Symptoms of arthritis study

Joint disease has manifested not only in the joints but also in other organs, so the visit to toandien include asking patients, physical examination, X-rays and tests.

 

Joint disease has manifested not only in the joints but also in other organs, so the examination   toandien to include questions disease, physical examination, X-rays and tests.

Clinical examination

The functional symptoms

Pain   joints: The main symptoms, and most important, is usually the main reason forcing patients to go khambenh and treatment.

Joint pain with two different types:

Inflammatory pain (pain or inflammation), pain often throughout the day, increased pain at night and in the morning, no pain at rest, but less pain. Inflammatory pain seen in inflammatory joint disease: low   matching grant, rheumatoid arthritis, ankylosing spondylitis, septic arthritis, diseases of the organization chuclien ...

Pain non-inflammatory or mechanical type pain: Pain increases when patients move, reduce pain, or pain when many benhnhan rest, common in osteoarthritis, birth defects ...

The joint movement disorders:

Signs of morning stiffness: As hard phenomena joints, difficulty moving joints when waking up, right after a period of time or after the new joint mobility back feeling soft joints. Time buoisang stiffness can last an hour to several hours. Common site is the joints of the wrist, finger table, sometimes in knee vakhop ankle.

This sign is relatively specific for rheumatoid arthritis. Morning stiffness in joints lumbar vertebrae valung common in ankylosing spondylitis in the early stages.

Restriction of movement joint mobility: Depending on the location and extent of joint damage that may manifest bangkho grip, travel restrictions, squat ... Restricting movement may be due to many reasons such as : joint damage, muscle damage, nerve damage ... Restricting movement can keodai shortly Reversible persistent or irreversible.

Exploiting the pathological factors in history:

History of the kidney: occupational injuries, illnesses before they manifest as joint infections, poisoning ...

Family factors: in many joint disease related to family factors such as ankylosing spondylitis, inflammatory khopdang low, gout ...

The physical symptoms

General principles examination of patients with arthritis:

Need exposed areas should be examined   enough to observe, touch and care in different postures.

Check to comply with the order to ease the assessment review. It should be noted comparing two sides together and compared with healthy people.

It should list the joints should be examined and if possible to use the system diagram of the joints.

The common symptoms:

Swollen joints: the key symptoms. Swelling a sign of inflammation in the membrane

synovial joints, organizational The Software edge joints, synovial effusion in or proliferative synovium   and fibrosis resulting held next match biendoi form of joint or joint deformity.

Swollen joints easily detected in the peripheral joints of expenditure on agriculture or lower extremities, and the joints of the spine, hip, shoulder joint is in deep difficulty accurately detect symptoms of arthritis.

Location, number: Can a swollen joints, swollen joints and swollen few more joints. Swollen joints can i value 2 benhoac puzzle asymmetric (small joints symmetry professed 2 side common in patients with rheumatoid arthritis, joint swelling large, medium fit, in one or a few joints asymmetrically common in rheumatoid matching grant.

Table-burning and swelling fingers   one foot on one side or both sides common in acute gout.

Swelling properties: heat included swelling, redness, pain, symmetric or asymmetric.

Evolution of arthritis:

Moving from match to match different from the old-match completely in a short time <1 week (common in rheumatic diseases).

Ascending: Swollen joints appear more in the new joint, while the former is still swollen joints, chronic pain (or gapxrong rheumatoid arthritis, chronic gout ...).

Do not move, fixed: Just hurt in a joint or several joints do not move to other joints.

Or recurrence: Swollen joints repeated many times in the same position.

Deformation: As a result of these changes bones, ligaments, bursae as misalignment of joints.

Often accompanied by deformation phenomenon stick, limited movement or adhesive joints completely.

Spinal deformity can lead to stooped, crooked, physiological loss curve (see the disease ankylosing spondylitis, drainage   You discs, degenerative spine and   Other diseases of the spine).

Deformed hand shaped back plate, hand wind blows encountered in patients with rheumatoid arthritis.

Restrict movement:

Note observing gait, posture of the patient, the ability to bend, squat movement, the movement of chi ...

