? Joint pain can have multiple causes - inflammation, cartilage
degeneration, crystal deposition, infection, and trauma.
--- Content provided by FirstRanker.com ---
- to determine the type of pathophysiologic process responsible for
their presence
--- Content provided by FirstRanker.com ---
- to localize the source of the joint symptoms.? The D/D are generated
- in large part from the history and physical examination.
--- Content provided by FirstRanker.com ---
- Screening laboratory test results serve primarily to confirm clinical
impressions and
--- Content provided by FirstRanker.com ---
can be misleading if used indiscriminately.Pathophysiology
--- Content provided by FirstRanker.com ---
? Joint pain ?from structures within or adjacent to the joint or
may be referred from more distant sites.
--- Content provided by FirstRanker.com ---
? The evaluation of joint pain, both in terms of the history and the physicalexamination findings, is best achieved through an understanding of the
basic pathophysiologic types of joint disease.
--- Content provided by FirstRanker.com ---
- often a difficult task
- Knowledge of the anatomy
--- Content provided by FirstRanker.com ---
? Synovitis, enthesopathy, crystal deposition, infection, andstructural or mechanical derangements.
Synovitis
--- Content provided by FirstRanker.com ---
? Rheumatoid arthritis (RA) & other
inflammatory arthritis
--- Content provided by FirstRanker.com ---
? Characterized pathologically:- Neovascularization
- Infiltration of the synovium with
--- Content provided by FirstRanker.com ---
lymphocytes, plasma cells, and macrophages
- Synovial lining cell hyperplasia
--- Content provided by FirstRanker.com ---
? The inflamed synovium may infiltrate and erode intra-articular boneand cartilage.
--- Content provided by FirstRanker.com ---
Enthesitis? transitional zone where
- col agenous structures such as tendons and
--- Content provided by FirstRanker.com ---
- ligaments are interwoven into bone.
- interface between cortical bone and the periosteum
--- Content provided by FirstRanker.com ---
- vertebral bodies and the annulus fibrosus.? Seronegative spondyloarthropathies.
? As a result of inflammation at these interfaces, the radial y oriented
--- Content provided by FirstRanker.com ---
col agen fibers undergo metaplasia, forming fibrous bone.
? These metaplastic transformations result in new bone formation
--- Content provided by FirstRanker.com ---
(periostitis), gradual ossification - syndesmophyte? Secondary synovitis may develop.
Crystal deposition
--- Content provided by FirstRanker.com ---
? Monosodium urate, calcium pyrophosphate dihydrate,
- basic calcium phosphate (including hydroxyapatite), and calcium oxalate.
--- Content provided by FirstRanker.com ---
? Monosodium urate crystal deposition occurs- on the surface of hyaline cartilage, within the synovium, and in periarticular
structures, including tendon sheaths and bursae.
--- Content provided by FirstRanker.com ---
- localized to a bursa or tendon sheath adjacent to the joint or may be widespread,
involving multiple joint structures.
--- Content provided by FirstRanker.com ---
? Calcium pyrophosphate crystal deposition- confined to hyaline cartilage, fibrocartilage, and areas of chondroid metaplasia
(ie, degenerated areas of tendons, ligaments, and the joint capsule) within the
--- Content provided by FirstRanker.com ---
joint.
- Shedding of these crystals into the joint space may trigger an acute inflammatory
--- Content provided by FirstRanker.com ---
arthritis, known as pseudogout.Infectious arthritis
--- Content provided by FirstRanker.com ---
? The synovium may become the seat of acute or chronic infections? bacterial, fungal, or viral organisms.
? almost always arise from blood-borne organisms and may be part of a
--- Content provided by FirstRanker.com ---
systemic infection.
? intense infiltration by neutrophils with resultant necrosis of the synovium
--- Content provided by FirstRanker.com ---
and? subsequent formation of granulation and scar tissue.
? A dense mass of fibrin, infiltrated by neutrophils, forms over the surface of
--- Content provided by FirstRanker.com ---
the synovium.
