msk 3- pbl joint pain compiled

8/12/2019 Msk 3- Pbl Joint Pain Compiled

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PBL JOINT PAIN

1) What are the signs and symptoms of gout?

Goutusuay de!eops after a num"er of years of "uidup of uri# a#id#rystas in the $oints and surrounding

tissues% &ymptoms in#ude'

Warmth( pain( seing( and e*treme tenderness in a $oint( usuay a"ig toe $oint% This symptom is

#aed podagra% &ymptoms sometimes start in a different $oint( su#h as the an+e or +nee%

Pain that starts during the night and is so intense that e!en ight pressure from a sheet is intoera"e%

,apid in#rease in dis#omfort( asting for some hours of the night and then easing during the ne*t fe

days%

As thegoutatta#+ su"sides( the s+inaround the affe#ted $oint may pee and fee it#hy%

Other symptoms may in#ude'

-ery red or purpish s+in around the affe#ted $oint( hi#h may appear to "e infe#ted%

Limited mo!ement in the affe#ted $oint%

&ymptoms of gout!ary%

&ymptoms may o##ur after an iness or surgery%

&ome peope may not e*perien#e gout as many painfu atta#+s "ut rather de!eop #hroni# gout% .hroni#

gout in oder aduts may "e ess painfu and #an "e #onfused ith other forms of arthritis%

Gout may first appear as nodues /tophi) on the hands( e"os( or ears% There may "e no #assi#symptoms of a gout atta#+%

By the time you ha!e the symptoms of a gout atta#+( uri# a#id has "een "uiding up in your"ood( and uri# a#id

deposits ha!e "een forming on one or more of your $oints% The "ig toe $oint is most #ommony affe#ted% But the

$oints of thefeet(an+es( +nees( rists( fingers( and e"os may aso "e in!o!ed% Infammation of the fuid sa#s

/"ursae) that #ushion tissues may o##ur( parti#uary in the e"o /oe#ranon"ursitis) and +nee /prepatear

"ursitis)% There are many other #onditions ith symptoms simiar to gout%

0) What #auses re#urrent atta#+s and seing of "oth +nees and sma $oints of fingers?

The e2uii"rium "eteen ana"oism and #ata"oism is eighted in fa!or of degradation

3isruption of the integrity of the #oagen netor+ as o##urs eary in OA aos hyperhydration and redu#esstiffness of #artiage

.ata"oism of #artiage resuts in reease of "rea+don produ#ts into syno!ia fuid hi#h then initiates aninfammatory response "y syno!io#ytes These antigeni# "rea+don produ#ts in#ude' #hondrointon sufate( +eratan sufate( PG fragments( type II#oagen peptides and #hondro#yte mem"ranes A#ti!ated syno!ia ma#rophages then re#ruit P4Ns esta"ishing a syno!itis They aso reease #yto+ines( proteinases and o*ygen free radi#as /supero*ide and nitri# o*ide) into ad$a#ent

and syno!ia fuid These mediators a#t on #hondro#ytes and syno!io#ytes modifying synthesis of PGs( #oagen( and hyauronanas e as promoting reease of #ata"oi# mediators ,esuts in in#reased infammatory rea#tion as e as in$ury in the #artiaginous $oint that i e!entuay eadto infammation too as a sef prote#tion me#hanism%

The seing and re#urrent atta#+s of the $oints are due to the infammatory rea#tion%IN5LA44ATO,6 ,7&PON&7Infammation pro"a"y pays at most a minor roe in the formation of osteoarthritis and is more i+ey to "e aresut 88 not a #ause 88 of the disease% 9oe!er( infammation may pay an important roe in the progression ofosteoarthritis and in its #hroni# nature% The effe#ts of the infammatory response in osteoarthritis are i+ey to "edifferent( and ess se!ere( from those in rheumatoid arthritis%5i!e #assi#a signs of Infammation'

3oor 8 Latin term for :pain: .aor 8 Latin term for :heat: ,u"or 8 hi#h in Latin means :redness: Tumor 8 a Latin term for :seing: 5un#tio aesa 8 hi#h in Latin means :in$ured fun#tion:( hi#h #an aso mean oss of fun#tionThe ists "eo sho the differen#e "eteen #hroni# and a#ute infammation regarding the #ausati!e agents(

hi#h ma$or #es are in!o!ed( features regarding onset( duration( and out#omes' A#ute Infammation .ausati!e agents 8 harmfu "a#teria or in$ury to tissue 4a$or #es in!o!ed 8 mainy neutrophis( "asophis /in the infammatory response)( and eosinophis /responseto parasites and orms)( and mononu#ear #es /ma#rophages( mono#ytes) Primary mediators 8 ei#osanoids( !asoa#ti!e amines Onset /hen does the infammation start) 8 straight aay

3uration 8 short8i!ed( ony a fe days
http://www.webmd.com/hw-popup/gout-8045http://www.webmd.com/hw-popup/uric-acidhttp://arthritis.webmd.com/gouty-big-toehttp://arthritis.webmd.com/gouty-big-toehttp://arthritis.webmd.com/tc/gout-topic-overviewhttp://arthritis.webmd.com/tc/gout-topic-overviewhttp://arthritis.webmd.com/tc/gout-topic-overviewhttp://www.webmd.com/skin-problems-and-treatments/picture-of-the-skinhttp://www.webmd.com/skin-problems-and-treatments/picture-of-the-skinhttp://arthritis.webmd.com/tc/gout-symptomshttp://www.webmd.com/hw-popup/arthritishttp://www.webmd.com/hw-popup/tophihttp://www.webmd.com/brain/picture-of-the-earhttp://www.webmd.com/heart/anatomy-picture-of-bloodhttp://www.webmd.com/pain-management/picture-of-the-feethttp://www.webmd.com/pain-management/picture-of-the-feethttp://www.webmd.com/pain-management/picture-of-the-feethttp://www.webmd.com/hw-popup/bursahttp://www.webmd.com/hw-popup/bursitishttp://www.webmd.com/pain-management/arthritis-bursitishttp://arthritis.webmd.com/other-conditions-with-symptoms-similar-to-gouthttp://arthritis.webmd.com/other-conditions-with-symptoms-similar-to-gouthttp://www.webmd.com/hw-popup/uric-acidhttp://arthritis.webmd.com/gouty-big-toehttp://arthritis.webmd.com/tc/gout-topic-overviewhttp://www.webmd.com/skin-problems-and-treatments/picture-of-the-skinhttp://arthritis.webmd.com/tc/gout-symptomshttp://www.webmd.com/hw-popup/arthritishttp://www.webmd.com/hw-popup/tophihttp://www.webmd.com/brain/picture-of-the-earhttp://www.webmd.com/heart/anatomy-picture-of-bloodhttp://www.webmd.com/pain-management/picture-of-the-feethttp://www.webmd.com/hw-popup/bursahttp://www.webmd.com/hw-popup/bursitishttp://www.webmd.com/pain-management/arthritis-bursitishttp://arthritis.webmd.com/other-conditions-with-symptoms-similar-to-gouthttp://www.webmd.com/hw-popup/gout-8045


