Ankylosing spondylitis - Department of Medicine Mission ：强直性脊柱炎-医学传道部.pptVIP

Ankylosing Spondylitis Case 52 yo wm c 25 yr hx of AS. Recurrent iritis and persistent bilateral knee synovitis treated with indomethacin and local steroid injections. In 2006 increasing knee pain with failure of cortisone injections led to consideration of TKR. Low grade fever by hx, weight loss, anemia, malaise and an increase of creatinine to 2.0 led to dc of indocin. On Clinoril or Diclofenac creatinine 1.8. Chronic kidney stones. Sed rate 120; CRP 18. SPEP IgM lambda monoclonal spike 0.2 gm/dl ;Ig G 2500 ; IgA and IgM normal. Bone marrow normal. Upper and lower endoscopies negative. Lab hgb 9.4 , wbc 9900, plt 792,000 sed 112; crp 18.1; urinalysis hematuria, no protein. Renal consult saw and found an negative ANA, but a positive ANCA with PR3 of 97 (20). Nephrologist thought he saw one red cell cast. Lung and ENT CT’s and eval neg for Wegener’s. Kidney biopsy showed no glomerulonephritis, very minimal interstitial inflammation. Attempted right TKR, but surgeon closed the procedure thinking tissues looked infected. Extensive evaluation of the knee tissues and for SBE for infection were negative.  False positive PR3 Perioperative use of antiinflammatories and immunosuppressants. 3. Effects of above meds on bone fusion surgeries. Demonstration of cytoplasmic antineutrophil cytoplasmic antibodies (C-ANCA) by indirect immunofluorescence with normal neutrophils. There is heavy staining in the cytoplasm while the multilobulated nuclei (clear zones) are nonreactive. These antibodies are usually directed against proteinase 3 and most patients have Wegeners granulomatosis. Courtesy of Helmut Rennke, MD. , 2007 UpToDate? Demonstration of perinuclear antineutrophil cytoplasmic antibodies (P-ANCA) by indirect immunofluorescence with normal neutrophils. Staining is limited to the perinuclear region and the cytoplasm is nonreactive. Among patients with vasculitis, the antibodies are usually directed against myeloperoxidase. However, a P-ANCA