? Bacterial products released within the joint are capable of producing rapid
--- Content provided by FirstRanker.com ---
cartilage destruction.Structural or mechanical
joint derangement
--- Content provided by FirstRanker.com ---
? Local factors:- Previous joint trauma (eg, meniscal tears)
- Developmental joint alterations (eg,
--- Content provided by FirstRanker.com ---
congenital hip dysplasia and slipped capital femoral epiphysis)
- Alterations of the subchondral bone (eg, osteopetrosis, avascular necrosis, and
--- Content provided by FirstRanker.com ---
Paget disease)- Alterations of supporting structures (eg, hypermobility)
- Cartilage derangements (eg, ochronosis and crystal deposition)
--- Content provided by FirstRanker.com ---
? Host factors: Genetic traits, Obesity
? Degeneration of the articular cartilage is the principal pathologic feature of
--- Content provided by FirstRanker.com ---
osteoarthritis? associated with subchondral bone sclerosis and marginal osteophyte formation
? may have an associated synovitis, with the formation of bland synovial effusions
--- Content provided by FirstRanker.com ---
Clinical Presentation - Patient history? A key initial step
- joint or
--- Content provided by FirstRanker.com ---
- an adjacent bursa, tendon, ligament, bone, or muscle or
- referred from a visceral organ or nerve root.
--- Content provided by FirstRanker.com ---
? more difficult - pain is in proximal, larger joints- hip pain can arise from degenerative disc disease or stenosis of the lumbar
spine, aortoiliac occlusive disease, hip arthritis, or trochanteric bursitis.
--- Content provided by FirstRanker.com ---
? the fol owing 3 broad categories of joint disease must be differentiated:
- Inflammatory arthritis
--- Content provided by FirstRanker.com ---
- Noninflammatory arthritis- Arthralgia
? Arthralgia is characterized
--- Content provided by FirstRanker.com ---
- joint tenderness, but abnormalities of the joint cannot be identified.- fibromyalgia) or
- early rheumatic syndrome whose clinical signs are not yet apparent
? 3 types of joint disorders may occur together in the same joint.
? Finally, reports of joint pain and tenderness in any type of joint
--- Content provided by FirstRanker.com ---
disease are
- influenced by the patient's emotional state and pain threshold.
--- Content provided by FirstRanker.com ---
Symptoms
? Pain ? Inflammatory - pain is present both at rest and with motion. It is
--- Content provided by FirstRanker.com ---
worse at the beginning of usage than at the end.- Noninflammatory - the pain occurs mainly or only during motion and
improves quickly with rest. advanced degenerative disease may also have
--- Content provided by FirstRanker.com ---
pain at rest and at night.
- Pain that arises from smal peripheral joints tends to be more accurately
--- Content provided by FirstRanker.com ---
localized than pain arising from larger proximal joints.? Stiffness - With inflammatory arthritis, the stiffness is present upon waking
and typical y lasts 30-60 minutes or longer.
--- Content provided by FirstRanker.com ---
- With noninflammatory arthritis, stiffness is experienced briefly (eg, for
about 15 minutes) upon waking in the morning or after periods of inactivity.
--- Content provided by FirstRanker.com ---
? Swelling ?- inflammatory - synovial hypertrophy, synovial effusion, or
inflammation of periarticular structures. The degree of swelling often
--- Content provided by FirstRanker.com ---
varies over time.
- noninflammatory arthritis - formation of osteophytes leads to bony
--- Content provided by FirstRanker.com ---
swelling. Patients may report gnarled fingers or knobby knees.- Mild degrees of soft tissue swelling do occur
- synovial cysts, thickening, or effusions.
--- Content provided by FirstRanker.com ---
? Limitation of motion ?
- structural damage, inflammation, or
--- Content provided by FirstRanker.com ---
- contracture of surrounding soft tissues.- Patients may report restrictions on their activities of daily living
? Weakness ?
- Muscle strength is often diminished around an arthritic joint as a
--- Content provided by FirstRanker.com ---
result of disuse atrophy.
- Weakness with pain suggests a musculoskeletal cause (eg, arthritis or
tendinitis) rather than a pure myopathic or neurogenic cause.
--- Content provided by FirstRanker.com ---
? Fatigue - Fatigue is usually synonymous with exhaustion and
depletion of energy in patients with arthritis.
