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

I-Degenerative Knee Arthritis

• Knee Arthritis
• I-Knee OA (arthrosis) yi-m / c yempawu ye-OA enamatyala angama-240 nge-100,000, i-12.5% ​​yabantu> 45 yo
• Izinto ezinobungozi ezinokuguqulwa: ukuxhwaleka, ukukhuluphala, ukungabikho komzimba, ubuthathaka obuthathaka
• Ukungaguquguquki: abasetyhini> amadoda, ukwaluphala, ufuzo, ubuhlanga / ubuhlanga
• I-Pathology: sisifo se-articular cartilage. Ukuqhubela phambili ukuvuselela oomatshini kulandela ukwanda kokuqala kwamanzi kunye nobukhulu be-cartilage. Ukulahleka ngokuthe ngcembe kweeproteoglycans kunye nezinto zomhlaba. Ukuqhawula/ukwahlula. I-Chondrocytes yonakaliswe kwaye ikhulule i-enzymes kwi-joint. Ukuqhubela phambili kwe-Cystic kunye nokulahleka kwe-cartilage ngakumbi. Ithambo le-subchondral likhutshiwe kwaye libonakaliswe kuxinzelelo lomatshini. Iba yi-hypervascular forming osteophytes. I-Subchondral cysts kunye nokuqina kwethambo / i-sclerosis ikhula.
• Ukucinga kudlala indima ebalulekileyo kwiDx / ukulinganisa kunye nokulawula
• Klinikhi: intlungu ekuhambeni / ukuphumla, i-crepitus, ukuvuvukala d / t synovitis, ukutshixa / ukubamba i-d / t i-osseocartilaginous fragments kunye nokulahleka komsebenzi ngokuthe ngcembe. I-Knee OA ibonakala njenge-mono kunye ne-oligoarthritis. I-DDx: intlungu yasekuseni / ukuqina ngu> 30-min DDx kwi-arthritis evuthayo
• Unyango: kwiimeko ezincinci ukuya kweziphakathi-ukhathalelo lolondolozo. I-OA enzima ye-knee arthroplasty

I-OA: I-LOSS Radiologic Presentation

• Unikezelo lweradiyologic-pathologic ye-OA: Ilahleko
• Ukulahlekelwa kwendawo edibeneyo (engeyiyo ifom
• Osteophytes
• Subchondral sclerosis
• Iigqithana zee-subchondral
• Ukukhubazeka kweThambo: I-Genu Varum- yi-m / c deformity d /
• Ukongeza: ukuncipha kwezicubu ezithambileyo ze-periarticular, ukungazinzi kunye nolunye utshintsho

Ukucinga

• Imifanekiso yezobugcisa yindlela yokukhetha
• Imibono kufuneka ifake ib / l lithwala ubunzima
• Ukuvavanywa kwendawo edibeneyo kubalulekile. Indawo edibeneyo -3-mm
• Ukulinganisa kusekelwe kwinqanaba le-joint joint (JSN), i-osteophytes, i-deformation de bone, njl.
• Bakala 1: i-JSN encinci, i-osteophyte
• Bakala 2: i-osteophyte kunye ne-JSN kwi-AP yokujonga ubunzima
• Bakala 3: ii-osteophyte ezininzi, i-JSN ecacileyo, i-subchondral sclerosis
• Bakala 4: I-JSN enamandla, i-osteophyte ephezulu, ibhalwe i-subchondral sclerosis kunye ne-bony deformity
• Ulwimi lwengxelo oluqhelekileyo luya kuthi:
• Umncinci, onobubele, onomodareyitha okanye onamandla ongu-arthrosis

ubuchule

• Imifanekiso-mboleko: Amadolo okuthwala i-AP: inqaku elincinci leJSN yecala lokudibanisa elingakumbi kunye negumbi lokuxotshwa kwamadolo. I-osteophytes kwaye ibonakaliswe i-genu varum deformity ne-deformation de bone
• Ngokwesiqhelo i-medial femorotibial compartment ichaphazeleka kwangethuba kwaye ngokuqatha
• I-patellofemoral compartment iphinda ichaphazeleke kwaye ibonakaliswe kakuhle kwimibono ye-lateral kunye ne-Sunrise
• Impressions: i-tri-compartmental knee arthrosis
• Iingcebiso: ukuhanjiswa kumgqirha wamazinyo

