0 penilaian0% menganggap dokumen ini bermanfaat (0 suara)
236 tayangan5 halaman
ARTHRITIS
Eugene Sherry, MD, MPH, FRACS.
Knee replacement
Pagets disease with OA
Charcot forefoot
Osteoarthritis(degenerative joint disease)- is the most common form of arthritis.
Aetiology - On a cellular level, osteoarthritis may be a result of a failed attempt of chondrocytes to repair damaged cartilage as well as increased water content may result from childhood (SUFE see case 14 , Perthes see POT, CDH, Sepsis, necrosis) or in adulthood from abnormal bone (Pagets, AVN see case 13 ), abnormal cartilage (see POT), abnormal loads (malunion).
S.U.F.E pot from Case 14
Paget's pot from Case 13
Characteristics - On exam include decreased ROM and crepitus. The knee is the most common joint affected. Treatment begins with supportive measures (activity modification, cane, etc.) and includes NSAIDs and a variety of surgical procedures ranging from arthroscopy to arthroplasty.
Neuropathic Arthropathy (Charcot Joint)
An extreme form of osteoarthritis caused by a disturbance in the sensory innervation of a joint. Causes include diabetes (foot), tabes dorsalis (lower extremity), syringomyelia (upper extremity), Hansen’s disease, myelomeningocele.
Acute Rheumatic Fever Group A B-hemolytic strep infections.
Ochronosis
Degenerative arthritis resulting from alkaptonuria, a rare inborn defect of the homogentisic acid oxidase enzyme system (tyrosine and phenylalanine catabolism).
(see case 10 for more information.)
Click to see pot from Case 10
Inflammatory Arthritides
Common Characteristics - Include a wide range of rheumatologic diseases. Rheumatoid arthritis, systemic lupus erythematosus (SLE), juvenile rheumatoid arthritis (JRA), the spondyloarthropathies, and crystalline arthropathies.
Rheumatoid Arthritis (RA) - The most common form of inflammatory arthritis, affects 3% of women and 1% of men. (See case 16 ).
Click to see pot from Case 16
Etiology - Unclear, but probably related to cell mediated immune response (T cell) that incites an inflammatory response initially against soft tissues and later against cartilage (chondrolysis) and bone (periarticular bone resorption). Hallmark is synovitis.
Characteristics - Usually an insidious onset of morning stiffness and polyarthritis. Synovium and soft tissues are first affected, elevated ESR and a positive RF (IgM). Radiographs demonstrate periarticular erosions and osteopenia.
Treatment - Control of synovitis and pain, maintenance of joint function, and prevention of deformities are the goals of therapy.
Systemic Lupus Erythematosus.
Polymyalgia Rheumatica
Juvenile Rheumatoid Arthritis - Three major types are recognised.
Spondyolarthropathies - Enthesopathies (occur at ligament insertion into bone) characterised by positive HLA-B27 (sixth chromosome, D).
Ankylosing spondylitis - Bilateral sacroilitis - acute anterior uveitis in a HLA-B27 - positive male is diagnostic of this disease.
Reiter’s Syndrome - Classic presentation is a young male with a triad of urethritis, conjunctivitis, and oligoarticular arthritis.
Psoriatic Arthropathy - Affects about 7% of patients with psoriasis. Many different HLA loci may be involved.
Enteropathic Arthritis - About 10-20% of Crohn’s disease and ulcerative colitis patients can develop peripheral joint arthritis.
Crystal Deposition Disease
Gout - A disorder of nucleic acid metabolism causes hyperuricemia, which leads to mono-sodium urate crystal deposition in joints. Recurrent attacks of arthritis, especially in males 40-60 yo (usually in the lower extremity - especially the great toe, crystal deposition in tophi (ear helix, eyelid olecranon, Achilles; usually seen in chronic form), and renal disease/stones (2% Ca2+ vs. normal 0.2%) are characteristic.
Chondrocalcinosis - Caused by several disorders, including calcium pyrophosphate deposition disease (CPPD), ochronosis, hyperparathyroidism, hypothyro
ARTHRITIS
Eugene Sherry, MD, MPH, FRACS.
Knee replacement
Pagets disease with OA
Charcot forefoot
Osteoarthritis(degenerative joint disease)- is the most common form of arthritis.
Aetiology - On a cellular level, osteoarthritis may be a result of a failed attempt of chondrocytes to repair damaged cartilage as well as increased water content may result from childhood (SUFE see case 14 , Perthes see POT, CDH, Sepsis, necrosis) or in adulthood from abnormal bone (Pagets, AVN see case 13 ), abnormal cartilage (see POT), abnormal loads (malunion).