--- Content provided by FirstRanker.com ---
- With inflammatory polyarthritis, the fatigue is usually noted in theafternoon or early evening.
- With psychogenic disorders, the fatigue is often noted upon arising in
--- Content provided by FirstRanker.com ---
the morning and is related to anxiety, muscle tension, and poor sleep.
Historical features important to the
--- Content provided by FirstRanker.com ---
differential diagnosis? Onset of symptoms ?
1. Abrupt - develop over minutes to hours
- trauma, crystalline synovitis, or infection.
2. Insidious - over weeks to months.
--- Content provided by FirstRanker.com ---
- typical of most forms of arthritis, including RA and osteoarthritis.? Duration of symptoms
- Acute - for less than 6 weeks
- Chronic - lasted for 6 weeks or longer.
--- Content provided by FirstRanker.com ---
? The temporal patterns of joint involvement
(1) Migratory- acute rheumatic fever or disseminated gonococcal
infection
--- Content provided by FirstRanker.com ---
(2) Additive or simultaneous
(3) Intermittent - intervening periods free of joint symptoms (as in
gout, pseudogout, or Lyme arthritis).
--- Content provided by FirstRanker.com ---
? Number of involved joints ?
(1) Monoarthritis.
(2) Oligoarthritis - 2-4 joints.
(3) Polyarthritis - 5 or more joints.
--- Content provided by FirstRanker.com ---
? Symmetry of joint involvement ?
- Symmetric arthritis - each side of the body ?
--- Content provided by FirstRanker.com ---
- RA and SLE.- Asymmetric arthritis ? psoriatic, reactive arthritis, and Lyme arthritis.
? Distribution of affected joints ?
--- Content provided by FirstRanker.com ---
- the distal interphalangeal joints of the fingers are usual y involved inpsoriatic arthritis, gout, or osteoarthritis but are usual y spared in RA.
- lumbar spine - ankylosing spondylitis but are spared in RA.
--- Content provided by FirstRanker.com ---
? Distinctive types of musculoskeletal involvement ?- Spondyloarthropathy - entheses, leading to heel pain (inflammation at the
insertions of the Achil es tendon or plantar fascia), dactylitis (sausage digits),
--- Content provided by FirstRanker.com ---
tendinitis, and back pain (sacroili tis and vertebral disc insertions).
- Gout commonly involves tendon sheaths and bursae, resulting in superficial
--- Content provided by FirstRanker.com ---
Extra-articular manifestations? Constitutional symptoms
- fatigue, malaise, and weight loss
--- Content provided by FirstRanker.com ---
- underlying systemic disorder
? Skin lesions - SLE, dermatomyositis, scleroderma, psoriasis, Henoch-
--- Content provided by FirstRanker.com ---
Sch?nlein purpura, and erythema nodosum.? Ocular symptoms ?
- Episcleritis and scleritis - RA or granulomatosis - Wegener granulomatosis
--- Content provided by FirstRanker.com ---
- Anterior uveitis- ankylosing spondylitis, and
- Iridocyclitis - juvenile idiopathic arthritis.
--- Content provided by FirstRanker.com ---
- Conjunctivitis - reactive arthritis.Physical examination
? Musculoskeletal examination include the following:
--- Content provided by FirstRanker.com ---
- Inspection- Palpation
- Movement
- Measurement
- Local motor & sensory examination
--- Content provided by FirstRanker.com ---
- Special testsSigns of inflammatory joint disease
--- Content provided by FirstRanker.com ---
? Swelling ?- Synovial hypertrophy - inflammatory - The synovial membrane is normally too
thin to palpate.
--- Content provided by FirstRanker.com ---
- In a person with chronic inflammatory arthritis, the synovial membrane has a
doughy or boggy consistency, a feature best appreciated at the joint line or
--- Content provided by FirstRanker.com ---
margin.- Joint effusions - develop in response to synovial inflammation, trauma, anasarca,
hemarthrosis. detected by performing fluid ballottement or cross-fluctuation
--- Content provided by FirstRanker.com ---
through the synovial cavity.
? Pain with motion - throughout the whole range of motion - acutely inflamed joint.