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Out#omes 8 the infammation either gets "etter /resoution)( de!eops into an a"s#ess( or "e#omes a #hroni#

infammation.hroni# infammation .ausati!e agent 8 non8degrada"e pathogens that #ause persistent infammation( infe#tion ith some types of!iruses( persistent foreign "odies( o!era#ti!e immune system rea#tions 4a$or #es in!o!ed 8 4a#rophages( ympho#ytes( pasma #es /these three are mononu#ear #es)( andfi"ro"asts

Primary mediators 8 rea#ti!e o*ygen spe#ies( hydroyti# en;ymes( I5N8< and other #yto+ines( groth fa#tors 3uration 8 from se!era months to years

Out#omes 8 the destru#tion of tissue( thi#+ening and s#arring of #onne#ti!e tissue /fi"rosis)( death of #es ortissues /ne#rosis)

=) &IGN&> &64PTO4& O5 A,T9,ITI&

Joint &tiffness

Osteoarthritis of the +nees is often asso#iated ith e*#ess upper "ody eight( ith o"esity( or a history of

repeated in$ury andor $oint surgery% Progressi!e #artiage degeneration of the +nee $oints #an ead to deformityand outard #ur!ature of the +nees( hi#h is referred to as "eing :"oegged%: Peope ith OA of the eight8

"earing $oints /su#h as the +nees) #an de!eop a imp% The imping #an orsen as more #artiage degenerates% In

some patients( the pain( imping( and $oint dysfun#tion may not respond to medi#ations or other #onser!ati!e

measures% Therefore( se!ere OA of the +nees is one of the most #ommon reasons for tota +nee repa#ement%

Limited ,ange of 4otion

OA #auses the formation of hard( "ony enargements of the sma $oints of the fingers% .assi# "ony enargement

of the sma $oint at the end of the fingers is #aed a 9e"erden@s node% The "ony deformity is a resut of the "one

spurs from OA at the $oint% Another #ommon "ony +no" /node) o##urs at the midde $oint of the fingers in many

patients ith OA and is #aed a Bou#hard@s node% 9e"erden@s and Bou#hard@s nodes may not "e painfu( "ut they

are often asso#iated ith imitation of motion of the $oint% The #hara#teristi# appearan#es of these finger nodes#an "e hepfu in diagnosing OA% OA of the $oint at the "ase of the "ig toe of the foot eads to the formation of a

"union%

Tenderness of Joints

OA of the #er!i#a spine or um"ar spine #auses pain in the ne#+ or o "a#+% Bony spurs( #aed osteophytes(

that form aong the arthriti# spine #an irritate spina ner!es( #ausing se!ere pain that #an radiate from the spine

as e as num"ness and tinging of the affe#ted parts of the "ody%

,edness and Warmth

Bursitis is infammation of a "ursa( a fuid8fied sa# o#ated "eteen "one and tendons or mus#e that ser!es to

pre!ent fri#tion "eteen tissues( aoing them to gide easiy o!er ea#h other% As"ursa is infe#ted( the s+ino!er the +nee may "e red and arm%

) Norma anatomy and physioogy of $oints( syno!ia $oints and fuids

Joints are the areas here to "ones meet% 4ost $oints are mo"ie( aoing the "ones to mo!e% Joints

#onsist of the fooing'

#artiage 8 a type of tissue that #o!ers the surfa#e of a "one at a $oint%% .artiage heps redu#e the

fri#tion of mo!ement ithin a $oint%

syno!ia mem"rane 8 a tissue #aed the syno!ia mem"rane ines the $oint and seas it into a $oint

#apsue% The syno!ia mem"rane se#retes syno!ia fuid /a #ear( sti#+y fuid) around the $oint to

u"ri#ate it% igaments 8 strong igaments /tough( easti# "ands of #onne#ti!e tissue) surround the $oint to gi!e

support and imit the $oint@s mo!ement%

tendons 8 tendons /another type of tough #onne#ti!e tissue) on ea#h side of a $oint atta#h to mus#es

that #ontro mo!ement of the $oint%


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"ursas 8 fuid8fied sa#s( #aed "ursas( "eteen "ones( igaments( or other ad$a#ent stru#tures hep

#ushion the fri#tion in a $oint%

syno!ia fuid 8 a #ear( sti#+y fuid se#reted "y the syno!ia mem"rane%

femur 8 the thigh "one%

ti"ia 8 the shin "one%

patea 8 the +nee8#ap%

menis#us 8 a #ur!ed part of #artiage in the +nees and other $oints%

.assifi#ation of Joints'

5i"rous $oints are hed together "y fi"rous #onne#ti!e tissue% No $oint #a!ity is present% 5i"rous $oints

may "e immo!a"e or sighty mo!a"e%

.artiaginous $oints are hed together "y #artiage /hyaine or fi"ro#artiage)% No $oint #a!ity is present%

.artiaginous $oints may "e immo!a"e or sighty mo!a"e%

&yno!ia $oints are #hara#teri;ed "y a syno!ia #a!ity /$oint #a!ity) #ontaining syno!ia fuid% &yno!ia

$oints are freey mo!a"e and #hara#teri;e most $oints of the "ody% 5igure 1 ists other features of a

syno!ia $oint( in#uding the fooing'

o Articular cartilage (hyaline cartilage),hi#h #o!ers the end of ea#h "one%

o A synovial membrane( hi#h surrounds the syno!ia #a!ity% Its areoar #onne#ti!e

tissue se#retes a u"ri#ating syno!ia fuid into the syno!ia #a!ity%

o A fibrous capsuleoutside the syno!ia mem"rane( hi#h surrounds the $oint% It often

#ontains "undes of dense( irreguar( #onne#ti!e tissue #aed ligaments% The

igaments pro!ide strength and fe*i"iity to the $oint%

o The articulate capsule( #omposed of the syno!ia mem"rane and fi"rous #apsue%

o Accessory ligaments( hi#h ie outside the arti#uar #apsue /e*tra#apsuar

igaments) or inside the syno!ia #a!ity /intra#apsuar igaments)%

) What .auses 4orning &tiffness?

