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HLA B27 and the shaggy dog storyFrom: David S. Buck (dsbuck@magnum.wpe.com)Sun Apr 28 09:39:05 1996
>From: "Peter V. Weston, M.D." <weston@riverwalk-obgyn.com>
>>61yo WF with ankylosing spondylitis and hypertension I'm not a rheumatologist but your case and question remind me of a very interesting patient who presented w/ known Ankylosing spondylitis for the first visit at 48 years old smoker whose FSH and symptoms were c/w menopause. She had a loud decrescendo diastolic murmur, 2nd ICS R>L, radiating into the neck, and Quincke's pulse. She said her last doctor heard it recently (before he died and she transferred to my care). Just out of curiosity I reviewed ankylosing spondylitis, to see if there was in association of ankyl. spon. and aortic regurg. To my suprise, my reference stated that it was associated with a rapidly progressive aortic insufficiency. I sent her for urgent consultation and her valve was replaced the same week (despite no symptoms but decreasing ejection fraction). I put her on estrogen/provera and Ca (with similar advice/encouragement to quit tobacco). I discussed the need for bone densitometry with an endocrinologist who said that is rarely helpful. He suggested unless absolutely contraindicated, a woman at risk should be offered estrogen. If they are symptomatic (fractures...) add a biphosphonate or calcitonin. If estrogen is absolutely contraindicated and the person is not symptomatic then a bone study would be helpful. ). There are many gaps in this strategy but it covers > 90% of the women I see. David S. Buck, MD, MPH Family Practice
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