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1、Note:Largeimagesandtablesonthispagemaynecessitateprintinginlandscapemode.Copyright©TheMcGraw-HillCompanies. Allrightsreserved.CURRENTMedicalDx&Tx > Chapter20.Musculoskeletal&ImmunologicDisorders >Diagnosis&EvaluationofMusculoskeletalDisordersExaminationofthePatientInthepatientwitharthrit
2、is,thetwoclinicalcluesmosthelpfulfordiagnosisarethejointpatternandthepresenceorabsenceofextra-articularmanifestations.Thejointpatternisdefinedbytheanswerstothreequestions:(1)Isinflammationpresent?(2)Howmanyjointsareinvolved?and(3)Whatjointsareaffected?Jointinflammationismanifestedbyrednes
3、s,warmth,swelling,andmorningstiffnessofatleast30minutes'duration.Boththenumberofaffectedjointsandthespecificsitesofinvolvementaffectthedifferentialdiagnosis(Table20–1).Somediseases—gout,forexample—arecharacteristicallymonarticular,whereasotherdiseases,suchasrheumatoidarthritis,arechieflyp
4、olyarticular.Thelocationofjointinvolvementcanalsobedistinctive.Onlytwodiseasesfrequentlycauseprominentinvolvementofthedistalinterphalangeal(DIP)joint:osteoarthritisandpsoriaticarthritis.Extra-articularmanifestationssuchasfever(eg,gout,Stilldisease,endocarditis),rash(eg,systemiclupuserythe
5、matosus,psoriaticarthritis,Stilldisease),nodules(eg,rheumatoidarthritis,gout),orneuropathy(eg,polyarteritisnodosa,Wegenergranulomatosis)narrowthedifferentialdiagnosisfurther.Table20–1. Diagnosticvalueofthejointpattern.CharacteristicStatusRepresentativeDiseaseInflammationPresentRheumatoida
6、rthritis,systemiclupuserythematosus,goutAbsentOsteoarthritisNumberofinvolvedjointsMonarticularGout,trauma,septicarthritis,Lymedisease,osteoarthritisOligoarticular(2–4joints)Reiterdisease,psoriaticarthritis,inflammatoryboweldiseasePolyarticular(5joints)Rheumatoidarthritis,systemiclupuseryt
7、hematosusSiteofjointinvolvementDistalinterphalangealOsteoarthritis,psoriaticarthritis(notrheumatoidarthritis)Metacarpophalangeal,wristsRheumatoidarthritis,systemiclupuserythematosus(notosteoarthritis)FirstmetatarsalphalangealGout,osteoarthritisArthrocentesisandExami