One theory a"out morning stiffness is referred to as the ge phenomenon% The ge phenomenon

essentiay means that stiffness de!eops after ong periods of sitting or ina#ti!ity% This is

#hara#teristi# of non8infammatory #onditions%

&ome resear#hers note that morning stiffness is a #ir#adian symptom that is not fuy understood%

&ome suspe#t there may "e insuffi#ient #ortiso reeased in the "ody during the night to offset

ee!ated pro8infammatory#yto+inesi+e IL8C( "ut a+ing up in the midde of the night to ta+e

gu#o#orti#oidsto redu#e the infammation oud "e in#on!enient and not ithout its on side

effe#ts%

C) 3eformity of fingers

What' 3istortion or a"norma appearan#e of the fingers%

.auses' there are =0 #auses( reated'

1% Rheumatoid arthritis' A #hroni# progressi!e disease #ausing infammation in the $oints andresuting in painfu deformity and immo"iity( esp% in the fingers( rists( feet( and an+es

0% Osteoarthritis/degenerative arthritis' 3egeneration of $oint #artiage /#ushioning #artiage

that #o!ers the "one surfa#e "egins to ear out) and the underying "one( most #ommon from

midde age onard% it #auses pain and stiffness( esp% in the hip( +nee( and thum" $oints
http://arthritis.about.com/od/inflammation/f/cytokines.htmhttp://arthritis.about.com/od/inflammation/f/cytokines.htmhttp://arthritis.about.com/od/steroids/https://www.google.com.my/search?hl=en&biw=1366&bih=667&noj=1&q=rheumatoid+arthritis&tbs=sx:1&tbo=u&sa=X&ei=1EN7UYzSHIeGrAevuoGoAw&ved=0CDEQjRMhttps://www.google.com.my/search?hl=en&biw=1366&bih=667&noj=1&q=osteoarthritis&tbs=sx:1&tbo=u&sa=X&ei=1EN7UYzSHIeGrAevuoGoAw&ved=0CDMQjRMhttp://arthritis.about.com/od/inflammation/f/cytokines.htmhttp://arthritis.about.com/od/steroids/https://www.google.com.my/search?hl=en&biw=1366&bih=667&noj=1&q=rheumatoid+arthritis&tbs=sx:1&tbo=u&sa=X&ei=1EN7UYzSHIeGrAevuoGoAw&ved=0CDEQjRMhttps://www.google.com.my/search?hl=en&biw=1366&bih=667&noj=1&q=osteoarthritis&tbs=sx:1&tbo=u&sa=X&ei=1EN7UYzSHIeGrAevuoGoAw&ved=0CDMQjRM


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=% Dislocation' In$ury or disa"iity #aused hen the norma position of a $oint or other part of

the "ody is distur"ed

% Mallet finger' An in$ury of the e*tensor digitorum tendon of the fingers at the dista

interphaangea $oint% %%%

% racture' A #ra#+ or "rea+ in a hard o"$e#t or materia( typi#ay a "one or a "ody of ro#+

in smaer $oints( su#h as at the fingers( hard "ony enargements( #aed 9e"erden@s nodes/on the dista

interphaangea $oints) andor Bou#hard@s nodes/on the pro*ima interphaangea $oints)( may form( andthough they are not ne#essariy painfu( they do imit the mo!ement of the fingers signifi#anty%

OA/osteoarthritis) at the toes eads to the formation of "unions(rendering them red or soen% &ome

peope noti#e these physi#a #hanges "efore they e*perien#e any pain%

In$ury to a $oint(

su#h as a "ad

sprain or

fra#ture( #an

#ause damage to

the arti#uar

#artiage%An

in$ury to any of

the $oints of the

fingers( e!en if it

does not in$ure

the arti#uar

#artiage

dire#ty( #an

ater ho the $oint or+s% After a fra#ture( the "one fragments may hea in sighty different positions%

This may ma+e the $oints ine up differenty% When an in$ury #hanges the ay the $oint ines up and

mo!es( for#e #an start to press against the surfa#e of the arti#uar #artiage% This is simiar to ho a

ma#hine that is out of "aan#e ears out faster%

O!er time( this im"aan#e in the $oint #an ead to damage to the arti#uar surfa#e% &in#e arti#uar

#artiage #annot hea itsef !ery e( the damage adds up% 7!entuay( the $oint #an no onger

#ompensate for the in#reasing damage( and symptoms "egin% The damage in the $oint starts e

"efore the symptoms of arthritis appear%

O!er time( this im"aan#e in the $oint #an ead to damage to the arti#uar surfa#e% &in#e arti#uar

#artiage #annot hea itsef !ery e( the damage adds up% 7!entuay( the $oint #an no onger

#ompensate for the in#reasing damage( and symptoms "egin% The damage in the $oint starts e

"efore the symptoms of arthritis appear%

D) What is the differen#e "eteen rheumatoid arthritis and osteoarthritis?

,heumatoid arthritis and osteoarthritis are different types of arthritis% Athough they share some simiar

#hara#teristi#s( ea#h has different symptoms and re2uires different treatment%

.hara#teristi#s of

rheumatoid arthritis

and osteoarthritis

,heumatoid arthritis Osteoarthritis

Age at hi#h the

#ondition starts

It may "egin any time in ife% It usuay "egins ater in ife%

&peed of onset ,eati!ey rapid( o!er ee+s to months &o( o!er years

Joint symptoms Joints are painfu( soen( and stiff% Joints a#he and may "e tender "ut ha!e

