Internal Medicine

0521779407-19 CUNY1086/Karliner 0 521 77940 7 June 6, 2007 17:50

1364 Spondyloarthropathies Spontaneous Bacterial Peritonitis

■Spine surgery for awkward flexion deformities

■Valve replacement for life-threatening aortic insufficiency

Side Effects & Complications

■As in rheumatoid arthritis

follow-up

■Assess adequacy of control of disease activity

■Monitor functional status every 3–6 months, more often w/very

active disease (see “Assessment” in http://www.asas-group.org)

■Reinforce education about daily exercise, stretching, activity

complications and prognosis

Complications

■Aortic incompetence in 3.5% after 15 years, 10% after 30 years

■Fibrosis of upper lungs after 20+years (infrequent), cystic changes,

Aspergillus infection

■Neurologic complications of spinal involvement

■Spinal fracture at C5, 6, 7 after minor trauma

■C1–C2 subluxation & cord compression

■Cauda equina syndrome

■IgA nephropathy (frequent, but functional significance unclear)

■Osteoporosis w/spinal compression fracture

■Secondary amyloidosis

Prognosis

■Vast majority of pts do well, w/o disabling disease

■Indicators of poor prognosis

➣Hip arthritis

➣ESR >30 mm/hr

➣Poor response to NSAIDs

➣Limitation of motion in lumbar spine

➣Sausage-like finger or toe

➣Onset at or before 16 years of age

SPONTANEOUS BACTERIAL PERITONITIS

ANDY S. YU, MD and EMMET B. KEEFFE, MD

history & physical

History

■cirrhotic ascites or ascites due to subacute liver failure

■fever, chills, rigors, abdominal pain, encephalopathy