I-Arthritis ye-Knee: Ukujonga ukujonga ukujonga ii-II El Paso, TX.

Sagittal Fluid Sensitivity

• I-Sagittal Fluid Sensitive Sensitive MR slice ebonisa iNetovial popliteal popliteal (i-Baker's) cyst (ngentla yemifanekiso ephezulu) kunye nesiphumo esivumelanayo sesinxibelelaniso esingaphezulu (umfanekiso ongezantsi)
• Qaphela iindawo ezininzi ezimnyama ezibonisa ubumnyama kwimifanekiso yomibini, emele ukubekwa kwemibhobho yokufakelwa kwi-fibrinoid aka aka "imizimba yerayisi" uphawu lwe-MRI ebonakalisa uphawu lweRA

Ukuhanjiswa kweRheumatological Referral kunye ne-DRM

• Ulawulo lokugcinwa kwemilondolozo olulandelwa lulondolozo lwentsebenziswano kwiimeko zamathambo ezihlukumezayo kunye namaqela ahlukeneyo
• Ukufunda okunye:
• Ukuxilongwa nokuLawula iRumatoid Arthritis -AAFP
• www.aafp.org/afp/2011/1201/p1245.html

ISeptic Arthritis (SA)

• Isifo samathambo - d / t ibhaktiriya okanye ukungqubana kokungunda kokudibeneyo. I-SA inokubangela ukutshatyalaliswa okuhlanganyelweyo okukhawulezayo kwaye ifuna ukuba i-Dx kunye nolawulo lwe-antibiotic ngokukhawuleza
• Amalungu achaphazelekayo: amalunga amakhulu anegazi elityebileyo (idolo i-50%> iinyonga> amagxa).
• Iirhuts of Infection:
• I-1) I-memo yodwa i-m / c
• 2) Sasaza kwiziko elikufutshane
• I-3) Ukufakwa ngokuthe ngqo (umz., Ukwenzakala, iatrogen)
• Izigulana ezisemngciphekweni: abantwana, isifo seswekile, ukugonywa, umonakalo odibeneyo / usulelo, umzekelo, RA, njl.
• Abasebenzisi beziyobisi ze-IV basengozini enkulu kwaye banokuthi bangcolise ukudibanisa ii-atypical joints "SI joints" SIJ, SCJ, Symphysis pubis, ACJ, njl.

• Klinikhi: ziyahluka kwaye kuxhomekeke kwimpendulo ye-immune response kunye ne-bacterial virulence. Inokuthi ivele ngokukhawuleza kokuqala okanye ukunyanzeliswa kweentlungu ezidibeneyo zangaphambili, ukuvuvukala, ukunciphisa iROM. Imiqondiso jikelele ye-malaise, umkhuhlane, ukukhathala nokuphakama kwe-ESR, i-CRP, i-Leucocytosis inokuba khona.
• Isifo seswekile se-NB kunye ne-immunocompromised sinokuthi sivelise ukubonakaliswa okumbalwa kunye nokungabikho komkhuhlane
• I-Dx: ikliniki, i-radiological kunye nebhubhoratri. I-Arthrocentesis ingafuneka ukuba inkcubeko, isibalo seeseli kunye nokuhlolwa kwe-synovial
• Ulawulo: IV antibiotics
• Ukujonga iDx: iqala nge-radiogra kodwa kwinqanaba lokuqala uninzi olunokubakho alunakuba lolwazelelekileyo. I-MRI inokuba nolwazelelelo kwaye incede ekuchongeni kwangoko kokudityaniswa kwamadlala, i-edema yamathambo, njl. I-US kunokuba luncedo kumalungu adibeneyo nabantwana. I-US inceda ngokukhokela ngenaliti. I-scintigraphy yethambo inokusetyenziswa ngokwasemoyeni ukuba i-MRI ichasene

Imizila yeContactination Joint

• 1. Uhlobo (M / C)
• 2. Ukusasaza kwisiza esiseduze
• 3. Inoculation ngqo
• I-M / C yendalo-iStaph aureus
• I-NB Intsholongwane ye-Gonococcal ingaba yintlukwano ephezulu kwezinye iimeko
• Abasebenzisi beziyobisi ze-IV: I-Pseudomonas, i-candida
• Isilya seSickle: i-Salmonella
• Izilwanyana (iikati / izinja) ziluma: Pasteurella
• Ngamaxesha athile ungcoliseko lokungunda lunokwenzeka

