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CURRENT Medical Diagnosis & Treatment 2013
Chapter 20. Musculoskeletal & Immunologic Disorders
Sections: Diagnosis & Evaluation of Musculoskeletal Disorders, Degenerative & Crystal-Induced Arthritis, Degenerative Joint Disease (Osteoarthritis), Crystal Deposition Arthritis, Gouty Arthritis, Chondrocalcinosis & Pseudogout, Pain Syndromes, Neck Pain, Thoracic Outlet Syndromes, Low Back Pain, Lumbar Spinal Stenosis, Fibromyalgia, Carpal Tunnel Syndrome, Dupuytren Contracture, Complex Regional Pain Syndrome, Bursitis, Autoimmune Diseases, Autoimmune Diseases: Introduction, Rheumatoid Arthritis, Adult Still Disease, Systemic Lupus Erythematosus, Antiphospholipid Syndrome, Raynaud Phenomenon, Scleroderma (Systemic Sclerosis), Idiopathic Inflammatory Myopathies (Polymyositis & Dermatomyositis), Mixed Connective Tissue Disease & Overlap Syndromes, Sjögren Syndrome, Rhabdomyolysis, Vasculitis Syndromes, Vasculitis Syndromes: Introduction, Polymyalgia Rheumatica & Giant Cell Arteritis, Polyarteritis Nodosa, Granulomatosis with Polyangiitis (Formerly Wegener Granulomatosis), Microscopic Polyangiitis, Cryoglobulinemia, Henoch-Schönlein Purpura, Relapsing Polychondritis, Behçet Syndrome, Primary Angiitis of the Central Nervous System, Livedo Reticularis, Seronegative Spondyloarthropathies, Seronegative Spondyloarthropathies: Introduction, Ankylosing Spondylitis, Psoriatic Arthritis, Reactive Arthritis (Formerly Reiter Syndrome), Arthritis & Inflammatory Intestinal Diseases, Infectious Arthritis, Nongonococcal Acute Bacterial (Septic) Arthritis, Gonococcal Arthritis, Rheumatic Manifestations of HIV Infection, Viral Arthritis, Infections of Bones, Acute Pyogenic Osteomyelitis, Mycotic Infections of Bones & Joints, Tuberculosis of Bones & Joints, Spinal tuberculosis (Pott Disease), Tuberculous Arthritis, Arthritis in Sarcoidosis, Tumors & Tumor-Like Lesions of Bone, Other Rheumatic Disorders, Rheumatic Manifestations of Cancer, Neurogenic Arthropathy (Charcot Joint), Palindromic Rheumatism, Osteonecrosis (Avascular Necrosis of Bone), Some Orthopedic Procedures for Arthritic Joints, Synovectomy, Arthroplasty, Tendon Rupture, Arthrodesis, Total Joint Arthroplasty, Allergic Diseases, Atopic Disease, Serum Sickness, Pseudoallergic Reactions, Primary Immunodeficiency Disorders, Selective Immunoglobulin A Deficiency, Common Variable Immunodeficiency.
Topics Discussed: arthritis; musculoskeletal diseases.
Excerpt:"In the patient with arthritis, the two clinical clues most helpful
for diagnosis are the joint pattern and the presence or absence
of extra-articular manifestations. The joint pattern is defined
by the answers to three questions: (1) Is inflammation present?
(2) How many joints are involved? and (3) What joints are affected?
Joint inflammation manifests as redness, warmth, swelling, and morning
stiffness of at least 30 minutes' duration. Both the number
of affected joints and the specific sites of involvement affect the
differential diagnosis (Table 20–1). Some diseases—gout, for example—are characteristically
monarticular, whereas other diseases, such as rheumatoid arthritis,
are usually polyarticular. The location of joint involvement can
also be distinctive. Only two diseases frequently cause prominent
involvement of the distal interphalangeal (DIP) joint: osteoarthritis
and psoriatic arthritis. Extra-articular manifestations such as
fever (eg, gout, Still disease, endocarditis), rash (eg, systemic
lupus erythematosus, psoriatic arthritis, Still disease), nodules
(eg, rheumatoid arthritis, gout), or neuropathy (eg, polyarteritis
nodosa, granulomatosis with polyangiitis [formerly Wegener granulomatosis]) narrow the differential..."
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