itte or no seing%
https://www.google.com.my/search?hl=en&biw=1366&bih=667&noj=1&q=dislocation&tbs=sx:1&tbo=u&sa=X&ei=1EN7UYzSHIeGrAevuoGoAw&ved=0CDUQjRMhttps://www.google.com.my/search?hl=en&biw=1366&bih=667&noj=1&q=mallet+finger&tbs=sx:1&tbo=u&sa=X&ei=1EN7UYzSHIeGrAevuoGoAw&ved=0CDcQjRMhttps://www.google.com.my/search?hl=en&biw=1366&bih=667&noj=1&q=fracture&tbs=sx:1&tbo=u&sa=X&ei=1EN7UYzSHIeGrAevuoGoAw&ved=0CDkQjRMhttp://en.wikipedia.org/wiki/Heberden's_nodehttp://en.wikipedia.org/wiki/Distal_interphalangeal_jointshttp://en.wikipedia.org/wiki/Distal_interphalangeal_jointshttp://en.wikipedia.org/wiki/Bouchard's_nodeshttp://en.wikipedia.org/wiki/Bunionhttp://en.wikipedia.org/wiki/Bunionhttp://popup%28%27http//www.eorthopod.com/eorthopodV2/index.php?ID=bc6117f6c5f98a17135e5aac6c0cf6d7&fuseaction=pic.main&File=http://www.eorthopod.com/images/ContentImages/hand/hand_finger_arthritis/hand_finger_joint_causes02.jpg%27)http://popup%28%27http//www.eorthopod.com/eorthopodV2/index.php?ID=bc6117f6c5f98a17135e5aac6c0cf6d7&fuseaction=pic.main&File=http://www.eorthopod.com/images/ContentImages/hand/hand_finger_arthritis/hand_finger_joint_causes02.jpg%27)http://popup%28%27http//www.eorthopod.com/eorthopodV2/index.php?ID=bc6117f6c5f98a17135e5aac6c0cf6d7&fuseaction=pic.main&File=http://www.eorthopod.com/images/ContentImages/hand/hand_finger_arthritis/hand_finger_joint_causes02.jpg%27)http://popup%28%27http//www.eorthopod.com/eorthopodV2/index.php?ID=bc6117f6c5f98a17135e5aac6c0cf6d7&fuseaction=pic.main&File=http://www.eorthopod.com/images/ContentImages/hand/hand_finger_arthritis/hand_finger_joint_causes02.jpg%27)http://www.webmd.com/hw-popup/rheumatoid-arthritishttp://www.webmd.com/hw-popup/osteoarthritishttp://www.webmd.com/rheumatoid-arthritis/guide/most-common-arthritis-typeshttps://www.google.com.my/search?hl=en&biw=1366&bih=667&noj=1&q=dislocation&tbs=sx:1&tbo=u&sa=X&ei=1EN7UYzSHIeGrAevuoGoAw&ved=0CDUQjRMhttps://www.google.com.my/search?hl=en&biw=1366&bih=667&noj=1&q=mallet+finger&tbs=sx:1&tbo=u&sa=X&ei=1EN7UYzSHIeGrAevuoGoAw&ved=0CDcQjRMhttps://www.google.com.my/search?hl=en&biw=1366&bih=667&noj=1&q=fracture&tbs=sx:1&tbo=u&sa=X&ei=1EN7UYzSHIeGrAevuoGoAw&ved=0CDkQjRMhttp://en.wikipedia.org/wiki/Heberden's_nodehttp://en.wikipedia.org/wiki/Distal_interphalangeal_jointshttp://en.wikipedia.org/wiki/Distal_interphalangeal_jointshttp://en.wikipedia.org/wiki/Bouchard's_nodeshttp://en.wikipedia.org/wiki/Bunionhttp://popup%28%27http//www.eorthopod.com/eorthopodV2/index.php?ID=bc6117f6c5f98a17135e5aac6c0cf6d7&fuseaction=pic.main&File=http://www.eorthopod.com/images/ContentImages/hand/hand_finger_arthritis/hand_finger_joint_causes02.jpg%27)http://popup%28%27http//www.eorthopod.com/eorthopodV2/index.php?ID=bc6117f6c5f98a17135e5aac6c0cf6d7&fuseaction=pic.main&File=http://www.eorthopod.com/images/ContentImages/hand/hand_finger_arthritis/hand_finger_joint_causes02.jpg%27)http://popup%28%27http//www.eorthopod.com/eorthopodV2/index.php?ID=bc6117f6c5f98a17135e5aac6c0cf6d7&fuseaction=pic.main&File=http://www.eorthopod.com/images/ContentImages/hand/hand_finger_arthritis/hand_finger_joint_causes02.jpg%27)http://popup%28%27http//www.eorthopod.com/eorthopodV2/index.php?ID=bc6117f6c5f98a17135e5aac6c0cf6d7&fuseaction=pic.main&File=http://www.eorthopod.com/images/ContentImages/hand/hand_finger_arthritis/hand_finger_joint_causes02.jpg%27)http://popup%28%27http//www.eorthopod.com/eorthopodV2/index.php?ID=bc6117f6c5f98a17135e5aac6c0cf6d7&fuseaction=pic.main&File=http://www.eorthopod.com/images/ContentImages/hand/hand_finger_arthritis/hand_finger_joint_causes02.jpg%27)http://www.webmd.com/hw-popup/rheumatoid-arthritishttp://www.webmd.com/hw-popup/osteoarthritishttp://www.webmd.com/rheumatoid-arthritis/guide/most-common-arthritis-types


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medi#ay +non asparesthesia% 3ia"etes anda#oho a"useare to #ommon #auses of periphera neuropathy%

The different forms of arthritis /infammation of the $oints) #an produ#e pain and stiffness of the $ointsin#uding the +nee $oint( and this pain may "e per#ei!ed as a "urning sensation in some #ases%

When the arteries that suppy the egs are narroed due to atheros#erosis( a #ondition +non asperiphera artery disease( pain o##urs intermittenty in the egs hie a+ing /#audi#ation)% This may aso "ee*perien#ed as a "urning sensation and o##urs hen there is inade2uate o*ygen dei!ery to the tissues in theegs due to the narroed arteries%

The sudden onset of a "urning or tinging sensation in the eg on one side of the "ody may o##ur ithother symptoms that might indi#ate a serious or ife8threatening #ondition su#h as stro+e%

Why?

The pain and "urning sensation in the +nees is often #aused due to the damage to the stru#tures in and

around the +nee $oint%

Wear and tear of +nee $oint #artiage is the most #ommon reason%

The other #ause #an "e igament tear( "ursitis%

Often( the #hara#teristi# "urning sensation in the +nee $oint is due to Iioti"ia "and fri#tion% It is a #ommon

#ause for +nee pain in athetes% Iioti"ia "and originates from the hip $oint and runs a the ay to the +nee$oint% It atta#hes at the atera /outer) side of the +nee% Together ith 2uadri#eps mus#es of the thigh(Iioti"ia "and heps sta"ii;e the +nee hie a+ing and running%

O!eruse( differen#e in ength of egs( in#rease in training pra#ti#e( running on une!en roads are some of the

#auses for Iioti"ia "and fri#tion and "urning +nee%

9o?

The ma$or pro"em in osteoarthritis of the +nee $oint is that the smooth #artiage ining the inside of

the $oint ears aay% This resuts in a narroing of the $oint spa#e ith the de!eopment of #ysts and

erosions in the "one ends% As a resut( "one #omes dire#ty in #onta#t ith "one( hi#h i "e

painfu% Bone spurs /sma "one groths) form around the $oint% A of these #hanges utimatey ead

to in#reasing pain and stiffness of the $oint%

.,A.LING NOI&7&

What?

.repitus refers to $oint

noises( su#h as popping

and #ra#+ing in the

$oints( espe#iay the

+nees% &u#h $oint noise

#an "e 2uite distur"ing

and #ause #on#ern(

parti#uary if it shos

up suddeny% In most

#ases( these noises are

not indi#ati!e of anyunderying pro"em%

4ost $oint #repitus(

#ra#+ing and popping

usuay has a @"ar+ that is

orse than its "ite%@ Joint

noises often persist for years ithout any signifi#ant pro"ems de!eoping%

Why and ho?