--- Content provided by FirstRanker.com ---
- Not throughout the entire range of motion - an extra-articular source, such astendinitis.
? Erythema and warmth - acute inflammatory forms of arthritis, such as
--- Content provided by FirstRanker.com ---
gout, septic arthritis, or acute rheumatic fever.
- Differences in warmth can also be detected by comparing the same
--- Content provided by FirstRanker.com ---
joint on each side of the body.? Limited range of motion - inflammatory joint disease
- tense effusion, a markedly thickened synovium, adhesions, capsular
--- Content provided by FirstRanker.com ---
fibrosis, or pain.? Joint tenderness - not specific
? Joint deformity
--- Content provided by FirstRanker.com ---
Signs of degenerative or mechanical jointdisease include the following:
? Bony overgrowth of the joints- osteophytes
- DIP - Heberden nodes
--- Content provided by FirstRanker.com ---
- PIP - Bouchard nodes.? Limited range of motion - intra-articular loose bodies, osteophyte
formation, or subluxation
--- Content provided by FirstRanker.com ---
? Crepitus during active or passive range of motion ?- A palpable or audible grating sensation produced during motion
? Joint deformity
Monoarthritis - Acute
--- Content provided by FirstRanker.com ---
qInflammatory ?
qNon-Inflammatory -
--- Content provided by FirstRanker.com ---
? Septic Arthritis? Trauma
? Gout and Pseudogout
--- Content provided by FirstRanker.com ---
? Hemarthrosis
? Systemic rheumatic disease
--- Content provided by FirstRanker.com ---
? Osteonecrosismanifesting as monoarticular
involvement
--- Content provided by FirstRanker.com ---
Monoarthritis - ChronicqInflammatory ?
qNon-Inflammatory -
--- Content provided by FirstRanker.com ---
? Chronic infectious arthritis
? Osteoarthritis
--- Content provided by FirstRanker.com ---
? Lyme Disease? Ischemic necrosis - Avascular
? Crystal ine synovitis - Gout and
--- Content provided by FirstRanker.com ---
Necrosis)
Pseudogout)
--- Content provided by FirstRanker.com ---
? Hemarthrosis? Pauciarticular juvenile idiopathic
? Paget disease involving the joint
--- Content provided by FirstRanker.com ---
arthritis
? Stress Fracture
--- Content provided by FirstRanker.com ---
? Systemic rheumatic diseasepresenting with monoarticular
? Osteomyelitis
--- Content provided by FirstRanker.com ---
involvement
? Osteosarcoma
--- Content provided by FirstRanker.com ---
? Metastatic tumor
Polyarthritis - acute
--- Content provided by FirstRanker.com ---
? Rheumatic fever
? Rheumatoid Arthritis
--- Content provided by FirstRanker.com ---
? Gonococcal Arthritis? Still disease (systemic-onset
? Polyarticular gout
--- Content provided by FirstRanker.com ---
juvenile idiopathic arthritis)
? Polyarticular pseudogout
--- Content provided by FirstRanker.com ---
? Systemic Lupus Erythematosus? Viral arthritis (eg, hepatitis B
? Reactive Arthritis
--- Content provided by FirstRanker.com ---
infection, parvovirus B-19
? Acute sarcoid arthritis
--- Content provided by FirstRanker.com ---
infection)? Mediterranean Fever, Familial
? Bacterial endocarditis
--- Content provided by FirstRanker.com ---
? Enteropathic Arthropathies
Polyarthritis - Chronic
qInflammatory ?
--- Content provided by FirstRanker.com ---
qNon-Inflammatory -
? Rheumatoid Arthritis
--- Content provided by FirstRanker.com ---
? Osteoarthritis? Systemic Lupus Erythematosus
? Traumatic osteoarthritis
--- Content provided by FirstRanker.com ---
? Viral arthritis
? Hemochromatosis
--- Content provided by FirstRanker.com ---
? Psoriatic Arthritis? Amyloidosis
? Reactive Arthritis
--- Content provided by FirstRanker.com ---
? Acromegaly
? Enteropathic Arthropathies
--- Content provided by FirstRanker.com ---
? Beh?et Disease? Ankylosing Spondylitis and
Undifferentiated Spondyloarthropathy
--- Content provided by FirstRanker.com ---
Laboratory Studies
--- Content provided by FirstRanker.com ---
? Erythrocyte sedimentation rate (ESR) ?- an elevated ESR supports the presence of an inflammatory arthritis.
