as the day progresses.  He denies any history of trauma in the past.  He works as a chef at a local restaurant.  His father and uncles also have "back problems."  His physical examination reveals a limited range of motion of his lumbosacral spine and markedly reduced chest expansion.  The rest of his physical and musculoskeletal examination is unremarkable. If the initial evaluation shows mild disease, what would you do to monitor the disease activity?

Quizplus · Accepted Answer

Explanation: The following radiographs are used in monitoring the disease progression of patients with ankylosing spondylitis: Anteroposterior and lateral views of the lumbar spine Lateral view of the cervical spine Pelvic radiograph, including the sacroiliac joints and hip Other acute phase reactants such as ESR can also be used. (Choice B) CT scans are almost never used to monitor the disease activity. MRI is also not used to monitor the disease activity, unless the patient develops complications such as cauda equina syndrome. Educational objective: Radiographs and acute phase reactants (i.e., ESR) are used to monitor the disease progression of patients with ankylosing spondylitis.

A 26-Year-Old Italian-American Man Comes to Your Office for the Evaluation