2009年現(xiàn)代疾病診斷與治療骨關(guān)節(jié)炎章

1、Note: Note: Large images and tables on this page may necessitate printing in landscape mode.Copyright Copyright © The The McGraw-Hill McGraw-Hill Companies. Companies. All All rights rights reserved. reserved.CURR

2、ENT CURRENT Medical Medical Dx Dx & Tx Tx > Chapter 20. Musculoskeletal & Immunologic Disorders >Diagnosis & Evaluation of Musculoskeletal DisordersExamination of the PatientIn the patient with arthriti

3、s, the two clinical clues most helpful for diagnosis are the joint pattern and the presence or absence of extra-articular manifestations. The joint pattern is defined by the answers to three questions: (1) Is inflammatio

4、n present? (2) How many joints are involved? and (3) What joints are affected? Joint inflammation is manifested by redness, warmth, swelling, and morning stiffness of at least 30 minutes' duration. Both

5、 the number of affected joints and the specific sites of involvement affect the differential diagnosis (Table 20–1). Some diseases—gout, for example—are characteristically monarticular, whereas other diseases, s

6、uch as rheumatoid arthritis, are chiefly polyarticular. The location of joint involvement can also be distinctive. Only two diseases frequently cause prominent involvement of the distal interphalangeal (DIP) jo

7、int: osteoarthritis and psoriatic arthritis. Extra-articular manifestations such as fever (eg, gout, Still disease, endocarditis), rash (eg, systemic lupus erythematosus, psoriatic arthritis, Still disease), nodules (eg

8、, rheumatoid arthritis, gout), or neuropathy (eg, polyarteritis nodosa, Wegener granulomatosis) narrow the differential diagnosis further.Table 20–1. Diagnostic value of the joint pattern.Characteristic Characte

9、ristic Status Status Representative Representative Disease DiseasePresent Rheumatoid arthritis, systemic lupus erythematosus, goutInflammationAbsent OsteoarthritisNumber of involved jointsMonarticular Gout, trauma, sept

10、ic arthritis, Lyme disease, osteoarthritisPolymorphonuclea r leukocytes 75,000/mcL and 100,000 white cells/mcL) joint effusions. Synovial fluid glucose and protein levels add little information and should not b