JSN efanelekileyo

• I-B/L ye-AP yokujonga ubunzima (phezulu komfanekiso ophezulu): I-Moderate ye-JSN ngokuyinhloko ye-medial femorotibial compartment. I-Osteophytosis, i-subchondral sclerosis kunye ne-mild bone deformation (i-genu varum)
• Iimpawu ezongezelelweyo: I-PF OA, i-osteophytes ye-intra-articular, imizimba ye-osteocartilaginous ekhululekileyo yesibini kunye ne-subchondral cysts (ngaphezulu kweentolo)

Osteochondromatosis yesibini

• I-Intra-articular osteocartilaginous imizimba ekhululekileyo eyaziwa ngokuba yi-osteochondromatosis yesibini
• Okuqhelekileyo kwi-DJD ngokukodwa ngamalungu amaninzi
• Inokukhawulezisa ukutshabalalisa i-cartilage kunye nokuqhubela phambili kwe-OA
• Iimpawu ezinokuba zibi kakhulu ze synovitis
• Ukuvalela kwe-intra-articular, ukubamba

Ulawulo lwe-Knee OA enamandla

• Unonophelo lokugcinwa kwe-Conservative: i-NSAID, umzimba, ukulahleka kwesisindo njl
• Ukunyamekela komsebenzi kufuneka kusetyenziswe ukuba unonophelo olungapheliyo aluphumelelanga okanye iimpawu ziyaqhubeka nangona imizamo ekhuselekileyo kwiimeko ze-OA ezinzima
• Ukuphononongwa kwinqaku
• www.aafp.org/afp/2018/0415/p523.html

I-Calcium Pyrophosphate I-Dehydrate Deposition Disease

• I-CPPD i-arthropathy eqhelekileyo emadolweni
• Inokubonisa njenge-asymptomatic chondrocalcinosis, i-CPPD arthropathy efana ne-DJD kunye ne-pan predominance yama-cysts amakhulu angaphantsi. Ihlala ifunyanwa njenge-PFJ DJD ekwanti
• I-pseudogout enohlaselo oluqatha lweentlungu zedolo ezifana ne-gouty arthritis
• Izahlulo-mfanekiso yinyathelo le-1st kwaye ihlala iveza iDx
• I-Arthrocentesis ene-polarized microscopy inokuba luncedo kwi-DDx phakathi kwe-CPPD kunye ne-Gouty arthritis

Irheumatoid arthritis

• I-RA: isifo sokuvuvukala kwenkqubo ye-autoimmune esijolise kwizicubu ezithambileyo zamalungu e-synovium, i-tendon / ligaments, i-bursae kunye neendawo ezingaphezulu kwe-articular (umzekelo, amehlo, imiphunga, inkqubo ye-cardiovascular system)
• I-RA yi-m / c i-arthritis evuthayo, i-3% yabasetyhini kunye ne-1% yamadoda. Ubudala: 30-50 F> M 3: 1, kodwa inokukhula nangaliphi na ixesha. I-RA yokwenyani ayiqhelekanga ebantwaneni kwaye akufuneki ibhidaniswe neJuvenile Idiopathic Arthritis
• I-RA ihlala ichaphazela amalungu amancinci ezandla kunye neenyawo njenge-symmetrical arthritis (i-2nd 3rd MCP, i-3rd PIPs, izihlahla kunye nee-MTPs, igcina ii-DIP zeminwe neenzwane)
• Ngezobugcisa: I-RA ibonakalisa ngokudibeneyo effusion ekhokelela kwi-hyperemia kunye ne-marginal erosions kunye ne-periarticular osteoporosis. Edolweni, i-lateral compartment ichaphazeleka ngokuphindaphindiweyo ngokukhokelela kwi-valgus deformity. Iyunifomu ye-aka concentric/symmetrical JSN ichaphazela onke amacandelo kwaye ihlala iyisitshixo se-Dx
• Ukungabikho kwe-subchondral sclerosis kunye ne-osteophytes. I-Popliteal cyst�(i-cyst ka-Baker) inokumela i-synovial pannus kunye ne-synovitis evuthayo enwebeka kwingingqi ye-popliteal enokuthi ixwilwe kwaye yandiselwe kwi-posterior leg compartment.
• I-NB Ukulandela ukutshabalaliswa okuhlangeneyo kwe-RA, akuqhelekanga ukuqaphela i-2nd OA ephakamileyo