S.U.F.E pot from Case 14
Paget's pot from Case 13
Characteristics - On exam include decreased ROM and crepitus. The knee is the most common joint affected. Treatment begins with supportive measures (activity modification, cane, etc.) and includes NSAIDs and a variety of surgical procedures ranging from arthroscopy to arthroplasty.
Neuropathic Arthropathy (Charcot Joint)
An extreme form of osteoarthritis caused by a disturbance in the sensory innervation of a joint. Causes include diabetes (foot), tabes dorsalis (lower extremity), syringomyelia (upper extremity), Hansen’s disease, myelomeningocele.
Acute Rheumatic Fever Group A B-hemolytic strep infections.
Ochronosis
Degenerative arthritis resulting from alkaptonuria, a rare inborn defect of the homogentisic acid oxidase enzyme system (tyrosine and phenylalanine catabolism).
(see case 10 for more information.)
Click to see pot from Case 10
Inflammatory Arthritides
Common Characteristics - Include a wide range of rheumatologic diseases. Rheumatoid arthritis, systemic lupus erythematosus (SLE), juvenile rheumatoid arthritis (JRA), the spondyloarthropathies, and crystalline arthropathies.
Rheumatoid Arthritis (RA) - The most common form of inflammatory arthritis, affects 3% of women and 1% of men. (See case 16 ).
Click to see pot from Case 16
Etiology - Unclear, but probably related to cell mediated immune response (T cell) that incites an inflammatory response initially against soft tissues and later against cartilage (chondrolysis) and bone (periarticular bone resorption). Hallmark is synovitis.
Characteristics - Usually an insidious onset of morning stiffness and polyarthritis. Synovium and soft tissues are first affected, elevated ESR and a positive RF (IgM). Radiographs demonstrate periarticular erosions and osteopenia.
Treatment - Control of synovitis and pain, maintenance of joint function, and prevention of deformities are the goals of therapy.
Systemic Lupus Erythematosus.
Polymyalgia Rheumatica
Juvenile Rheumatoid Arthritis - Three major types are recognised.
Spondyolarthropathies - Enthesopathies (occur at ligament insertion into bone) characterised by positive HLA-B27 (sixth chromosome, D).
Ankylosing spondylitis - Bilateral sacroilitis - acute anterior uveitis in a HLA-B27 - positive male is diagnostic of this disease.
Reiter’s Syndrome - Classic presentation is a young male with a triad of urethritis, conjunctivitis, and oligoarticular arthritis.
Psoriatic Arthropathy - Affects about 7% of patients with psoriasis. Many different HLA loci may be involved.
Enteropathic Arthritis - About 10-20% of Crohn’s disease and ulcerative colitis patients can develop peripheral joint arthritis.
Crystal Deposition Disease
Gout - A disorder of nucleic acid metabolism causes hyperuricemia, which leads to mono-sodium urate crystal deposition in joints. Recurrent attacks of arthritis, especially in males 40-60 yo (usually in the lower extremity - especially the great toe, crystal deposition in tophi (ear helix, eyelid olecranon, Achilles; usually seen in chronic form), and renal disease/stones (2% Ca2+ vs. normal 0.2%) are characteristic.
Chondrocalcinosis - Caused by several disorders, including calcium pyrophosphate deposition disease (CPPD), ochronosis, hyperparathyroidism, hypothyro
Hak Cipta:
Attribution Non-Commercial (BY-NC)
Format Tersedia
Unduh sebagai DOC, PDF, TXT atau baca online dari Scribd
ARTHRITIS
Eugene Sherry, MD, MPH, FRACS.
Knee replacement
Pagets disease with OA
Charcot forefoot
Osteoarthritis(degenerative joint disease)- is the most common form of arthritis.
Aetiology - On a cellular level, osteoarthritis may be a result of a failed attempt of chondrocytes to repair damaged cartilage as well as increased water content may result from childhood (SUFE see case 14 , Perthes see POT, CDH, Sepsis, necrosis) or in adulthood from abnormal bone (Pagets, AVN see case 13 ), abnormal cartilage (see POT), abnormal loads (malunion).
S.U.F.E pot from Case 14
Paget's pot from Case 13
Characteristics - On exam include decreased ROM and crepitus. The knee is the most common joint affected. Treatment begins with supportive measures (activity modification, cane, etc.) and includes NSAIDs and a variety of surgical procedures ranging from arthroscopy to arthroplasty.
