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Erythema marginatum
1%
42/3665
Positive HLA-DR3
5%
197/3665
Uveitis
80%
2933/3665
Positive Rheumatoid Factor
7%
244/3665
Elevated urine phosphoethanolamine
6%
230/3665
Select Answer to see Preferred Response
The radiograph in Figure A shows bilateral sacroiliitis. Bilateral sacroiliitis (with or without uveitis) and a postive HLA-B27 is diagnostic of ankylosing spondylitis. Ankylosing spondylitis is characterized by a positive HLA-B27 with a negative RF titer. It typically presents in the 4th decade of life and is more common in men than women. Low back pain usually precedes the radiogaphic findings of bilateral sacroiliitis. Of note, HLA-B27 is positive in ~6% of the white population. Rudwaleit et al, looked at variables that could help make an early diagnosis of ankylosing spondylitis. They found the highest likelihood ratio was found in patients with a positive HLA test and positive MRI findings. Burgos-Vargas et al, studied the clinical and radiographic features of sacroiliac and spinal involvement in patients with seronegative enthesopathy and arthropathy. Based on their findings, they recommend periodical measurements of the spinal flexion and radiographs of the pelvis from age 3 in high risk children. Incorrect Answers: Answer 1: Erythema marginatum is a major criteria for Acute Rheumatic Fever. Answer 2: HLA-DR3 is associated with SLE. Answer 4: RF is found in rheumatoid arthritis, Sjogren's, sarcoid, and SLE. Answer 5: Elevated urine phosphoethanolamine is found in hypophosphatasia.
3.5
(38)
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