• I-Radiografi yinyathelo le-1st kodwa ukubandakanyeka kokuqala ngokubambisana kungabonakali ngo-x-ray kwaye kunokuncediswa yi-US kunye / okanye iMRI.
• Iimvavanyo zeLab: RF, CRP, anti-cyclic citrulline peptide antibodies (anti-CCP Ab). I-CBC
• I-Dx yokugqibela isekelwe kwi-Hx, uvavanyo lweklinikhi, iilebhu, kunye ne-radiology
• Iiparele zonyango: izigulane ezine-RA zingabonisa ngegolo elinye elichaphazelekayo
• Uninzi lwezigulane zinokuthi zibe nezandla / iinyawo ezilinganayo zomhlaba.
• Umgudu wesibeletho, ngakumbi i-C1-2 ithinteke kwi-75-90% yamatyala ngexesha lonke lesi sifo
• I-NB Ukunyanzeliswa ngokukhawuleza kwintlungu edibeneyo kwi-RA akufanelekanga ukunciphisa i-articritis ye-septic ngenxa yokuba izigulane ezine-RA ezandulele zihlala zingengozini enkulu yokugula. Iinjongo ezidibeneyo zinokunceda ngeDx.

Radiographic DDx

• RA (ngasentla ngasekhohlo) kunye ne-OA (ngasentla)
• RA: I-concentric (yunifomu) yokulahleka kwendawo yokudibana, ukungabikho kwe-osteophytes kunye ne-juxta-articular osteopenia.
• Iiperile zeeKlinikhi: izigulane ezine-RA zingabonisa i-radiographically nge-subchondral sclerosis d / t i-DJD ephakamileyo. Inxalenye yokugqibela ayifanele iguqulelwe njenge-OA kodwa kunoko ithathwa njenge-OA yesibini

AP Knee Radiograph

• Qaphela ukuba i-JSN ifanelweyo, i-opiopenia ye-juxta-articular kunye neenguqulelo ze-subchondral cystic
• Iiperile zeklinikhi: ii-subcortical cysts kwi-RA ziyakunqongophala umphetho we-sclerotic ophawulwe kwi-OA enxulumene ne-subcortical cysts.

Sensitivity

• I-MRI ibuhlungu kakhulu kwaye inokunceda ngexesha lokuqala iDx ye-RA.
• I-T2-fat-sitting okanye i-STIR kunye ne-T1 + C gad eyahlukileyo yokulandelana kwamanxeba anokucatshulwa
• I-MRI Dx ye-RA: ukuvuvukala kwe-synovial / ukutshatyalaliswa, i-synovial hyperplasia, kunye nokwakheka kwe-pannus kunciphisa ubukhulu be-cartilage, i-subchondral cysts, kunye nokukhukuliseka kwamathambo
• I-MRI iyanqabisa kakhulu ukutyhila i-somema ye-bone edrow, i-precursor to erosions
• Iziqhekeza ze-fibrinoid ezibizwa nge-intra-articular ezibizwa ngokuthi "imizimba yamarandi" ziphawu loMM we-RA
• Qaphela: i-T2 fat-sat sagittal MRI iveza ukudumba okukhulu kwamalungu kunye nokwanda kwe-pannus synovial (ngasentla kweentolo). Akukho bungqina be-radiographic okanye i-MRI ye-bone erosions ekhoyo. Dx: RA

I-STIR MR IiSlices

• Qaphela: I-STIR MR izilayi kwi-axial (phezulu komfanekiso ongezantsi) kunye neenqwelomoya ze-coronal (ngaphezulu komfanekiso ophezulu) zibonisa i-synovitis ebanzi / i-effusion (ngaphezu kweentloko zeentolo) kunye nokukhukuliseka okuphindaphindiweyo kwi-plateau ye-tibial ephakathi kunye ne-lateral (ngaphezulu kweentolo)
• Ukongezelela, iindawo eziqhekekileyo zendawo yamathambo e-edema ziqatshelwe (ngaphezu kwe-asterisks) utshintsho lwemorrow edema lubonakaliso kunye nokuqikelela kwexesha elizayo lokungabikho kwemimoya.
• Iinkcukacha ezongezelelweyo: inqaku elincinci kunye nokutshabalalisa i-cartilage

Knee Arthritis