MUSCOInroducion肌肉骨骼系统PPT课件.ppt

* 24 * 25 * 27 * 28 * 33 * 32 * 31 * * * * * * C/O fatigue. Denies fever, rash * * * * * WBC = 11.2 H/H = 13.7 / 38.9 MCV = 89 ESR = 123 mm/hr SMA-12 WNL, except albumin = 3.3 ANA negative RF 31 IU/ml (nl 30 IU/ ml) C3 173, C4 28, ASO = 151 Todd units Uric Acid = 6.6 Normal SPEP, UPEP, TFT’s, TSH, Ferritin HBsAg (+), Neg. for HCV, HAV, HIV Viral arthritis (hepatitis B) Rheumatic fever Gonococcal arthritis SLE Behcets Arthritis and urticaria part of the “prodrome” Manifestations due to immune complex deposition Before the Jaundice Usually while LFTs elevated Acute onset Additive (RA like) or migratory (ARF like) arthritis Often with tenosynovitis Synovial fluid: inflammatory Arthritis disappears with onset of Jaundice What am I? * * * * * * * * * * * 3 * 4 * 5 Associated deformities: Zeta thumb, swan neck, buttonierres, subluxation, ulnar deviation * 5 Associated deformities: Zeta thumb, swan neck, buttonierres, subluxation, ulnar deviation * 10 * 7 * 9 * 12 * 13 * 15 * 17 * 18 * 19 * 19 * 20 * 21 * 22 Inflammation of the DIP joints Sausage fingers Joint involvement shows radial pattern Nail changes Psoriatic patches Arthritis may start before the skin Psoriatic arthritis May look like psoriasis or syphilis Can occur in patches or as sterile pustules Keratoderma blennorrhagica in Reiter’s syndrome “Butterfly”/Malar rash Involves cheeks, spares nasolabial fold Systemic lupus erythematosus Both have periungual erythema Interarticular dermatitis of SLE Dermatomyositis Periungual changes Seen in lupus erythematosus, dermatomyositis, and scleroderma Thickening of capillary loops Dropout of capillary loops Hemorrhage in the nail fold may also be present “Mantle” aka “Shawl” Sign of Dermatomyositis Not usually associated with systemic disease Linear scleroderma Appears in a broad- based interrupted pattern in systemic vasculitis, including SLE May occur as a fine, connected, lacy pattern in normals Livedo reticularis Can be 1o or 2o Stress/cold