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Pathologic process
sx
Physical signs
x-ray
(+) antigen to
lymphocyte
t-cell proliferation
in synovial
membrane
1. Accumulation of
neutrophils
2. Synoviocytes
proliferation
3. WBC invasion in
cartilage
(-)
(-)
(-)
1.
2.
3.
1.
2.
Malaise
Mild jt stiffness
Swelling
Jt swelling
Morning
stiffness > 4hrs
3. Diminished
pain when
submerged in
hot h2o
4. Malaise
5. weakness
^ sam
Swelling or pain of
small jts
(-)
^ same
But c pronounced
swelling
Periarticular
osteopenia
*MRI
proliferative
pannus
^ same
+ Loss of fxn
+ early dfo (Z-dfo)
^ same c stage 3
+ jt instability
+ flexor
contracture
+ ROM
+ extraarticular
complications
1. polarization of
synovitis into a
centripetal
invasion of
pannus
2. activation of
chondrocyte
3. initiation of
proteinase
cartilage
degradation
1. erosion of
subchondral
bone
2. invasion of
pannus to
cartilage
3. chondrocyte
proliferation
4. stretched
ligaments
Warms
Swollen jt
Excess synovial
fluid
Synovial prolif
Pain LOM
Nodules
Specific manifestaions
1. cervical
2. TMJ
3. shoulder
4. Elbow
5. Wrist
C1 C2
Rotn
C2 and mid cervical: MC of inflamm
(N) ~ is altered
N/A to open mouth
GH, AC, SC
Degen, pain, LOM
Complication: bursitis and tenidinitis
Unstable jt
Irreg / catching movt
Flxn contracture d/t pain
Flxn contracture d/t synovitis
Volar subluxation of carpas on radius d/t erosion of RC jt
6. Hand
7. PIP
8. DIP
9. thumb
10.Hip
11.Knees
12.Ankle
13.Tenosynoviti
s
14.Lag
phenomeno
n
2 for 3 mos
3 for 6 wks
5 for 6 wks
7/11 for 6 wks
Stills
20 %
F=M
(-) RF ANA
Intermittent fever
Rashes
Lymphadenopathy
Hepatomegaly
Leukocytosis
Anemia
Inc ESR and WBCC
Marked anemua
Most severe
Causes of long
term steroid use
a.
b.
c.
d.
e.
f.
Morning stiffness
Tenderness/pain in motion
Swelling
Nodules
Elevated ESR/ c-reactive protein
iritis
Polyarticular
40%
F
No extraarticular
Malaise
Low fever
Organomegaly
Adenopathy
Anemia
GR
Weight loss
Symmetric
Pauciarticular
40%
F
Oligo c 4 mos
Jts commonly
affected:
Knee
Ankle
Elbow
Significant growth
retardation
Flex position and
refuse to walk