7s#aping gases' ientists e*pain that syno!ia fuid present in your $oints a#ts as a u"ri#ant% The

fuid #ontains the gases o*ygen( nitrogen( and #ar"on dio*ide% When you pop or #ra#+ a $oint( you

stret#h the $oint #apsue% Gas is rapidy reeased( hi#h forms "u""es% In order to #ra#+ the same

+nu#+e again( you ha!e to ait unti the gases return to the syno!ia fuid%

4o!ement of $oints( tendons and igaments' When a $oint mo!es( the tendons position #hanges andmo!es sighty out of pa#e% 6ou may hear a snapping sound as the tendon returns to its origina

position% In addition( your igaments may tighten as you mo!e your $oints% This #ommony o##urs

in your +nee or an+e( and #an ma+e a #ra#+ing sound%

,ough surfa#es' Arthriti# $oints ma+e sounds #aused "y the oss of smooth #artiage and the

roughness of the $oint surfa#e%
http://www.localhealth.com/article/paresthesiahttp://www.localhealth.com/article/paresthesiahttp://www.bettermedicine.com/topic/alcohol-abuse/http://www.bettermedicine.com/topic/alcohol-abuse/http://www.bettermedicine.com/topic/stroke/http://www.bettermedicine.com/topic/stroke/http://www.localhealth.com/article/paresthesiahttp://www.bettermedicine.com/topic/alcohol-abuse/http://www.bettermedicine.com/topic/stroke/


7/19

3I55I.HLT6 IN A,I&ING 5,O4 A &7AT73 PO&ITION

What?

9erniated dis#s #an #ause mus#e ea+ness( ma+e it hard to get up hen you@!e "een sitting or ying

don

Why and ho?

.artiage reies on mo!ement for nourishmentE it does not #ontain "ood !esses% As you shift your

eight onto and off of your eg( the #hanges in pressure in the +nee $oint #ause the $oint fuid to mo!e

into and out of the #artiage( #arrying nourishing su"stan#es in and ashing unanted su"stan#es

aay% This #auses diffi#uty or pain hen getting up from sitting don% Not using your +nee $oint #an

#ause pain "e#ause ithout mo!ement the #artiage doesn@t re#ei!e enough fuid8"orne nourishment%

97B7,37N@& AN3 BOH.9A,3@& NO37&

What?

Bony"umps on

the finger

$oint #osest

to the

fingernai

are #aed

9e"erden@s

nodes%

Bony

"umps on

the midde

$oint of thefinger are

+non as

Bou#hard@s

nodes%

Bony "umps are aso #ommon at the "ase of the thum"% These "umps do not ha!e a ni#+name( "ut the

$oint is #aed the .4. or #arpometa#arpa $oint% The name #omes from the "one of the rist /#arpa)

and the "one of the thum" /meta#arpa)%

Why?

9e"erden@s nodes are #aused dire#ty "y osteoarthritis due to the #onsistent trauma the "ones must

endure hen $oints a#+ #artiage% The soen "oney outgroths appear at the end of the finger@s or

toes%

The Bou#hard@s node is ess #ommon than 9e"erden@s node% They are "eie!ed to "e #aused "y

osteophytes%

9o?

The "ony deformity is a resut of the"one spursfrom the osteoarthritis in that $oint%

BA7,& .6&T

What?

Ba+er@s #yst is a "uidup of $oint fuid /syno!ia fuid) that forms a #yst "ehind the +nee% A Ba+er #yst

is sometimes #aed a popitea #yst% When an e*#ess of +nee $oint fuid is #ompressed "y the "ody

eight "eteen the "ones of the +nee $oint( it #an "e#ome trapped and separate from the $oint to form

the fuid8fied sa# of a Ba+er #yst%
http://www.medicinenet.com/script/main/art.asp?articlekey=98517http://www.medicinenet.com/script/main/art.asp?articlekey=98517


8/19

Why?

Ba+er #ystsare not un#ommon and #an "e #aused "y !irtuay any #ause of $oint seing /arthritis)%

The e*#ess $oint fuid /syno!ia fuid) "uges to the "a#+ of the +nee to form the Ba+er #yst% The most

#ommon type of arthritis asso#iated ith Ba+er #ysts is osteoarthritis(aso #aeddegenerati!e

arthritis%

9o?

When an e*#ess of +nee $oint fuid is #ompressed "y the "ody eight "eteen the "ones of the +nee

$oint( it #an "e#ome trapped and separate from the $oint to form the fuid8fied sa# of a Ba+er #yst%

) ,ain and $oint pain?

Who 7*perien#es ,ain ,eated Joint Pain?

Peope ho e*perien#e rain8reated $oint pain often suffer from osteoarthritis( rheumatoid arthritis and

other arthritis #onditions% Indi!iduas ith pre!iousy "ro+en "ones and those ith mutipes s#erosis

and other neuroogi#a diseases are aso affe#ted%

What Is Affe#ted?

Any eight8"earing $oint #an "e affe#ted and fee pain% Typi#ay( pain is fet in the hips( +nees(

e"os( shouders and hands%

Why?

The "ody@s $oints ha!e sensory ner!es% These ner!es are #aed "aro8re#eptors and they do respond to

#hanges in the atmosphere% When the "arometri# pressure drops or is o( it signifies that the air has

"e#ome moist( signaing a #han#e for rain% The "ody@s ner!e re#eptors respond to o "arometri#

pressure%

7*panation

When air and en!ironmenta pressure #hanges and fas( the amount of fuid or pressure in the "ody@s

$oints !aries% Peope ith arthritis i fee the #hange more signifi#anty "e#ause they ha!e ess

#artiage that #ushions the "ody@s $oints%

Hps and 3on

Peope ith $oint pain often +no a"out the eather "efore it o##urs% When the "arometri# pressure

goes don immediatey "efore a storm( their pain goes up%

1K) What aging does to "ones and $oints?

Age8reated #hanges in "one' Bone is i!ing tissue% Throughout ife( "ones #onstanty #hange through

a pro#ess of a"sorption and formation #aed :remodeing%: As e age( the "aan#e "eteen "one

a"sorption and "one formation #hanges( resuting in a oss of "one tissue% Bones "e#ome ess dense as

e age for a num"er of reasons( in#uding'

An ina#ti!e ifestye #auses "one astage%

9ormona #hanges in omen( menopause triggers the oss of mineras in "one tissue% In

men( the gradua de#ine in se* hormones eads to the ater de!eopment of osteoporosis%

Bones ose #a#ium and other mineras%

Ligaments( #onne#ti!e tissues "eteen "ones( "e#ome ess easti#( redu#ing fe*i"iity%

Age8reated #hanges in $oints' In a $oint( "ones do not dire#ty #onta#t ea#h other% They are #ushioned
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9/19

"y #artiage that ines your $oints /arti#uar #artiage)( syno!ia mem"ranes around the $oint and a

u"ri#ating fuid inside your $oints /syno!ia fuid)% As you age( $oint mo!ement "e#omes stiffer and

ess fe*i"e "e#ause the amount of u"ri#ating fuid inside your $oints de#reases and the #artiage

