Cơ - Xương - Kh p
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Sơ đ 10.2 Arthritis
OSTEOARTHRITIS (OA)
What is OA?
This is a degenerative arthritis affecting synovial joints and is
characterised by cartilage degeneration, the associated response of the
periarticular tissue and pain that is typically worse at the end of the day.
Causes
Damage to the joints and general wear and tear of the joint over time is
thought to be the primary cause of OA. There are certain factors that
increase the risk of OA such as:
•
Increased age.
•
Obesity.
•
Trauma to the joint.
•
Conditions such as haemochromatosis and Ehlers–Danlos syndrome.
Signs and symptoms
•
Pain and stiffness.
•
Swelling around the joints involved.
•
Crepitus.
•
Heberden’s nodes at distal interphalangeal (DIP) joints.
Remember they are the ‘outer Hebrides’.
•
Bouchard’s nodes at proximal interphalangeal (PIP) joints.
RHEUMATOID ARTHRITIS (RA)
What is RA?
This is a chronic, autoimmune type III hypersensitivity reaction that
principally affects the joints but may also affect other organs.
Joint involvement is characterised by symmetrical deformation with
pain that is worse in the morning.
Cause
The exact cause of RA is unknown, but it is thought to involve a type III
hypersensitivity reaction. This condition is associated with HLA DR4
and HLA DR1.
Signs and symptoms
•
Hands: Z deformity, boutonnière deformity, swan neck deformity,
ulnar deviation, subluxation of the fingers, Raynaud’s phenomenon.
•
Wrist: carpal tunnel syndrome.
•
Feet: subluxation of the toes, hammer toe deformity.
•
Skin: rheumatoid nodule, vasculitis.
•
Cardiovascular: atherosclerosis is increased in RA.
•
Respiratory: pulmonary fibrosis.
•
Bones: osteoporosis.
•
Pain and stiffness.
VKDT (Ti p) C n lâm sàng
•
XN máu:
80% có y u t d ng th p dương tính.
T c đ máu l ng và CRP tăng.
Kháng th kháng CCP (Cyclic citrullinated peptide). N u
dương tính g i ý có h y ho i kh p.
•
CĐHA: hình nh c a VKDT có th nhìn th y trên phim X
quang quy ư c:
S phá h y xương.
Tr t kh p.
C tay m t n đ nh.
T n thương c a kh p bàn ngón tay và kh p bàn ngón
chân.
Loãng xương quanh kh p.
Đi u tr
•
B o t n: Giáo d c b nh nhân. Khuy n khích t p th d c. Tham
kh o v t lý tr li u và đánh giá ho t đ ng cu c s ng hàng ngày.
•
N i khoa: glucocorticoids, các thu c ch ng th p kh p làm thay
đ i b nh (DMARDs), e.g. mu i vàng, methotrexate, sulfasalazine.
Thu c kháng cytokin đư c xem xét b nh nhân không dung
n p methotrexat.
•
Ngo i khoa: Ph u thu t c t b ho c thay kh p đư c cân nh c
khi các kh p b nh hư ng nghiêm tr ng..
Bi n ch ng
•
H i ch ng ng c tay.
•
Viêm màng ngoài tim.
VXK (Ti p) C n lâm sàng
•
XN máu: thư ng không đ ch n đoán nhưng thích h p trong
b nh VXK có liên quan đ n ch ng nhi m s c t s t.
•
CĐHA: hình nh X quang:
LOSS
H p khe kh p.
Ch i xương.
Nang xương dư i s n.
Xơ c ng.
Đi u tr
•
B o t n: giáo d c b nh nhân. Khuy n khích t p th d c và gi m
cân.
•
N i khoa:
Thu c gi m đau: e.g. paracetamol ho c thu c ch ng viêm
không steroid.
Gel như capsaicin có th hi u qu .
Tiêm Steroid..
•
Ngo i khoa: ph u thu t kh p.
Bi n ch ng
•
Tăng nguy cơ Gút.
•
Vôi hóa s n kh p.
•
B nh lí r c .
•
Đ t gân.
•
H i ch ng
Sjögren
Continued overleaf
Continued overleaf
MAP 10.2 Arthritis
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