The Rheumatic Hand E-Book

Raphael Micheroli

• Herausgeber: Books on Demand
• Kategorie: Wissenschaft und neue Technologien
• Sprache: Englisch

Seitenzahl: 38

Veröffentlichungsjahr: 2015

Beschreibung

Many rheumatic diseases cause changes that are visible in the hands. This book provides an overview of the most common rheumatic diseases with a focus on their hand manifestations and includes the following topics: Epidemiology, Etiology and Pathogenesis; Hand Manifestations; Further Clinical Manifestations; and the Diagnosis and Therapy of Each Disease. The rheumatic diseases addressed are osteoarthritis, rheumatoid arthritis, gout, calcium pyrophosphate dihydrate deposition disease, psoriatic arthritis, reactive arthritis, systemic sclerosis and dermatomyositis/polymyositis. The non-rheumatic diseases included are diabetic cheiroarthropathy, endocarditis, secondary hypertrophic osteoarthropathy and chronic regional pain syndrome. The roles of clinical evaluation, X-ray, MRI and high-resolution ultrasonographic images are also discussed.

Leseprobe

As Editor, I want to

thank my wife

Esnur, my parents

Rico and Ursula

Micheroli-Blum, my

mentors and friends

Giorgio Tamborrini,

Adrian Ciurea,

Diego Kyburz and

Thomas Brack.

I dedicate this book

to Can.

Raphael Micheroli

EDITORS AND AUTHORS

Raphael Micheroli, MD

Fellow sonographer

Kantonsspital Glarus

Burgstrasse 99

8750 Glarus, Switzerland

Giorgio Tamborrini, MD, KD

Head of departement

Ultrasound SGUM/Sonar/

EFSUMB/Eular/QIR

Rheumatology FMH

Ultrasound Center

c/o Bethesda Hospital

4020 Basel, Switzerland

Diego Kyburz, MD, Prof.,

Chief of departement

Rheumatology

University Hospital of Basel

4020 Basel, Switzerland

Glarus, 2015

EDITORIAL DESIGN AND PHOTOS

Janine Wiget, Graphic

Design & Illustration

CONTENTS

INTRODUCTION

RHEUMATIC-DISEASES

Osteoarthritis (OA)

Rheumatoid Arthritis (RA)

Gout (Urate Arthropathy)

Calcium Pyrophosphate Dihydrate Deposition Disease (CPPD)

Psoriatic Arthritis (PsA)

Reactive Arthritis (ReA)

Systemic Sclerosis (SSc)

Dermatomyositis/Polymyositis (DM/PM)

Systemic Lupus Erythematosus (SLE)

NON-RHEUMATIC-DISEASES

Diabetic Cheiroarthropathy (Diabetic Hand-Syndrom)

Endocarditis

Secondary Hypertrophic Osteoarthropathy (Morbus Pierre-Marie-Bamberger)

Chronic Regional Pain Syndrom (CRPS, Morbus Sudeck)

REFERENCES

INTRODUCTION

Many rheumatic diseases show changes that are visible in the hands. Fundamental information on these diseases is revealed by the pattern of distribution in the relevant joints, soft-tissue changes, skin manifestations, neurological and vascular symptoms, and clinical findings. Imaging and lab results provide diagnostic support.

In this book, these common diseases are presented in terms of their clinical expressions in the hands: osteoarthritis, rheumatoid arthritis, gout, calcium pyrophosphate dihydrate deposition disease, psoriatic arthritis, reactive arthritis, systemic sclerosis and dermatomyositis/polymyositis. Furthermore, we discuss the pathological findings in the hands as a result of diabetic cheiroarthropathy, endocarditis, secondary hypertrophic osteoarthropathy and chronic regional pain syndrome.

R. MICHEROLI

G. TAMBORRINI

D. KYBURZ

RHEUMATIC-DISEASES

OSTEOARTHRITIS (OA)

1a Clinical image showing swelling and deformity of the distal and proximal interphalangeal joints

1b X-ray image with joint space narrowing (arrowhead), subchondral cyst (arrow), osteophytes (star) and deformities of the distal and proximal interphalangeal joints

2a-c Ultrasound of the volar longitudinal DIP joint (at the top) and of the longitudinal PIP joint (at the bottom, 2D and 3D) with osteophytes (arrows) and joint effusion (stars)

EPIDEMIOLOGY

Osteoarthritis is the most common joint disease. The incidence of coxarthrosis (hip OA) is 40-80/100,000 inhabitants/year, that of gonarthrosis (knee osteoarthritis) is 160-240/100,000 inhabitants/year, and that of finger osteoarthritis is 100/100,000 inhabitants/year. In general, women are affected approximately 1.7 times more frequently. The prevalence in 34-year-olds is as high as 17% but increases to over 90% in people aged 65 and over.

ETIOLOGY AND PATHOGENESIS

The causes of primary idiopathic osteoarthritis are unclear. However, genetic predisposition (association with HLA-A1,-B8), endocrine factors and metabolic disorders seem to have an influence.

Risk factors for secondary osteoarthritis include age, gender (women aged 55 and over are especially affected), joint trauma, obesity, dietary factors, biomechanical malalignment, deformity, inflammatory diseases and diseases of the nervous system. Chondrozytic dysfunction, which is associated with an inadequate synthesis capacitiy, leads to an overall degradation of the cartilage and to a secondary loss of tissue surrounding the joint.

HAND MANIFESTATIONS

Osteoarthritis of the finger joints is usually a primary, polyarticular osteoarthritis with an affinity for the distal interphalangeal (DIP) joints. Heberden’s osteoarthritis refers to the involvement of the DIP joints. Bouchard’s osteoarthritis is a proximal interphalangeal (PIP) joint osteoarthritis that occurs simultaneously with Heberden’s osteoarthritis in every third patient. In contrast to Heberden’s osteoarthritis, Bouchard’s osteoarthritis often has no knots. Rhizarthrosis (first carpometacarpal joint osteoarthritis) leads to more severe functional deficits than Heberden’s or Bouchard’s osteoarthritis. Erosive (destructive) osteoarthritis may occur as an inflammatory (activated) osteoarthritis variant. Osteoarthritis of the fingers is not always painful; however, it can lead to cosmetic disfigurement.

FURTHER CLINICAL MANIFESTATIONS

Patients often present with the following symptoms: impact pain, fatigue pain and stress pain. Over time, constant pain, night pain and muscle pain (localized, “joint-associated”) can occur. In very severe cases of osteoarthritis, thickening and bony deformity, instability and muscular atrophy as well as stiffening of the deformity has been observed. The classic signs of inflammation occur inn activated osteoarthritis and include pain, hyperthermia, swelling, redness and impairment.

DIAGNOSIS

Conventional x-rays show typical changes that include asymmetric (“eccentric”) joint space narrowing, subchondral sclerosis, the building up of osteophytes with cysts and, in severe cases, deformity and erosions. Small osteophytes or joint effusion can be observed using ultrasound (US). In primary osteoarthritis, laboratory findings alone are not of diagnostic value. Joint aspiration is not inflammatory (less than 2000 cells/μL to 200-500 cells/μL, predominantly mononuclear inflammatory cells) and may include hydroxyapatite crystals.

THERAPY