"e#omes thinner%

Ligaments aso tend to shorten and ose some fe*i"iity( ma+ing $oints fee stiff%

11) PAT9OG7N7&I& O5 OA

A"norma stress and oading eading to me#hani#a #artiage damage pay roe in se#ondary

OA%

O"esity may in#rease s+eeta mass in#rease #artiage !oume%

.oagenases /44P81 and 44P81=) #ea!e #oagen and other meoprteinasesau#h as

stromeysin /44P8=) and geatinases /44P80 and 44P8) are aso present in e*tra#euar

matri*% 44Ps se#reted "y #hondro#ytes in an ina#ti!e form% 7*tra#euar a#ti!ation then

eads to degradation of "oth #oagen and proteogy#an around #hondro#ytes%

Tissue inhi"itors of meoproteinases /TI4Ps) reguate the 44Ps% 3istur"an#es of this

reguation may ead to an in#rease in #artiage degradation o!er synthesis and #ontri"ute to

the de!eopment of OA%

Osteoprotegerin /OPG)( ,AN and ,AN igand /,ANL) may #ontro the remodeing of

su"#hondra "one remodeing% Their e!es are signifi#anty different in OA #hondro#ytes%

Inhi"iting ,ANL may pro!e ne therapeuti# approa#h in OA%

Aggre#anase produ#tion is stimuated "y proinfammatory #yto+ines and aggre#an /the ma$or

proteogy#an) e!es fa%

&yno!ia infammation is present in OA( and .8,ea#ti!e Protein /.,P) in the serum may "e

raised% IL81 and TN5 reease stimuates meoproitenase produ#tion and IL81 inhi"its type II

#oagen produ#tion% IL8C and IL8F may aso "e in!o!ed% Produ#tion of #yto+ine "y

ma#rophages and of 44Ps "y #hondro#ytes in OA are dependent on trans#ription fa#tor N58

+B may ha!e a therapeuti# roe in OA%

IL81 re#eptor antagonist genes are asso#iated ith radiographi# se!erity of +nee OA%

Groth fa#tor in#uding insuin8i+e groth /IG581) and transforming groth fa#tor /TG58B)

are in!o!e in #oagen synthesis and their defi#ien#y may pay a roe in impairing matri*

repair% 9oe!er( in#rease TG58B #an #ause in#reased su"#hondra "one density%

.artiage "rea+don produ#ts ead to ma#rophage infitration and !as#uar hyperpasia and

IL18B and TN58a may #ontri"ute to further #artiage degradation%

-as#uar endotheia groth fa#tor /-7G5) from ma#rophage is a potent stimuator of

angiogenesis and may #ontri"ute to infammation and neo!as#uari;ation in OA% Inner!ation

#an a##ompany !as#uari;ation of arti#uar #artiage%

4utations in the gene for type II #oagen /.OL0A1) ha!e "een asso#iated ith eary

poyarti#uar OA%

10) What is 7&, test #ondu#ted for?


10/19

Bood tests for 7&, or 7rythro#yte &edimentation ,ate is a measure that is traditionay used

to #he#+ for infammation in the "ody% Infammation is a response that is mounted "y the

"ody@s immune system due to some +ind of trigger i+e infe#tion or as part of the geneti#

programming mista+es that #an sometimes happen in the "ody% At many times( one oud not

e!en +no that there is infammation in the "ody% This is usuay hat happens in the #ase of

autoimmune diseases that systemati#ay destroy organs and important tissues( ith the !i#tim

not e!en reai;ing it( unti it is mu#h too ate%

Reasons or !onducting the Test

7&, "ood testing is #aed for hen there is a suspi#ion of an infammatory pro#ess

underay in the "ody% The pro"em ith the 7&, test ith "ood is that it doesn@t reay state

hat e*a#ty the #ause of the infammation is% 5or this reason( other tests need to "e

#ondu#ted i+e #ompete "ood #ounts for hite "ood #es and ympho#ytes% Another test

that is generay #ondu#ted is the .8rea#ti!e protein test% 7&, and .,P"ood tests#an

generay ma+e for a more definiti!e diagnosis a"out the presen#e of infammation%

"nterpretation of Test Results

A high 7&, #ount #oud mean that one is suffering from some +ind of infe#tion( an

infammation of the ma$or arteries( upus( or e!en anemia% The entire premise of the test is

that during an infammatory phase the e!es of #oaguant fi"rinogen in the "ood #auses the

red "ood #es to #ump together and fa to the "ottom of a measuring tu"e% 9oe!er( this

same effe#t #an aso happen in #onditions i+e anemia as e%

When you are diagnosed ith a high 7&,( hi#h is #a#uated "y di!iding your age "y 0 that

i gi!e you a !aue to hi#h you add the metri# mmhr% Women shoud add 1K to their age

and then perform the di!ision% If your 7&, is high( it means that you shoud aso as+ for a .8

rea#ti!e protein test and a #ompete hite "ood #e #ount% 7&, is ony an indi#ation that

something is rong ith the "ody and that it re2uires further in!estigation% 7nsure that your

do#tor has the #orre#t e2uipment to perform these tests% The .,P test is something that on@t"e a!aia"e in hospitas that are "eo a #ertain standard%

#$) %&ray result of osteoarthritis 'nee

A% spi'ing tibia/ spurring tibial spine' Bone spurs( aso +non as osteophytes% 5ri#tion "eteen

the "ones may #ause sma deposits of "one #aed "one spurs to form on the edges of the $oint%

nee Osteoarthritis' One of the most #ommon reasons for "one spurs in the +nees is +nee

osteoarthritis( hi#h is #hara#teri;ed "y #onstant ear and tear of the +nee $oints% With e*#essi!e

pressure( #onstant fri#tion "eteen the +nee $oints and stret#hing of the $oints( the #artiage in the

"ones tend to ear out% The "ody attempts to repair this damage done to the #artiage "y #reating "onespurs "eteen these $oints% The e*tra surfa#e pro!ided "y the "one spurs is used for oad8"earing and

for pre!enting further damage to the +nees%

nee In$uries' In$ury to the #artiage tissue( aso +non as a menis#us in$ury( #an aso ead to "one

spurs% When the #res#ent8shaped sho#+ a"sor"ers "eteen the femur and the ti"ia( aso +non as

menis#us( are damaged or torn( it #an ead to "one spurs%

Other .auses' &ome of the other #auses of this #ondition are o"esity( aging( a#+ of physi#a a#ti!ity(

poor posture( stru#tura a"normaities during "irth( and nutritiona defi#ien#ies% Buidup of #a#ium

deposits in the "ody( degeneration of the $oints( and hereditary fa#tors #an aso ead to the appearan#e

of "one spurs%
http://www.medicalhealthtests.com/blood-tests.htmlhttp://www.medicalhealthtests.com/blood-tests.htmlhttp://www.medicalhealthtests.com/blood-tests.html