? C-reactive protein (CRP) ?
--- Content provided by FirstRanker.com ---
- In contrast to the ESR, the CRP level
(1) can be measured on frozen serum,
--- Content provided by FirstRanker.com ---
(2) is not influenced by the presence of anemia or hyperglobulinemia,(3) rises more rapidly in response to an inflammatory stimulus but
(4) may require more time for the laboratory result to be available (ie,
--- Content provided by FirstRanker.com ---
more than 24 hours, as opposed to 1 hour for the ESR).
? RF & AntiCCP -
- An RF test may be positive in as many as 20% of healthy elderly persons
--- Content provided by FirstRanker.com ---
and in persons with other rheumatic diseases (eg, SLE, Sj?gren syndrome,
and vasculitis), chronic infections (eg, subacute bacterial endocarditis and
--- Content provided by FirstRanker.com ---
hepatitis C), chronic liver disease, or chronic lung disease.- CCP antibody testing has higher specificity than the RF test but lower
sensitivity.
--- Content provided by FirstRanker.com ---
? ANAs - SLE or another connective-tissue disorder.
- More than 95% of patients with SLE have ANAs; thus, a negative ANA result
--- Content provided by FirstRanker.com ---
is a strong indicator that SLE is not present.- However, a positive ANA result lacks specificity and may occur in persons
with other connective-tissue diseases or certain medical il nesses, as wel
--- Content provided by FirstRanker.com ---
as in 5-10% of otherwise healthy individuals.
- Test for Smith (Sm) and double-stranded DNA antibodies, which are more
--- Content provided by FirstRanker.com ---
specific for SLE but are present in only 30% and 60% of SLE patients,respectively
? Serum uric acid level
--- Content provided by FirstRanker.com ---
? Urinalysis? Septic arthritis ? Gram stain and culture of synovial fluid
? Blood cultures
? Antistreptolysin O titer
? HLA-B27
--- Content provided by FirstRanker.com ---
Others? Additional tests that may be considered
? antineutrophil cytoplasmic antibody (ANCA) test
--- Content provided by FirstRanker.com ---
? HIV test, a rubel a titer, Hepatitis B serology, Parvovirus B-19
immunoglobulin G (IgG) and immunoglobulin M (IgM) levels
--- Content provided by FirstRanker.com ---
? Creatine kinase and aldolase level to exclude myositis? Thyroid testing
? Chemistry profile (ie, calcium, phosphorus, electrolyte, glucose, and total
--- Content provided by FirstRanker.com ---
protein) to exclude metabolic or endocrine disorders
? 25-hydroxy vitamin D level (in elderly housebound individuals, to exclude
--- Content provided by FirstRanker.com ---
osteomalacia)? electrophoresis (to exclude multiple myeloma)
Plain Radiography
--- Content provided by FirstRanker.com ---
? least expensive imaging modality and
? most useful for clarifying the nature
? Rheumatoid arthritis
- Early - soft tissue swelling and periarticular demineralization.
--- Content provided by FirstRanker.com ---
- Later - include uniform loss of joint space (indicative of diffusecartilage loss) and bony erosions (initially along joint margins where
intra-articular bone is not covered by cartilage).
--- Content provided by FirstRanker.com ---
- Advanced - diffuse bony erosions, joint subluxation, and
foreshortening of digits.
--- Content provided by FirstRanker.com ---
Psoriatic arthritis
- Early - soft tissue swelling
occasionally involving the entire digit (ie, sausage digit)
--- Content provided by FirstRanker.com ---
and an absence of periarticular demineralization.
- Later - erosions coupled with reactive new bone formation, initially at joint
--- Content provided by FirstRanker.com ---
margins and later within the center of the joint.- uniform joint space narrowing and ankylosis of involved joints.