There are two types of restricted movement:

Restrict movement initiative: Patients do not get up   at the request of a physician, but the physician tacdong under the passive movements still do. This symptom is caused by muscle damage, nerve hoacphoi both.

Limit passive movement: patients   do the work   work as required, under the impact of the action thaythuoc   That did not work   do. This symptom is caused by lesions in the joints (by adhesive joints, ligaments or cartilage from joints tonthuong ...).

At each joint should check all the action   work to detect the movement restrictions in the posture: folding, stretching, form, kh p, swivel ...

Range of injured joints should be compared with the range of healthy contralateral joints of patients, or the range of the normal joints to assess the limited joint mobility. Or measuring range vandong match with protractor.

The other physical signs:

Synovial effusion: most clearly in the knee (signs floating patella), effusion, synovial joints khackho detect.

Loose joints: movement joints in excess of normal (in the knee joints when thou signs bentrong ligament, or outside, signs of withdrawal drawer when cross ligament).

English shook Iraq: When movements could hear the crunching sound shake or sprinkle in synovial (common in osteoarthritis).

The skin changes and software:

Erythema round: rash on the skin edges well rounded or oval borders around the center binhthuong skin, appearance and lost quickly, no itching and no peeling flakes. Location erythema round encounter at the chest, abdomen lachu weak. Erythema round encounter in rheumatic diseases.

Scarlet butterfly floating on the skin in the cheeks and the lips on two sides no desquamation, no itching.

Scattered erythematosus, discoid rash occurs in the kidney or expenses; the original circular or may have ulcers, gangrene otrung mind. Butterfly erythema and erythema form   Disc common in lupus erythematosus system.

Erythema accompanying flaking scales   White drops or array formation seen in psoriatic arthritis.

The county subcutaneous common extensor surface of the joints in size from a few millimeters to several centimeters, painless, khongdo, no cell found in patients with rheumatoid arthritis called subcutaneous low seed. These particles have low particle properties near giongnhu    utans skin but appear and quickly lost in the early stages of rheumatic diseases termed particle cloud-ne (Meynet). In chronic gout deposition a.uric particles in the ear, near the joints; size to small khacnhau (called tophi).

Scar contractures, or leak pus caused by tuberculosis.

Block common cold abscess in the lumbar region.

Thigh muscle atrophy, muscle butt.

Teo general lumbar muscle mass, lumbar spine straight and flat form a   Photo waist shaped "wing reaction" met in ankylosing spondylitis late stage.

The binding of tendon pain during the examination ...

The systemic symptoms:

Fever, weight loss, fatigue: met in many different joint disease, prolonged high fever common in lupus erythematosus system.

The lesions in the organs concerned:

Cardiovascular: Rheumatic (TKC) cardiac inflammation manifested by tachycardia, heart sounds fuzzy, galloping rhythms, heart overflows dichmang outside ...

Lung tumor in the lung apex, together with symptoms typical swollen painful joints, finger Drumstick (Pierre-Marie syndrome).

Nervous cord compression syndromes encountered in VCSDK spinal deformity severity.

Damage to other parts of the body (inflammation of the iris and ciliary iritis common in VCSDK).

X - ray in the diagnosis of diseases of the joints

X - ray joints is of great significance in the diagnosis of arthritis, but the change of image X - ray thuongxuat out late and have some arthritis can not change the image X - rays of the joints. Thus, in principle, also be baogio combination of clinical, X-rays and tests are diagnostic value correctly.

Photos X - rays show the general morphology of bone-joints, axle joints, bones, shells and bones bexuong.

The changes in the bones, including: sparse bone, bone defects drives, fiber phenomenon, thick periosteum.

Change the slot joints:

Narrow slit joints, change the image of the shore joints, uneven, choppy.

Spondylitis: Lost shaped slot joints, the fibrous bands, may have destroyed bones, misalignment.

Wide slots fit into the joint effusion.

Dislocations partially or completely dislocated.

The image object in the slot joints encountered in the case of calcified cartilage.

Changes of the spine:

Changes in the curve of the spine, morphological   and size of renal burning

such as kidney collapsed vertebra, vertebrae dinhcac TB, the formation of the spine in VCSDK bridge, bone formation mines in hoakhop degradation.

