What does Infectious Spondylitis present as?
Deep back pain, and insomnia due to pain
What does Infectious Spondylitis have a history of?
Infection, intravenous drug use, diabetes
How will the patient present with Infectious Spondylitis ?
Antalgic, and Febrile
What is the cause of Infectious Spondylitis?
Infection of disc and vertebral body (adults)
Discitis in (children)
Pyogenic Infectious Spondylitis =
Staph, strep, gram negative
Nonpyogenic Infectious Spondylitis =
TB, Brucella, fungal infection
What is the protrusion of the spine called with infectious spondylitis?
Gibbs deformity
With IS, pain is worsened by _____
Compression and percussion
What are lab findings for IS?
Elevated ESR, increase leukocytes
Mantoux test for TB is for what disease?
Infectious Spondylitis
Radiographic findings take _____ for IS
3-4 weeks
What will you see with AS?
No rheumatoid factor or nodules
Is AS more common in males or females?
Males 5:1, 15-35 y.o.
What is primary complaint with AS?
Primarily complaint is LBP, aching, stiffness, especially after rest
Is AS aggravated by physical activity?
NO
What is the onset of AS?
Insidious episodic onset
What does 75% of AS patients have?
Some form of sciatica (unilateral, alternating, or bilateral) usually occurring during early phases
What can AS be associated with?
Iritis
What is (+) in more than 90% of patients?
HLA B27
What is mildly elevated in AS?
ESR & C-Reactive proteins
What are the first 3 findings of AS?
- Paraspinal spasm
- Flattening of lumbar lordosis
- Painful palpating/percussion of SI joint
What are the last 3 findings of AS?
- Eventful flattening of lower thoracic spine
- Restriction of C-spine
- X rays: Initially bilateral sacroilitis, then enthesopathy at thoracolumbar spine which descends & ascends from there
What does Reactive arthritis (Reiter’s Syndrome) present as?
Low back pain after the can’t see, pee, dance with me triad
What is the cause of Reactive Arthritis (Reiter’s Syndrome)?
- Seronegative arthropathy post infection
- HLA-B27 marker; more prone to reactive arthritis
What is the evaluation of Reactive Arthritis (Reiter’s) ?
- Arthritis affecting knees, ankles unilaterally
What is MC place for Reiter’s ?
SI joint
What is Multiple Myeloma a cancer of?
The plasma cell, incurable but treatable
What is the estimated frequency of Multiple Myeloma?
5-6 new cases per 100,000 per year
In the USA _______ new cases are expected to be diagnosed in ______
15,980 & year 2005*
How many people in the US are living with Multiple Myeloma?
50,000 people
What is Multiple Myeloma aka?
“Myeloma” or “Plasma cell Myeloma”
What is multiple Myeloma the cancer of?
The plasma cell, part of the immune system that produces immunoglobulins (antibodies)
What are you gonna see in the blood with Multiple Myeloma?
Excessive # of abnormal plasma cells in the bone marrow and overproduction of intact monoclonal immunoglobulin (IgG, IgA, IgD, or IgE) or Bence Jones protein
What is the MC monoclonal spike seen in the IG profile of Multiple Myeloma?
IgG (55%)
What is the 2nd MC IG profile found in multiple myeloma?
IgA
Bence Jones proteins are ____
Free monoclonal k and alpha light chains
40% of patients with IgG/IgA will express ______ in their urine?
Bence Jones proteins
What are the clinical manifestations of MM?
Hypercalcemia, anemia, renal damage, increased susceptibility to bacterial infection, and impaired production of normal immunoglobulin are common
What are clinical manifestations also characterized by?
Diffuse osteoporosis, usually in the pelvis, spine, ribs, and skull
What is the pathophysiology of MM?
Cells destined to become immune cells, like all blood cells, arise in the bone marrow from stem
cells (see figure). Some stem cells develop into the small white blood cells called lymphocytes.
The two major classes of lymphocytes are B cells (B lymphocytes) and T cells (T lymphocytes).
Plasma cells develop from B cells.
In MM, the B cell is ______
damaged and gives rise to too many
plasma cells (myeloma cells). These malignant cells do not function
properly and their increased numbers produce excess
immunoglobulins of a single type that the body does not need along
with reduced amounts of normal immunoglobulins.
Myeloma plasma cells have:
Specific adhesion molecules on their surface allowing them to target bone marrow where they attach to structural cells called stromal cells
Cytokines are produced by:
Both myeloma cells and stromal cells
What do cytokines stimulate?
The growth of myeloma cells and inhibit (prevent) natural cell death (apoptosis), leading to proliferation of myeloma cells and ultimately resulting in bone destruction
Myeloma cells produce growth factors that promote:
Angiogenesis, the creation of new blood vessels. These new blood vessels provide the oxygen and nutrients that promote tumor growth
How does Angiogenesis affect MM?
It encourages reproduction of myeloma cells, which increase in # and begin to infiltrate the bone marrow, eventually compromising more than 10% of cells present, which is 2 times the normal percentage of normal plasma cells
Mature myeloma cells fail to activate:
The immune system and may produce substances that decrease the body’s normal immune response to a foreign body
Levels of functional IG are _____ in individuals with myeloma?
Depressed
What do Bence Jones proteins do?
They may deposit in the kidney and clog tiny tubules, this can cause kidney changes and damage
What is the test that detects the exact amount of immunoglobulins in urine and blood?
Immunoelectrophoresis
What do you use for Bence Jones protein detection?
Acidic urine sample 40-60 degrees Celsius
What is the 2nd most prevalent blood cancer?
Multiple myeloma after #1 non-Hodgkin’s Lymphoma
What does Multiple Myeloma represent?
Approximately 1% of all cancers and 2% of all cancer deaths
Avg death of MM?
68 years
MM is more common in men or women?
MEN
What race has the highest prevelance of MM?
Blacks and native Pacific Islanders
Asians have lowest
What is the Prostate, Mets Carcinoma called?
Batson’s Plexus
Mets Carcinoma Lytic:
Increase serum calcium
Mets Carcinoma Blastic:
Alkaline Phosphatase