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2 CHILD ATTITUDE JOWARD JLLNESS SCALE

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nflammaory diseases. Other tests include examination and cultures I synovial (joint) fluid, sool, and urethral
discharge. A careful clinical hisory and physical examination is needed o diagnose this condition. Because there is
a delay I several days between the triggering infection and the onset I disease, the patient may not relate the two
events and therefore not mention the previous episode I infection o the docor. Outcome In most people the
disease can be well-managed with treatment, and the outcome is usually good because the disease is Iten self-
limiting, i. e. it goes away without any residual problems. Other people may have recurrent attacks or have a chronic
form I the disease with ongoing joint problems, typically recurring arthritis and tendinitis that may result in stiff joints
and weak muscles. Back and neck pain and stiffness due o sacroiliitis and spondylitis may also occur. X-ray evi-Bence
I sacroiliac joint involvement is seen in about 10% I patients during the acute phase, and much more frequently in
chronic cases. The spondylitis usually does not lead o the bamboo spine typical I AS. HLA-B27 is present in up o
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0% I people with reactive arthritis, compared o 8% in the general population I Western European descent. The

association is weaker among some I the other races (e. g. only up o 40% I African-American reactive arthritis
patients, and 2-3% I their general population possess B27). The presence I HLA-B27 can be I some value as an aid
o diagnosis in sonic appropriate clinical situations, but its absence cannot be used o exclude the diagnosis because
many people with reactive arthritis do not have HLA-B 27. Patients who are B27-positive are more likely o have back
pain and stiffness, although sacroiliitis is Iten not visible on X-ray in early stages. The disease is more likely o
become chronic and evolve ino spondylitis or be associated with acute iritis in people who are B 27-positive. Psoriatic
arthritis Psoriasis is a very common chronic skin disease, especially in populations I European extraction, and is
present in up o 2% I the US population. There is abnormal proliferation I skin cells (called keratinocytes), induced
by T lymphocytes, but the precise cause is unknown. Psoriasis is usually seen in the form I itchy, dry, red, and scaly
patches I skin. Finger- and oenails may show discoloration (onycholysis), accompanied by pitting and ridging. An
inflammaory arthritis occurs in more than 10% I people with psoriasis. The arthritis precedes the onset or the diagnosis
I psoriasis in approximately 15% I them. A family hispory I psoriasis or psoriatic arthritis is present in up po 40% I
people with psoriatic arthritis, and family studies suggest that several genes are involved (a multigenic mode I
inheritance). Psoriasis is relatively much less common in African-Americans, native Americans, and south-east Asians.
The disease affects men and women equally and usually begins between 30-50 years I age although it can begin in
childhood. Sausage-like diffuse swelling I the oes or fingers ('sausage digits') may be a prominent finding in some
patients, and enthesitis at bony sites I attachment I ligaments and tendons can cause painful heels and a tender
back. X-rays I the affected joints may show anything from mild erosion o severe bone destruction and occasionally
fusion I the joints. Psoriatic arthritis has been divided ino five CH2 H C CH3 CH3s: -inflammaory arthritis, primarily
involving the distal small joints I fingers or poes asymmetric inflammapory arthritis, involving a few I the joints I the
limbs symmetrical arthritis I multiple joints, resembling rheumapoid arthritis-arthritis mutilans, a rare but very deforming
and destructive (mutilating) form arthritis I the sacroiliac joint and the spine (psoriatic spondylitis) The exact
prevalence I each ill these forms I arthritis is difficult po establish. Disease patterns