- Advanced changes
--- Content provided by FirstRanker.com ---
joint-space widening in IP joints caused by severe
destruction of marginal and subchondral bone
--- Content provided by FirstRanker.com ---
resorption of tufts of distal phalanges of fingers and toesarthritis mutilans (ie, severe joint destruction)
and the pencil-in-cup deformity.
--- Content provided by FirstRanker.com ---
Gout
- soft tissue swel ing.
--- Content provided by FirstRanker.com ---
- Degenerative changes of the involved joint are common.
- Intercritical gout does not manifest radiographic abnormalities, apart from
--- Content provided by FirstRanker.com ---
possible degenerative changes in the joint.- The joint space may be preserved despite extensive erosions, a finding not
expected in RA.
--- Content provided by FirstRanker.com ---
- Bone erosions are contiguous with tophi and are characterized by
overhanging and sclerotic margins.
--- Content provided by FirstRanker.com ---
- Osteolytic bone lesions occur near joints.- Periarticular demineralization is absent or mild, except late in the disease
course.
--- Content provided by FirstRanker.com ---
Pseudogout
? Calcium pyrophosphate dihydrate crystal
--- Content provided by FirstRanker.com ---
- most often in the knee, symphysis pubis, wrist, elbow, and hip.
- Hyaline cartilage calcification, Fibrocartilage calcification, Synovial
--- Content provided by FirstRanker.com ---
calcification, Capsular calcification, Extra-articular calcification occursin tendons, ligaments, and para-articular soft tissue
- Radiographic findings are the same as those for osteoarthritis.
--- Content provided by FirstRanker.com ---
- Prominent subchondral cysts
- Occasional articular destruction (resembling a neuropathic joint) with
--- Content provided by FirstRanker.com ---
subchondral bone collapse and fragmentation and formation ofintraarticular loose bodies
--- Content provided by FirstRanker.com ---
Infectious arthritis- Early - symmetric soft tissue swel ing
? absence of periarticular demineralization
--- Content provided by FirstRanker.com ---
? joint-space loss (although joint-space widening may be seen initial y
because of fluid accumulation in a smal joint space).
--- Content provided by FirstRanker.com ---
- Later - marginal bone erosions.? A periosteal reaction occurs.
- Final y, gas formation within the joint and adjacent soft tissues can be seen
--- Content provided by FirstRanker.com ---
with infections related to Escherichia coli, Enterobacter liquefaciens, and
Clostridium perfringens.
--- Content provided by FirstRanker.com ---
- Advanced - destruction of subchondral bone, bony ankylosis, andsubluxation or dislocation.
--- Content provided by FirstRanker.com ---
Osteoarthritis? Early - smal osteophytes at joint margins,
- focal narrowing of joint spaces (more uniform joint-space loss is noted in
--- Content provided by FirstRanker.com ---
the IP and MCP joints of the hands
- subchondral bony sclerosis in the segment affected by joint-space loss, and
--- Content provided by FirstRanker.com ---
- absence of periarticular demineralization.? Later - large and more extensive osteophytes at joint margins or at
ligamentous attachments (eg, tibial spikes),
--- Content provided by FirstRanker.com ---
- more pronounced focal joint-space narrowing, subchondral bone cysts with
sclerotic margins in the areas of joints affected by joint-space loss,
--- Content provided by FirstRanker.com ---
- and the formation of bony ossicles (round or oval fragments of bone) insoft tissues adjacent to the joint or within the joint cavity.
? Advanced - extensive joint-space loss and joint deformity.
--- Content provided by FirstRanker.com ---
Other Imaging Studies
? Ultrasonography ?
--- Content provided by FirstRanker.com ---
- It is safe and does not involve any exposure to radiation.- Joint aspirations and injections are greatly facilitated
? Computed tomography
- Assessing trauma of the spine and pelvis
- Evaluating arthritis in axial joints (eg, sacroiliac, atlantoaxial)
--- Content provided by FirstRanker.com ---
- Evaluating pain in complex joints in which overlying structuresobscure plain radiography views (eg, ankle, wrist, and
temporomandibular joint)
--- Content provided by FirstRanker.com ---
? Magnetic resonance imaging- best modality for assessing soft tissue and spinal cord elements
? Radionuclide bone scanning
- widely available, and its cost is comparable to that of CT scanning.
