MUSCO 01 Introduction肌肉骨骼系统ppt课件

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Evidence of: Temporal (Giant Cell) Arteritis
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Musculoskeletal Complaint
Joint Pain Joint Swelling Diffuse/Systemic Sxs
Initial Rheumatic History and Physical Exam to Determine:
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Peri-/Non-articular Pain
• Fibromyalgia • Fracture • Bursitis, Tendinitis, Enthesitis, Periostitis • Carpal tunnel syndrome • Polymyalgia rheumatica • Sickle Cell Crisis • Raynaud’s phenomenon • Reflex sympathetic dystrophy • Myxedema
Identify “Red Flag” conditions Conditions with sufficient morbidity/mortality to warrant an expedited diagnosis
Make a timely diagnosis Common conditions occur commonly Many SkM conditions are self-limiting Some conditions require serial evaluation over time to make a Dx
Immunologically-Mediated Diseases (adaptive immunity) Rheumatoid Arthritis* Systemic Lupus Erythematosus* Spondyloarthropathies* Ankylosing spondylitis Reactive Arthritis (Reiter’s Syndrome) Psoriatic Arthritis Spondylitis associated with IBD Sjogren’s Syndrome Polymositis/Dematomyositis Lyme Disease Rheumatic Fever Behcet’s Syndrome Systemic Sclerosis (Scleroderma) Wegener’s Granulomatosis Giant Cell Arteritis*
DR TIMOTHY SONG
CINTCTMRODUCTION TO
MUSCULOSKELETAL
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Definition:
Rheumatologic (or Rheumatic) Disease: diseases characterized by pain and inflammatio in joints and connective tissues, often referred to as “collagen-vascular diseases”.
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Introduction to Rheumatology: Historical Perspective
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The Painter’ s Family Jacob Jordaen s (15931678)
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Evidence of: Rheumatoid Arthritis
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The Virgin with Canon van Der Paele, 1436 Jan van Eyck (13851440)
1. Is it articular 2. Is it acute or chronic? 3. Is inflammation present? 4. How many/which joints are involved? 5. Are there RED FLAGS?
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Goals of Assessment
Provide relief, reassurance and plan for evaluation and treatment
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RED FLAG CONDITIONS
• FRACTURE • INFECTION • ORGAN INVOLVEMENT
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Articular vs. Periarticular
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Diversity of Rheumatologic Diseases: Common and Uncommon Diseases Involving
Inflammatory and Immune Responses
Inflammatory Diseases (innate immunity) Osteoarthritis* Gout* Pseudogout
Systemic Features+ Elevated ESR or CRP* Synovial Fluid WBC Examples
Sometimes Present Frequent WBC > 2,000 /mm3 Septic arthritis, RA, Gout, Polymyalgia rheumatica
Finding ARTICULAR PERIARTICULAR
Pain
Diffuse, deep tenderness
"point"
ROM Pain Swelling
Active+passive
in all planes Common
Active motion
in few planes Uncommon
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Inflammatory vs Noninflammatory
Feature
Inflammatory
Pain (worse when?)
Yes (morning)
Swelling Erythema Warmth Morning Stiffness
Soft Tissue (+ effusቤተ መጻሕፍቲ ባይዱon) Sometimes Present Sometimes Present Prominent ( > 1 hr.)