Neuropathic Arthropathy (Charcot Joint)
An extreme form of osteoarthritis caused by a disturbance in the sensory innervation of a joint. Causes include diabetes (foot), tabes dorsalis (lower extremity), syringomyelia (upper extremity), Hansen’s disease, myelomeningocele.
Acute Rheumatic Fever Group A B-hemolytic strep infections.
Ochronosis
Degenerative arthritis resulting from alkaptonuria, a rare inborn defect of the homogentisic acid oxidase enzyme system (tyrosine and phenylalanine catabolism).
(see case 10 for more information.)
Click to see pot from Case 10
Inflammatory Arthritides
Common Characteristics - Include a wide range of rheumatologic diseases. Rheumatoid arthritis, systemic lupus erythematosus (SLE), juvenile rheumatoid arthritis (JRA), the spondyloarthropathies, and crystalline arthropathies.
Rheumatoid Arthritis (RA) - The most common form of inflammatory arthritis, affects 3% of women and 1% of men. (See case 16 ).
Click to see pot from Case 16
Etiology - Unclear, but probably related to cell mediated immune response (T cell) that incites an inflammatory response initially against soft tissues and later against cartilage (chondrolysis) and bone (periarticular bone resorption). Hallmark is synovitis.
Characteristics - Usually an insidious onset of morning stiffness and polyarthritis. Synovium and soft tissues are first affected, elevated ESR and a positive RF (IgM). Radiographs demonstrate periarticular erosions and osteopenia.
Treatment - Control of synovitis and pain, maintenance of joint function, and prevention of deformities are the goals of therapy.
Systemic Lupus Erythematosus.
Polymyalgia Rheumatica
Juvenile Rheumatoid Arthritis - Three major types are recognised.
Spondyolarthropathies - Enthesopathies (occur at ligament insertion into bone) characterised by positive HLA-B27 (sixth chromosome, D).
Ankylosing spondylitis - Bilateral sacroilitis - acute anterior uveitis in a HLA-B27 - positive male is diagnostic of this disease.
Reiter’s Syndrome - Classic presentation is a young male with a triad of urethritis, conjunctivitis, and oligoarticular arthritis.
Psoriatic Arthropathy - Affects about 7% of patients with psoriasis. Many different HLA loci may be involved.
Enteropathic Arthritis - About 10-20% of Crohn’s disease and ulcerative colitis patients can develop peripheral joint arthritis.
Crystal Deposition Disease
Gout - A disorder of nucleic acid metabolism causes hyperuricemia, which leads to mono-sodium urate crystal deposition in joints. Recurrent attacks of arthritis, especially in males 40-60 yo (usually in the lower extremity - especially the great toe, crystal deposition in tophi (ear helix, eyelid olecranon, Achilles; usually seen in chronic form), and renal disease/stones (2% Ca2+ vs. normal 0.2%) are characteristic.
Chondrocalcinosis - Caused by several disorders, including calcium pyrophosphate deposition disease (CPPD), ochronosis, hyperparathyroidism, hypothyro
Hak Cipta:
Attribution Non-Commercial (BY-NC)
Format Tersedia
Unduh sebagai DOC, PDF, TXT atau baca online dari Scribd
Senior Lecturer, Dept. of Orthopaedic Surgery, University of Sydney, Australia.
Osteoarthritis(degenerative joint disease)- is the most
common form of arthritis.
Aetiology - On a cellular level, osteoarthritis may be a result of
a failed attempt of chondrocytes to repair damaged cartilage as well as increased water content may result from childhood (SUFE see case 14 , Perthes see POT, CDH, Sepsis, necrosis) or in adulthood from abnormal bone (Pagets, AVN Knee replacement see case 13 ), abnormal cartilage (see POT), abnormal loads (malunion).
S.U.F.E pot from Case 14
Paget's pot from Case 13
Characteristics - On exam include decreased ROM and
crepitus. The knee is the most common joint affected. Treatment begins with supportive measures (activity modification, cane, etc.) and includes NSAIDs and a variety of surgical procedures ranging from arthroscopy to arthroplasty.
Neuropathic Arthropathy (Charcot Joint)
An extreme form of osteoarthritis caused by a disturbance in
the sensory innervation of a joint. Causes include diabetes Pagets disease with OA (foot), tabes dorsalis (lower extremity), syringomyelia (upper extremity), Hansen’s disease, myelomeningocele.
Acute Rheumatic Fever Group A B-hemolytic strep
infections.