- most useful for assessing osteomyelitis, stress fractures, and bony
--- Content provided by FirstRanker.com ---
metastasis.
Synovial Fluid Analysis
--- Content provided by FirstRanker.com ---
Normal ?Noninflammatory?
Inflammatory?
--- Content provided by FirstRanker.com ---
Septic?
Hemorrhagic?
--- Content provided by FirstRanker.com ---
-clear to pale yel ow -pale yel ow color,-yel ow-to-white
-white-to-cream
--- Content provided by FirstRanker.com ---
-hemorrhagic color
color, transparent
--- Content provided by FirstRanker.com ---
transparent claritycolor, translucent-to color, opaque clarity and opaque clarity
clarity
--- Content provided by FirstRanker.com ---
-WBC count of 200- -opaque clarity
-WBC count higher -fat globules should
--- Content provided by FirstRanker.com ---
-white blood cel2000/L with
-WBC count of 2000- than 50,000/L with be sought in
--- Content provided by FirstRanker.com ---
(WBC) count lower -less than 25%
50,000/L with
--- Content provided by FirstRanker.com ---
-more than 90%hemorrhagic
than 200/L with
--- Content provided by FirstRanker.com ---
PMN leukocytes
-more than 70%
--- Content provided by FirstRanker.com ---
PMN leukocytesfluids by
-less than 25%
--- Content provided by FirstRanker.com ---
-high viscosity
PMN leukocytes
--- Content provided by FirstRanker.com ---
-very low viscositycentrifuging the
polymorphonuclear -e.g. osteoarthritis, -low viscosity
--- Content provided by FirstRanker.com ---
-bacterial arthritis,
synovial fluid (a
--- Content provided by FirstRanker.com ---
(PMN) leukocytestraumatic arthritis, -e.g. rheumatoid
but the fluid type
--- Content provided by FirstRanker.com ---
supernatant of fat is
-very high viscosity
--- Content provided by FirstRanker.com ---
and an early orarthritis (RA) and
also may
--- Content provided by FirstRanker.com ---
indicative of a juxta-
resolving stage of an other chronic
--- Content provided by FirstRanker.com ---
occasional y be seen articular fracture)inflammatory
inflammatory
--- Content provided by FirstRanker.com ---
in crystal ine
arthritis
--- Content provided by FirstRanker.com ---
arthritidesarthritis and flares
of RA
--- Content provided by FirstRanker.com ---
? Crystal analysis requires
- compensated polarized light microscopy
--- Content provided by FirstRanker.com ---
- performed on a wet smear preparation of synovial fluid.
? Urate crystals are needle-shaped with strong negative birefringence.
--- Content provided by FirstRanker.com ---
? Calcium pyrophosphate dihydrate crystals are rhomboid-shaped withweak positive birefringence.
? Urate crystals appear yellow and calcium pyrophosphate dihydrate
--- Content provided by FirstRanker.com ---
crystals blue when their long axes are aligned parallel to that of the
red compensator filter.
--- Content provided by FirstRanker.com ---
Synovial biopsy? Various granulomatous arthritides (eg, tuberculous arthritis, fungal
arthritis, and sarcoidosis)
--- Content provided by FirstRanker.com ---
? Amyloidosis
? Synovial tumors
? Hemochromatosis
? Multicentric reticulohistiocytosis
--- Content provided by FirstRanker.com ---
Management
? Goals of treatment
--- Content provided by FirstRanker.com ---
-relief of pain-restoration or maintenance of joint function
-and prevention of joint damage.
? both pharmacologic and nonpharmacologic therapeutic modalities.
--- Content provided by FirstRanker.com ---
Medicines &
Surgeries
--- Content provided by FirstRanker.com ---
Patienteducation,
Energy
--- Content provided by FirstRanker.com ---
conservation and
Intra-articular
--- Content provided by FirstRanker.com ---
psychosexualinjections
rehab
--- Content provided by FirstRanker.com ---
Management
What is in our box?
--- Content provided by FirstRanker.com ---
ExercisesOrthotics
Modalities
--- Content provided by FirstRanker.com ---
THANK YOU