Yezigulanaa

• Ekuqaleni ayingacaciswanga nge-ST / ukufakwa ngokudibeneyo, ukubonwa / ukugqobhoza kweenqwelomoya. Kuba kuthatha i-30% ye-compact kunye ne-50-75% ithambo le-trabecular ukuba litshatyalaliswe ngaphambi kokuba kubonwe kwi-x-ray, i-radiography ayikhathaleli kwezinye zeenguqu zokuqala. Ukucingela i-MR yeyona ndlela ikhethiweyo
• Ukuba i-IRM ayifumaneki okanye iyaphikiswa. I-Bone scintigraphy kunye ne-Tc-99 MDT inokunceda
• Kubantwana, e-US bakhetha ukuphepha i-ionizing radiation. Kubantwana, i-US inokuba nobuthathaka ngakumbi kunabantu abadala ngenxa yokunqongophala kwamathambo

Radiographic Dx

• Iziphumo zakuqala azinamvuzo. Iimpawu zakuqala zingabandakanya ukwandiswa okuhlanganisiweyo kwe d / t. Ukudumba kwezicubu ezithambileyo kunye nokuchaphaza / ukungcungcuthekiswa kweenqwelomoya
• Iiveki ze-1-2: i-periarticular and adjacent osseous changes zibonakalisa njengokutsalwa kwesinambuzane, ukudliwa kwenundu, ukuvumela ukutshutshiswa kwamathambo, ukulahleka, kunye nokungaqondakali kwe-epiphyseal "cortical line" ekhulayo kunye nokunyuka kokuvuvukala kwezicubu. I-MRI inokuba luncedo ekuqaleni kuka-Dx.
• Iimpawu ezisezantsi: ukuzaliswa kokuhlanganiswa kunye kunye ne-anloloses
• I-NB ye-arthritis ye-Septic ingaphuthuka ngokukhawuleza ngaphakathi kweentsuku kwaye idinga i-antibiotic yakudala ye-IV ukukhusela ukutshabalalisa okukhulu

I-T1 kunye ne-T2 Knee MRI

• I-T1 (ngasentla ngasekhohlo) kunye ne-T2 i-sagittal knee ii-MRI izilayi zibonisa ukulahleka kwesiginali eqhelekileyo yomqondiso kwi-T1 kunye nokunyuka kwi-T2 ngenxa yeedema ye-septic. Ithambo le-sequestrum d / t osteomyelitis eqhubela phambili kwi-septic arthritis iyaphawulwa. Ukumakishwa kokudityaniswa okudibeneyo kunye needema ezikufuphi nezicubu ziyabonakala. I-Dx: i-OSM kunye ne-septic arthritis

• Ukuxeliswa kunganceda i-Dx ye-septic yokudibanisa. Nangona kunjalo, i-Dx yokugqibela isekwe kwi-Hx, uvavanyo lomzimba, uvavanyo lwegazi kwaye okubaluleke kakhulu kukunqweneleka ngokufana (arthrocentesis)
• I-Synovial umthambo kufuneka ithunyelwe kwi-Gram staining, inkcubeko, ukuhlolwa kwe-glucose, isibalo se-leukocyte, kunye nokuzimisela
• ISR / CRP inokuphakanyiswa
• I-Synovial fluid: I-WBC ingaba yi-50,000-60,000 / ul, ne-80% ye-neutrophils enezinga le-glucose echanekileyo I-Gram stain: kwi-75% ye-co-accin cocci. Ukuguqulwa kwegram kuncinci kwiintsholongwane ze-gonococcal nge-25% yeenkcubeko kuphela
• Kwi-9% yamatyala, iikholeji zegazi ziphela zivela kumthombo we-pathogen kwaye kufuneka zifunyenwe ngaphambi kokuba unyango lwe-antibiotic
• Amanqaku: www.aafp.org/afp/2011/0915/p653.html
• www.aafp.org/afp/2016/1115/p810.html