11/19

B% suaring of the

edges of the

femorotibial

compartments'

#a#ifi#ation

.% marginal

ostephytes' for

formation of spi+ing

ti"ia( Osteophytes

typi#ay de!eop as

a reparati!e response

"y the remaining

#artiage%

3% subchondral

bone/subchondral

sclerosis' in#reased "one formation around the $oint% &u"#hondra "one is the ayer of "one $ust

"eo the #artiage% When someone has osteoarthritis( there is in#reased "ood fo and other#hanges that de!eop in the su"#hondra ayer 88 su"#hondra s#erosis /in#reased "one density)

7% eburnation' With progression of the disease( there i "e #ontinous oss of arti#uar #artiage

eads to e*posure of su"#ondria "one 8 hi#h appears as shiny fo#i on the arti#uar surfa#e

/+non as 7BH,NATION)% &e#ondary #hanges are fre2uenty seen in the underying "one su#h

as fi"rosis( #ysti# #hange > ne "one formation% Progressi!e oss of arti#uar #artiage stimuates

ne "one formation( usuay in the form of nodues /+non as O&T7OP96T7&) at the "ony

edges%

1) .omposition

of syno!ia fuids

&yno!ia

fuid is a

thi#+(

stringy

fuid

found in

the

#a!ities ofsyno!ia

$oints% It

redu#es

fri#tion

"eteen

the arti#uar #artiage and other tissues in $oints "y u"ri#ating and #ushioning them during

mo!ement%

&yno!ia fuid is made of hyauroni# a#id and u"ri#in( proteinases( and #oagenases%

o Lu"ri#in is se#reted "y syno!ia #es that is #hiefy responsi"e for so8#aed"oundary8ayer u"ri#ation( hi#h redu#es fri#tion "eteen opposing surfa#es of

#artiage% It may aso ha!e a roe in syno!ia #e groth%


12/19

o 9yauroni# a#id( synthesi;ed "y syno!ia ining #es( is se#reted into the syno!ia

fuid( ma+ing the fuid !is#ous%

Physi#a #hara#teristi#s'

o .ooress and transparent

o Amount thin fim #o!ering surfa#es of syno!ium and #artiage ithin $oint spa#e

#) *hat is the

morphological

changes of

osteoarthritis+

A% G,O&&

ANATO46'

NO,4AL O&T7OA,T9I&TI& JOINT

Thi#+ #artiage and spa#es "eteen the

#artiages/ith pure syno!ia fuid)

Thinu#eratederoded #artiage( $oint spa#e

narroing

Norma #apsue Thi#+ening of #apsue

No margina osteophytes 4argina osteophytes 8 "one spurs

eroti# "one

&u"#hondra s#erosis > #yst

&yno!ia fuid #ontains orn8aay #artiage


13/19

B% 9I&TOLOG6'

1C) Type of

osteoarthritis '

a -rimary

This type

of OA is a

chronic

degenerative disorder

,eated to "ut not #aused "y aging( as there are peope ha!e no #ini#a or fun#tiona signs of this

disease

As human aged( the #artiage ater #ontents de#reases as a resut of a redu#ed proteogy#an

#ontent%

.ause the #artiage to "e ess resiient

The prote#ti!e effe#ts of the proteogy#an "e#ome diminished% It #auses the #oagen fi"ers of the

#artiage to "e#ome sus#epti"e to degradation and undergoes degeneration%

Infammation of the surrounding $oint #apsue #an aso o##ur /often mid#ompared to that hi#h

o##urs in rheumatoid arthritis)

This #an happen as "rea+don produ#ts from the #artiage are reeased into the syno!ia spa#e(

and the #es ining the $oint attempt to remo!e them


14/19

Ne "one outgroths( #aed :spurs: or osteophytes( #an form on the margins of the $oints(

possi"y in an attempt to impro!e the #ongruen#e of the arti#uar #artiage surfa#es

These "one #hanges( together ith the infammation( #an "e "oth painfu and de"iitating%

b .econdary

This type of OA is #aused "y other fa#tors "ut the resuting pathoogy is the same as for primary OA'

.ongenita disordersGeneti#'

o .ongenita hip u*ation

o Peope ith a"normay8formed $oints /hip dyspasia)( as added stress is spe#ifi#ay pa#ed on the

$oints hene!er they mo!e

o 3ia"etes

Infammatory diseases /su#h as Perthes@ disease)( /Lyme disease)( and a #hroni# forms of arthritis /e%g%

#osto#hondritis( gout( and rheumatoid arthritis)

In gout( uri# a#id #rystas #ause the #artiage to degenerate at a faster pa#e%

In$ury to $oints( as a resut of an a##ident

A $oint infe#tion /due to in$ury)

9ormona disorders

Ligamentous deterioration or insta"iity may "e a fa#tor

O"esity% O"esity puts added eight on the $oints( espe#iay the +nees%

&ports in$uries( or simiar in$uries from e*er#ise or or+% In$uries resuting in "ro+en igaments #an

ead to insta"iity of the $oint and o!er time to ear on the #artiage and e!entuay osteoarthritis%

Pregnan#y

&tru#tures

of OA

+nee'

.an o##ur at'

Inter!erte"ra $oint


15/19

nee $oint

9ip $oint

9and $oint /interphaangea $oint( meta#arpaphaangea $oint( #arpameta#arpa $oint)

Wrist $oint

5oot $oint /interphaangea $oint( metatarsophaangea $oint)

1D) 4e#hanism of

N&AI3 and side

effe#t

1% ,eationship of N&AI3 and #yoo*ygenase'

.y#oo*ygenase is en;yme responsi"e for synthesis of #e mediator hi#h the prostanoid

/prostagandin( prosta#y#in( throm"o*ane)

!O#

.ontinuousy stimuated "y the"ody

.onstituti!e /Its #on#entration inthe "ody remain sta"e)

.reates prostagandins used for "asi# house8+eeping throughout "ody

Prostagandins stimuate norma"ody fun#tions su#h as stoma#h mu#ous produ#tion(

reguationof gastri# a#id and +idney atere*#retion

M .o* 0

Indu#ed / normay not inpresent in #es)

Buit ony in spe#ia #es /7 aung #es)

Hsed for signaing pain andinfammation

Produ#es prostagandins forinfammatory response

&timuated ony as part ofimmune response

Produ#tion is stimuated "yinfammatory #yto+ines andgroth fa#tors N&AI3 a#tion is to

inhi"it #o*81 and #o*80


16/19

0% Non8steroida anti infammatory drug /N&AI3) me#hanism'

4ost N&AI3s #urrenty used today shos no see#ti!ity to .O1 and .O0 / Aspirin)

