[Joint examination].

In the United States, the incidence of Lyme disease is considered to be disproportionately high among Whites because of risk of exposure. For assessment of racial differences in Lyme disease incidence and the role of risk exposure, incidence rate ratios (IRRs) for Lyme disease and its manifestations between Whites and African Americans in Maryland and in its focus of endemicity, the Upper Eastern Shore, were calculated. Calculations were based on reported cases of Lyme disease in Maryland during the years 1992-1996. The IRR for Lyme disease between Whites and African Americans was 6.3 (95% confidence interval (CI): 5.0, 8.0), decreasing to 1.8 (95% CI: 1.2, 2.7) for the Upper Eastern Shore. Statewide, there was a significant difference between the White to African American IRR for erythema migrans and for Lyme disease-associated arthritis, at 17.7 (95% CI: 11.2, 27.8) and 2.3 (95% CI: 1.7, 3.2), respectively. On the Upper Eastern Shore, the IRR for arthritis reversed, indicating higher incidence among African Americans than among Whites: IRR = 5.7 (95% CI: 2.4, 13.9) for erythema migrans and IRR = 0.7 (95% CI: 0.4, 1.1) for arthritis. White patients were more likely to have erythema migrans (risk ratio = 2.8, 95% CI: 1.9, 4.1) and less likely to have arthritis than were African Americans (risk ratio = 0.4, 95% CI: 0.3, 0.5). Among all patients, there was a significant negative association between arthritis and erythema migrans. Although much of the racial disparity in incidence rates diminishes in a rural, endemic area, consistent with exposure risk being responsible for much of the variation, a difference remains. This may be due to failure to recognize early disease (erythema migrans) among African Americans, resulting in increased rates of late manifestations. Geographic spread of the disease warrants efforts to increase awareness of Lyme disease and its manifestations among people of color and the health care providers who serve them.

Arthritis↗

PubMed2000

[1: Clinical aspects, laboratory diagnosis and therapy. Low backache--when is sacroiliitis the cause?].

Despite the availability of modern imaging modalities, early diagnosis of sacroiliitis remains a challenge. The patient's history and the results of the clinical examination form the basis for establishing a working diagnosis, which then needs to be confirmed by laboratory tests and diagnostic imaging. Common causes of sacroiliitis are inflammatory diseases of the spine, in particular seronegative spondyloarthropathies; infectious sacroiliitis is much less common. Besides serological testing (HLA-B27), imaging techniques are essential for diagnosing early forms of sacroiliitis. The treatment of the condition initially involves the use of non-steroidal anti-inflammatory drugs (NSAIDs). In patients with infectious sacroiliitis, antibiotics are the treatment of choice. Local application of steroids, or physiotherapy, can be helpful. The value of disease-modifying drugs (DMARDs) (sulfasalazine, methotrexate) has not been verified, and is questionable. New approaches such as anti-tumor necrosis factor alpha (anti-TNF alpha) need to be tested in controlled studies.

Arthritis↗