Photos calcification of ligaments of the spine.

Morphological changes the size of the joints associated vertebrae and intervertebral discs.

Changing of the pelvic joints in VCSDK slot.

Fuzzy, narrow slot joints, the   Image fiber strips or adhesive joints entire slot depending on the severity of arthritis and pots.

The tests used in arthritis

The test for inflammation

Reflects inflammation in the body, valuable monitoring, treatment of arthritis caused by inflammation, but no price tritrong diagnose the cause.

Erythrocyte sedimentation rate: Increase in many diseases: TKC, VKDT, the patient's affiliates, septic arthritis, acute gout.

Fibrinogen: increase in patients with inflammatory joint.

CPR (+).

Serum protein electrophoresis can see α2-globulin increased, γ-globulin increased in chronic inflammatory diseases.

The immunoassay

The streptococcal antibody:

ASLO (anti strepxolysin 0).

ASK (anti strepxokinase).

ASH (anti strepxo hyaluronidase).

Common than is ASLO. When the reaction (+) was demonstrated in vivo   streptococcal infection   Group A β tanhuyet ASLO (+) when> 200dv; test often (+) in the TKC, sometimes positive in other diseases such conhiem streptococcal glomerulonephritis level, ulcerated skin.

Rheumatoid factor (rheumatoid factor):

As an IgG antibody capable of γ-globulin agglutination with. In essence it is IgM, IgG or IgA but mainly IgM.

There are two ways to detect:

Reaction waaler-rose: Use the group O RBCs, rh (-) γ-globulin associated with the response to human serum cuabenh. If you have rheumatoid factor (+) will have the phenomenon of hemagglutination. Reaction (+) when the dilution   is 1/16.

The reaction γ-latex: Use latex particles associated with   γ-globulin   person, then reacted with benhnhan serum agglutination phenomenon will be. Reaction (+) when the dilution   is 1/32.

Rheumatoid factor (+) in 70% of cases VKDT, often (+) late after illness> 6 months. It can be seen tothap weak in some other diseases such as lupus erythematosus, chronic hepatitis attack ...

Find Hargraves cells (LE) in the blood and bone marrow.

LE cells were polymorphonuclear leukocytes   fragments of human phagocytic cells damaged by factors operating in serum resistance nhanluu. LE (+)   in 85% of cases of lupus erythematosus system, and (+) in 10% VKDT.

When incubated in serum of patients (antinuclear factor) with the white blood cells, the nucleus leak out, and other white blood cells, macrophages produce LE cell phenomenon called Haserick

The antinuclear antibody test:

Often   Using tests for antinuclear antibodies by   immunofluorescence method, or using cultured tebao WIL2, HEP2 incubated with patient sera, antibodies against human if it binds to the cell nucleus and use the detection system using optical huznh antibodies.

Antinuclear antibodies (+) 90-95% in the case of lupus erythematosus.

The other immunoassay:

Quantification of complement C3 CH50-, C4, quantification of immune complexes ...

These tests look for the cause

Implant throat mucus find strepxococus, aspiration care for bacteria, find malignant cells, blood cultures suspected nhiemkhuan blood.

Mantoux reaction.

Quantitative blood a.uric in gout.

Synovial membrane biopsies for pathology tests.

The special tests

The test fluid:

Normal joint fluid   clear, colorless, viscous, cells <500 / mm3, mostly monocytes   and synovial membrane cells, approximately 2 g% albumin, mucin 800 mg%.

Mucin test: Use a.axetic 7N, solidification phenomena of mucin in varying degrees.

Other tests:

Implant bacteria, find crystals in the joint fluid, cells grapes (VKDT). XN rheumatoid factor in synovial fluid.

HLA testing:

HLA B27 (+) 80-90% of cases VCSDK, or with low rates   more (30%) in other spinal diseases.

HLADR4: (+) in 70% of cases VKDT.

HLADR3: In lupus erythematosus ...

Soi joints: can observe the formation   picture can, synovial membrane biopsy, removal of foreign bodies in the joints, and a number of other tricks. Soi synovial be conducted only in specialized facilities to ensure absolute sterility.