This non see#ti!ity eads to !arious side effe#ts

o Aspirin and other simiar N&AI3s ead to e*#essi!e produ#tionof stoma#h a#id as

e as u#eration and gastrointestina"eeding

This is due to the inhi"iting of .O1 house +eeping roe ase as .O0 infammatory

response

o ,esent resear#h has "een dire#ted at the see#ti!ity of .O0 o!er .O1

Nonsteroida Anti8Infammatory 3rugs or+ "y interfering ith the #y#oo*ygenase pathay%

3ifferent me#hanisms stimuate the to different types of #y#oo*ygenase

.O81 is stimuated #ontinuousy "y norma "ody physioogy% The .O81 en;yme is

#onstituti!e( meaning that its #on#entration in the "ody remains sta"e% It is present in most

tissues and #on!erts ara#hidoni# a#id to prostagandins

These prostagandins in turn stimuate "ody fun#tions( su#h as stoma#h mu#ous produ#tion

and +idney ater e*#retion( as e as pateet formation%

The o#ation of the .O81 en;yme di#tates the fun#tions of the prostagandins it reeases% 5or

e*ampe( .O81 in the stoma#h a produ#es prostagandins that stimuate mu#ous

produ#tion%

In #ontrast( the .O80 en;yme is indu#ed% It is not normay present in #es "ut its

e*pression #an "e in#reased dramati#ay "y the a#tion of ma#rophages( the s#a!enger #es of

the immune system

.O80 pays a !ery important roe in infammation% .o*80 is in!o!ed in produ#ing

prostagandins for an infammatory response

.O81 is stimuated #ontinuay( and .O80 is stimuated ony as a part of an immune

response%


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=% N&AI3 side effe#t'

There are se!era fa#tors that seem to affe#t the #han#es of side effe#ts ith N&AI3s%

In#udes'

The dosage and type of N&AI3

6our age

Other medi#a #onditions you may ha!e

Other medi#ines you may "e ta+ing

.ommon &ide 7ffe#ts of N&AI3s

A N&AI3s ha!e "een studied e*tensi!ey in #ini#a trias( ith many peope ordide

ha!ing "een e!auated

Based on these studies( the most #ommon N&AI3 side effe#ts in#ude'

1% Nausea

0% A"domina pain /stoma#h pain)

=% 9eart"urn

% 3i;;iness

% An une*pained rash

C% .onstipation

D% 3iarrhea

F% Gas

% -omiting

Terms to +no

,heumatoogy #ini#s

Rheumatologyis a su"8spe#iaty in interna medi#ine and paediatri#s( a "ran#h of medi#ine

spe#iai;ing in the study of pathoogies in the mus#es( tendons and $oints( de!oted to the diagnosis

and therapy of rheumati# diseases/diseases of infammation and auto8immunity( su#h as arthritis( gout(upus erythematosus( s#eroderma( and Lyme disease)% .ini#ians ho spe#iai;e in rheumatoogy are

#aed rheumatoogists ho dea mainy ith #ini#a pro"ems in!o!ing $oints( soft tissues and the

aied #onditions of #onne#ti!e tissues%

The ,heumatoogy #ini# offers #ini#a #are( resear#h( and edu#ation% The #omprehensi!e and

#oordinated mutidis#ipinary team pro!ides diagnosis and treatment for #hidren and adoes#ents ith

rheumati# diseases% These diseases in#ude'

#hroni# arthritis /$u!enie idiopathi# arthritis)

systemi# upus erythematosus

dermatomyositis

s#eroderma !as#uitis

mus#uos+eeta pain syndromes

Purpura


18/19

Purpura is purpe8#oored spots and pat#hes that o##ur on the s+in( organs( and in mu#us mem"ranes(

in#uding the ining of the mouth% Purpura o##urs hen sma "ood !esses $oin together or ea+

"ood under the s+in%Purpura may aso o##ur in the mu#ous mem"ranes( espe#iay of the mouth( and

in the interna organs% Purpura is not a diseaseper se"ut is indi#ati!e of an underying #ause of

"eeding%

When purpura spots are !ery sma( they are #aedpete#hiae% Large purpura are #aed e##hymoses%

Pateetshep the "ood #ot% A person ith purpura may ha!e norma pateet #ounts

/nonthrom"o#ytopeni#purpuras) or o pateet #ounts /throm"o#ytopeni# purpuras)%

.auses

Nonthrom"o#ytopeni#purpuras may "e due to'

Amyoidosis

Bood #otting disorders

.ongenita #ytomegao!irus

.ongenita ru"easyndrome

3rugs that affe#t pateet fun#tion

5ragie "ood !esses /senie purpura)

9emangioma

Infammation of the "ood !esses /!as#uitis)( su#h as 9eno#h8honeinpurpura( hi#h

#auses a raised type of purpura

Pressure #hanges that o##ur during !agina #hid"irth

ur!y

&teroid use

Throm"o#ytopeni# purpura may "e due to'

3rugs that pre!ent pateets from forming

Idiopathi# throm"o#ytopeni# purpura /ITP)

Immune neonatathrom"o#ytopenia/#an o##ur in infants hose mothers ha!e ITP)

4eningo#o##emia88 a raised type of purpura

Hrti#aria esion

Hrti#aria des#ri"es a group of #onditions in hi#h there are heas /or eas) in the s+in( it#hy hite

or red umps% Hrti#aria #an o##asionay "e a sign of systemi# disease%

Hrti#aria /hi!es) is a !as#uar rea#tion of the s+in mar+ed "y the transient appearan#e of smooth(

sighty ee!ated pat#hes /heas) that are erythematous and that are often attended "y se!ere pruritus%

Indi!idua esions reso!e ithout s#arring in se!era hours% 4ost #ases of urti#aria are sef8imited

and of short durationE the eruption rarey asts more than se!era days( it "ut may "e re#urrent o!er

ee+s% .hroni# urti#aria is defined as urti#aria ith re#urrent episodes asting onger than C ee+s%

The de!eopment of urti#aria is often an isoated e!ent ithout systemi# rea#tion% ,arey( it #an "e a

preude to the de!eopment of an anaphya#ti# /eg( hypotension( respiratory distress( stridor(

gastrointestina distress( saoing pro"ems( $oint seing( $oint pain)

7"urnation

It is a #on!ersion of "one into a hard( i!ory8i+e mass at hi#h a #hange in e*posed su"#hondra "onein degenerati!e $oint disease here"y it is #on!erted into a dense su"stan#e ith a smooth surfa#e i+e

i!ory hi#h is aso +non as "one s#erosis%
http://www.nlm.nih.gov/medlineplus/ency/article/003235.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003647.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003647.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/001343.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/001574.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/001459.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000425.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000355.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000535.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000586.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000586.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/001349.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/001349.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003235.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003647.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/001343.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/001574.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/001459.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000425.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000355.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000535.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000586.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/001349.htm


19/19

msk 3- pbl joint pain compiled

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