[Role of the family physician in the prevention of chronic backache].
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Biomedical subjects
Publications and source records attributed to U Diethelm.
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Based on the literature we describe the prognosis and natural history of ankylosing spondylitis. The data on mortality are controversial and it seems that only a small group of patient show a decreased survival. It is a chronic disease with most prominent features of pain and increasing stiffness during the first decade. After a course of 40 years 90% of patients have none or only mild disability. Generally quality of life is slightly reduced. Most patients remain engaged in full-time employment, but job adaptations are often unavoidable and vocational counseling seems to be worthwhile.
Two patients are described with parcellar algodystrophy, a special form of algodystrophy. Bone biopsy in one patient revealed increased bone resorption and irregular new bone formation. Parcellar algodystrophy is characterized by the very localized pathological changes in the region of a joint. Only a small area of demineralization may be visible on X-ray. Skeletal scintigraphy shows hyperfixation of technetium-99m already in an early stage. Although the inflammatory signs are clinically impressive, the ESR may be normal. History may reveal previous involved joints. Parcellar algodystrophy normally runs a benign course. The difficulty of correct diagnosis is discussed. The changes are compared to those of partial algodystrophy and algodystrophy with no radiological abnormality throughout the course of the disease.
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