MCR I Class

Purine metabolism disorder.

• - Gouty Arthritis
• - elevated serum uric acid levels
• - No.

male to female 20:1. over 40 y.o. 1st MTPJ

• -family history in 50% of patients
• - infection, ETOH use, rich (high protein and purine) foods, injury, exposure to cold

sodium monorate crytals accumulate in the synovial membrane. Leukocytes atttack the crystals, but release an enzyme that produces severe inflammation in the joint.

intense pain w/ increase AROM, marked tenderness, redness, and swelling. Possibly fever and cellulites (inflammation of overlying skin).

tophi: after attacks, not all crystals get reabsorbed, the residual crystal tend to form subcutaneous clusters aka tophi. Tophi can exist in the synovial membrane, cartilage, subchondral bone, synovial sheaths of tendons. Tophi develop in about 1/2 of people with gout.

avoid purine rich foods (organ meats, scrapple), anti-inflammatory drugs, and possible long term medications to control uric acid production in the body (people who over produce it)

It's either you make too much or your body can't get rid of it efficiently.

• - unknown
• - course is variable and unpredictable

4:1 female

• - diffuse fibrosis and degenerative changes in skin, joints, and internal organs
• - thickening of skin in face and hands
• - cardiac / pulmonary probs: arrhthymias, pericarditis, lung fibrosus, pleurisy, and pulmonary hypertension.
• - polyarthralgias (joint aches)
• - GI disturbances and renal hypertension

• - steroids for acute episodes
• - meds for specific organ involvement

• - idiopathic (unknown)
• - factors: stress, trauma, other rheumatoid disorders, and injection
• - disturbed sleep cycles: less then normal "beta" sleep; body can't heal of the daily stress on tissues

• - achy, diffuse pain that "moves around" from one area or joint to another over time.
• - localized tenderness or spasm that may change location
• - pain provoked by overuse or activity

• - may spontaneously resolve but can be chronic
• - aeobic exercise: gets rid of stress
• - anti-inflammatory drugs, analgesics used as needed
• - sleep disorders: SSRI's (anti-depressant); zoloft/paxil
• - local symptoms treated w/modalities, massage but you might "chase" them

• - not truely inflammatory
• - unclear; could be viral orgin
• - disseminated bone disorder

excessive osteoblast and osteoclast activity leading to huge bones, deformities, DJD, and pathologic fractures

• - thickening of tibia, femur, skull, pelvis, and vert. bodies
• - pain / functional limitations

• - meds for osteoclast activity
• - specific interventions (immobilization after a fracture)

• - chronic inflammatory connective tissue disease
• - unknown

• - joints, kidneys, vessel walls
• - patients experience exacerbations and remissions

90% females

• - fever, malaise, headache, polyarthralgias, malar butterfly erythema (butterfly rash on face)
• - lesions of skin of face, alopecia, pleurisy, pericarditis, CNS, renal disorders

meds: immunosuppressive drugs, steriods, anti-inflammatories

any disease or condition that involves inflammation

• - heat (warmth)
• - erythemia (redness)
• - swelling
• - pain (due to increase pressure of tissue from swelling)
• - loss of function

• - metabolic disorder
• - infection
• - disease process
• - trauma (macrotrauma / microtrauma)

• -usually children
• -more male

bacterial infection from abrasions, pimples, upper respiratory infections, local trauma to bone play a role in location

if untreated, pressure # in bones; development of subperiostial abscess; necrosis

puss increases pressure --> pain

spreads --> septic --> bloodborn infection

affects growing (metabollically active) bones in metaphyseal region

50% of time: local trauma, severe constant pain, tenderness, malaise, fever, soft tissue swelling on surface

antibiotics, rest, analgesics, surgical decompression (abcess, necrotic dead bone to remove it)

bone destruction and septicemia, pathological fx, joint contracture, overgrowth or cessation of bone growth, death

occurs when the acute version goes untreated

sequestrum (piece of bone) maybe spontaneously extruded

creates draining sinus, PAIN, swelling, tenderness

bed rest, antibiotics, surgical excision and. or drainage

chronic draining sinus, contracture, pathological fx, septicemia, malignant changes in epidermis

patient is pain free and FWB

younger children (lower TS/ upper LS) or in immunosuppressed individuals

pain, spasm, tenderness

antiobiotics, bed rest, excision, drain insertion

• -bacterial infection of synovial joint
• - children

associated w/hematogenous osteomyelitis if the metaphysis is intracapsular

purulent exudate destroys cartilage, body forms pannus

a sticky membrane that deprives nutrition, diffusion of synovial fluid

joint effusion, severe pain with weight bearing or movement, spasm, tenderness

exogenous

• puncture wound
• open fx
• trauma that broke skin
• surgical technique that aren't sterile

careful wound cleaning, debridement, drain; antibiotics

back pain, tenderness, spasm

progressive bone destruction, pathological fx

• Pott's Disease
• spine kyphosis

antibiotics for tuberculosis, surgery

SCI (paraplegia), cauda equina syndrome (pressure on nerve roots), spread of abcess into pleura or psoas

pain esp with wt bearing and motion, swelling

pannus formation, synovial membrane hypertrophy forming an effusion, cartilage necrosis

• antibiotics
• rest
• ice
• elevation
• synovectomy

pain and stiffness in musculoskeletal tissue, include various forms of arthritis and skin diseases

inflammatory polyarthritis; cycles of exacerbation and remission; more cyles = more deformity progresses; disability progress

1.5% of adults; 3:1 female; age 20-40

distal joint first; symmetrical

not known; viral? exxagerated normal immune mechanism?

inflammation of synovial membrane, pannus formation, jt destruction (autoimmune response)

effusion, periarticular swelling, contractures/adhesion withing joint, fatigue, pain, stiffness, ruptured tendons

• pharmocological: corticosteroids
• protective positioning and splinting
• therapeutic exercise
• thermal agents
• surgery (synovectomy, arthroplasties, tendon repairs/grafts/transfers
• athrodesis in upper CS

• pauciarticular vs polyarticular
• systemic (joints and organ systems involved)
• intervention same as RA

bony ankylosis of spine and proximal joints

onset late teens and 20s

genetic, unknown cause

facet/iv joints become fused; bamboo spine; whole spine maybe fused

vague spine pain, spine pain at night, may feel temporarily better with exercise, tenderness; spasm

• pharmacological: corticosteroids
• orthopedic apliances: spinal brace (fuse in good posture)
• therapeutic exercise
• surgery: correction of deformity- spinal osteotomy and or reconstruction