Ochronosis
Charcot forefoot Degenerative arthritis resulting from alkaptonuria, a rare
inborn defect of the homogentisic acid oxidase enzyme system (tyrosine and phenylalanine catabolism).
(see case 10 for more information.)
Click to see pot from Case 10
Inflammatory Arthritides
Common Characteristics - Include a wide range of
rheumatologic diseases. Rheumatoid arthritis, systemic lupus erythematosus (SLE), juvenile rheumatoid arthritis (JRA), the spondyloarthropathies, and crystalline arthropathies.
Rheumatoid Arthritis (RA) - The most common form of
inflammatory arthritis, affects 3% of women and 1% of men. (See case 16 ). Click to see pot from Case 16
Etiology - Unclear, but probably related to cell mediated
immune response (T cell) that incites an inflammatory response initially against soft tissues and later against cartilage (chondrolysis) and bone (periarticular bone resorption). Hallmark is synovitis.
Characteristics - Usually an insidious onset of morning
stiffness and polyarthritis. Synovium and soft tissues are first affected, elevated ESR and a positive RF (IgM). Radiographs demonstrate periarticular erosions and osteopenia.
Treatment - Control of synovitis and pain, maintenance of joint
function, and prevention of deformities are the goals of therapy.
Systemic Lupus Erythematosus.
Polymyalgia Rheumatica
Juvenile Rheumatoid Arthritis - Three major types are
recognised.
Spondyolarthropathies - Enthesopathies (occur at ligament
insertion into bone) characterised by positive HLA-B27 (sixth chromosome, D).
uveitis in a HLA-B27 - positive male is diagnostic of this disease.
Reiter’s Syndrome - Classic presentation is a young male
with a triad of urethritis, conjunctivitis, and oligoarticular arthritis.
Psoriatic Arthropathy - Affects about 7% of patients with
psoriasis. Many different HLA loci may be involved.
Enteropathic Arthritis - About 10-20% of Crohn’s disease
and ulcerative colitis patients can develop peripheral joint arthritis.
Crystal Deposition Disease
Gout - A disorder of nucleic acid metabolism causes
hyperuricemia, which leads to mono-sodium urate crystal deposition in joints. Recurrent attacks of arthritis, especially in males 40-60 yo (usually in the lower extremity - especially the great toe, crystal deposition in tophi (ear helix, eyelid olecranon, Achilles; usually seen in chronic form), and renal disease/stones (2% Ca2+ vs. normal 0.2%) are characteristic.
Chondrocalcinosis - Caused by several disorders, including
calcium pyrophosphate deposition disease (CPPD), ochronosis, hyperparathyroidism, hypothyroidism, and hemochromatosis, which lead to increased calcium -+ pyrophosphate crystal deposition.
Calcium Hydroxyapatite Crystal Deposition Disease
Infectious Arthritides
Common Characteristics - Aspirates of acute, red, hot,
effusions usually show opaque fluid with >80,000 WBCs (75 + % PMNs), low glucose (>25 mg/dl less than serum values), and positive Gram’s stains/cultures.
Pyogenic Arthritis - Occurs from haematogenous spread or
by extension of osteomyelitis. Commonly occurs in children. Occurs more commonly in adults who are at risk, including IV drug abusers (esp. SC and sacroiliac joints), sexually active young adults (gonococcal, especially if seen with skin papules), diabetics (feet and lower extremities), rheumatoids, and following trauma (fight bites, open injuries) and surgery (iatrogenic).
Tuberculous Arthritis - The chronic granulomatous infection
caused by Mycobacterium tuberculosis usually involves joints by haematogenous spread. Spine and lower extremities are most often involved, typically in Mexicans and Asians. Radiographically, both sides of the joint. Diagnosis is helped with positive PPD, demonstration of acid-fast bacilli and rice bodies (fibrin globules) in joint fluid, positive cultures (may take several weeks), and characteristic x-rays (subchondral osteoporosis, cystic changes, notch-like bony destruction of the edge of the joint, and joint space.
Fungal Arthritis - More common in neonates, AIDS victims,
and drug users.
Lyme Disease
Haemorrhagic Effusions.
Can be the result of haemophilia, sickle cell disease,
pigmented villonodular synovitis, or other causes discussed elsewhere.
Haemophilic Arthropathy - X-linked recessive factor VIII
deficiency (haemophilia A -classic or factor IX deficiency; haemophilia B-Christmas disease) associated with repeated hemarthrosis from minor trauma leading to synovitis, cartilage destruction (enzymatic processes).