I-Crystal-Induced Knee Arthritis

• I-crystalline arthritis: iqela lezinto ezibangelwa yi-crystal deposition kunye neenxa zonke.
• 2-m/c: Iikristale zeMonosodium urate (MSU)� kunye neCalcium Pyrophosphate Dehydrate crystals (CPPD) arthropathy
• Igawuthi: Ukubekwa kwe-MSU kumalungu ajikeleze kunye nezicubu ezithambileyo. Amanqanaba aphakamileyo e-serum uric acid (UA) (> 7mg / dL) ebangelwa kukuveliswa ngokugqithisileyo okanye ukukhutshwa okungaphantsi kwe-uric acid
• Nje ukuba i-UAU ifikelele / idlule kwi-7mg / dL, iya kufaka kwizicubu zomzimba. I-gout eyintloko: ukuphazamiseka kwe-metabolism ye-nucleic acids kunye ne-purines iyaphule. Ukuphuma kwesibini: Ukunyuka kweseli okunyukayo: I-Psoriasis, i-leukemia, i-myeloma emininzi, i-hemolysis, ichemotherapy, njl.
• I-Gout ibonisa ngezigaba ze-5:
• 1) i-hyperuricemia (iminyaka / iminyaka emininzi)
• Ukuhlaselwa ngokukrakra kwe-arthritis ye-gouty (i-wax kunye neyadala kwaye idlulela iminyaka emininzi)
• Isigaba sesithuba phakathi kokuhlaselwa
• Isifo se-tophaceous esingapheliyo
• Gouty nephropathy

Ukunikezelwa kwezonyango

• Kuxhomekeke kumanqanaba
• Uhlaselo olusebenzayo: iintlungu ezidityanisiweyo ezinobukrakra "zokuqala kunye ezimbi" kude kube buhlungu ukubamba ukukhanya
• I-DDx: ukuhlanganiswa kwe-septic (zombini inokuthi ikhona) i-bursitis njl
• I-gouty arthritis ibonisa nje nge-monoarthropathy
• Inqanaba lokunyanga okungapheliyo: idiphozithi kumalungu, i-pinna yendlebe, iioyile, kunye neminye imimandla. I-Nephrolithiasis njl. Amadoda> abafazi. Ukutyeba kakhulu, ukutya kunye nobudala> 50-60.
• Iimpawu zengxowankulu: Ukuhlaselwa kwangethuba kungekhona kwaye kungabonakalisa ukuxhatshazwa okuthe ngqo
• I-radiography ye-ging tophaceous engapheliyo: ihlikiwe ngaphandle kwe-peri-articular, para-articular kunye ne-intraosseous yukhukuliseko olunemiphetho engaphezulu. Umphetho obonakalayo wes sclerosis kunye nokubalwa kwangaphakathi, itouti ethambileyo yecuthi. Indawo ekujoliso kuzo: isiphelo esisezantsi m / c
• I-Rx: allopurinol, colchicine (esp ukuthintela iziqalo ezikhulu kunye nolondolozo)

Synovial Aspiration

• I-Synovial aspiration kunye ne-microscopy ephazamisayo ibonakalisa i-MSU enokungahambi kakuhle kweenaliti ezinobungqina obukhulu be-PMN. I-DDx: ama-crystals (CPFD) angaphantsi kwe-CPPD (ngenhla ngasekunene) abonwa kwi-Pseudogout ne-CPPD

Enkulu ST

• Ubungqingqwa kunye nokudityaniswa okuhlanganyelweyo kukhuphe ukhukuliseko lomhlaba ngokuguguma, ukugcinwa okugcwele koxinano lwethambo, ukubalwa kwangaphakathi Dx: isifo esingapheliyo esifumbileyo

Iimpawu zeMRI Gout

• Ukhukuliseko olunemida engaphezulu, umqondiso ophantsi kwi-T1 kwaye uphezulu kwi-T2 kunye nemifanekiso egxinwa ngamafutha. Ukuphucuka kokungafani kokuphuculwa kwe-tophaceous deposits d / t izicubu zokugcoba
• Dx: yokugqibela Dx; i-synovial aspiration kunye ne-microscopy ephazamisayo

Amanqaku angaphezulu

• I-10-inyaniso malunga ne-gout www.pharmacytimes.com/publications/issue/2013/july2013/a-bout-of-gout-a-region-of-pain
• www.aafp.org/afp/1999/0215/p925.html

Knee Arthritis