Reiter’s syndrome is associated with a sexually transmitted disease with clamydia and occasionally with enterocolic infections such as dysentery the infection ceases and the syndrome begins as an autoimmune disease the hallmarks are urethritis conjunctivitis and arthritis there’s also significant heel pain in seventy percent from achilles tendonosis and there’s also SI pain associated forty percent of patients will develop conjunctivitis as noted in this eye exam seen on the right myalgias are common sausage digits or large swollen fingers are very rare and circinate balanitis is a painless sore on the glans penis which is quite common.
With reiter’s psoriatic arthritis is a typical disease estimated at three percent of the population has psoriasis and it’s a skin disease normally seen with silvery erythematous patches over extensor surfaces patients with the nail bed changes as seen on the right have a higher correlation with the arthritic components of psoriasis twenty three percent of patients with nail bed changes will develop arthritis and five percent will have spondyloarthropathy enteropathic arthritis as crohn’s and ulcerative colitis and possibly even irritable bowel ten to twenty percent will develop sacroilitis and ten percent.
Will develop spondylitis here we see a CT scan of a normal right SI joint and a fused left SI joint rheumatoid arthritis is noted for the destruction of synovial joints throughout the body you develop enthesopathy as we note on the right picture of an inflamed joint with worn cartilage versus the normal joint the rheumatoid arthritis problem is typically symmetrical there’s painful subcutaneous nodules and spinal involvement is almost always exclusively cervical very uncommon to have a lumbar spine involved patients with rheumatoid arthritis can develop mononeuritis multiplex and even.
Autoimmune, Inflammatory, Infectious Diseases Part 3 Mimic Lower Back Pain CO Spine Surgeon
Vasculitis rheumatoid arthritis of course is an immune system which destroys the synovium of the joints the hands are the most commonly affected and in fact the picture that we see here shows the typical intra articular absorption and windswept deformity of the fingers spinal involvement is also noted in there can be a dislocation or translocation of C one and two causing significant spinal cord compression neuropathic pain is from the damage from the nerve itself the pain signals relentlessly and becomes amplified by facilitation and memory neuropathic pain tends to be a big.
Burning quality those patients will talk about crushing gnawing and crawling type of pain neuropathic pain typically is worse at night and generally not affected by activity but that’s not always the case patients will develop allodynia or pain generated from innocuous stimulation a simple brush of a feather against the skin can be painful patients with neuropathic pain commonly develop reactive depression polyneuropathy is a compartment of the fiber link dependent diseased nerves typically found in both feet the times that it starts it will be more in the evening.
It’ll be a burning sensation and it can ascend up the legs to the knees by the time numbness gets to the knees the hands become involved because the hands are at about the same length of nerves as the length of nerves going down to the knees acquired peripheral neuropathies patients with acquired peripheral neuropathies have many disease processes which could be associated diabetes alcoholism autoimmuned diseases infectious diseases and even inherited diseases as we talked about normally the diseases attack the myelin sheath but can destroy the nerves themselves.
Sensory nerves are the most commonly involved but peripheral neuropathies these can affect motor nerves it starts distally in the longest nerves which of course go to the feet and ascends slowly as noted before burning numbness is the first symptoms again as noted before symptoms are intensified at night and there’s allodynia asso a lot of patients with this problem can’t tolerate bed sheets on their feet with advanced peripheral neuropathies there’s a loss of proprioception and gait disturbance it’s diagnosed with a EMG and NCV can be treated with the use of physical therapy.
And medication such as membrane stabilizers there are metabolic peripheral neuropathies such as hypothyroidism which causes carpal tunnel syndrome and hung up reflexes when the reflexes typically tested such as a biceps the muscle will contract but release very slowly B12 deficiencies cause a disease process called subacute combined deficiency of the cord there’s degeneration of the posterior and lateral columns intial symptoms are numbness of the limbs and trunk which are an early sign and then unsteadiness and gait imbalance as a delayed sing the complex regional pain syndrome CRPS used to be called reflex sympathetic dystrophy.
It’s an involvement of the autonomic nervous system and there’s probably a deep sensory component to the sympathetic system which causes pain and sympathetic postganglionic system afferent pathways RSD onset is very commonly after a simple injury or surgery there is severe burning pain and eventually trophic changes of the skin such as loss of skin texture and swelling there’s two essential stages the initial stage where there’s increase circulation swelling and color change and later three to six months swelling disappears but the extremities cool and pale with contracted joins.
Brittle nails and continuing pain pictures of early RSD here noted and late RSD myopathies are not uncommon it’s a primary disorder of skeletal muscle there’s associated weakness cramping and myoglobinuria generally there is proximal weakness difficulty from rising from a chair is noted patients cannot climb stairs because of quid and buttocks weakness and they can’t work with their arms overhead it’s typically symmetric and there’s no sensory loss this is purely a muscle disorder polymyositis is muscle pain and tenderness neck flexor and proximal limb weakness there’s noted to be typically a high ESR.
And creatine kinase and this is treated with steroids finally fibromyalgia fibromyalgia is a syndrome it’s a constellation of symptoms found in a group of individuals but they cannot be identified by any marker there’s no lab test there’s no EMG finding there’s no type of specific test that can identify this patients with chronic pain and this chronic pain is diffuse and nonspecific and found throughout the body are typically patients with fibromyalgia there must be four areas or four quadrants with discrete tender points to make the diagnosis thank you for your attention.