Arthritis Jilibka: Qaababka Sawirka Cilad-sheegidda II | El Paso, TX.

Dareenka Dheecaanka Sagittal

• Dheecaannada Sagittal ee xasaasiga ah ee MR jeex ah oo muujinaya cyst weyn oo popliteal (Baker's) cyst (sawirka sare) iyo dheecaanka synovial ee la qiyaasi karo (sawirka hoose ka sarreeya)
• U fiirso meelo badan oo calaamad madow ah oo labada sawir ah, oo ka dhigan kaydka bararka fibrinoid aka "jidhka bariiska" sifo MRI ah oo RA ah.

Gudbinta Rheumatological Maareynta & DRM

• Maareynta muxaafidka ah oo ay ku xigto daryeelka qalliinka ee xaaladaha adag ee dillaaca seedaha iyo kala-baxa kala-goysyada
• Akhriska dheeriga ah:
• Ogaanshaha iyo Maareynta Rheumatoid Arthritis – AAFP
• www.aafp.org/afp/2011/1201/p1245.html

Septic Arthritis (SA)

• Septic arthritis – d/t wasakhowga bakteeriyada ama fungal ee wadajirka. SA waxay sababi kartaa burbur wadajir ah oo degdeg ah waxayna u baahan tahay Dx degdeg ah iyo maamulka antibiyootiga
• Kala-goysyada ayaa saameeya: kala-goysyada waaweyn oo leh dhiig hodan ah (jilibka 50%>miskaha>garbaha).
• Wadooyinka caabuqa:
• 1) Hematogenous waa m/c
• 2) Ku faafi meel ku dhow
• 3) Gelitaanka tooska ah (tusaale, trauma, itrogenically)
• Bukaannada halista ugu jira: carruurta, macaanka, difaaca jirka, dhaawaca wadajirka/barar horay u jiray, tusaale, RA, iwm.
• Isticmaalayaasha maandooriyaha faleebbaha ayaa si gaar ah khatar ugu jira waxayna sidoo kale wasakhayn karaan kala-goysyada aan caadiga ahayn ee "kala-goysyada S" SIJ, SCJ, Symphysis pubis, ACJ, iwm.

 

• Caafimaad ahaan: way kala duwanaan kartaa waxayna ku xidhan tahay jawaabta difaaca ee martida loo yahay iyo fayraska bakteeriyada. Waxaa laga yaabaa inuu la yimaado bilaw degdeg ah ama ka sii dara xanuunka wadajirka ah ee hore u jiray, barar, xaddidnaanta ROM. Calaamadaha guud ee xumayn, qandho, daal iyo kor u kaca ESR, CRP, Leukocytosis ayaa laga yaabaa.
• NB Diabetes and immunocompromised waxaa laga yaabaa inay la yimaadaan astaamo yar iyo xummad la'aan d/t jawaabcelinta difaaca oo hoos u dhacda.
• Dx: bukaan-socod, shucaac iyo shaybaar. Arthrocentesis waxay lagama maarmaan u noqon kartaa dhaqanka, tirada unugyada iyo baaritaanka synovial ee purulent
• Maareynta: antibiyootiga IV
• Sawirka Dx: Waxay ku bilaabataa shucaaca laakiin marxaladda hore waxay u badan tahay inay noqon doonto mid aan la arki karin. MRI waxay noqon kartaa mid xasaasi ah oo kaa caawin karta in goor hore la ogaado dheecaanka wadajirka ah, bararka lafaha, iwm. Waxaa laga yaabaa in Maraykanku uu ku caawiyo kala-goysyada kore iyo carruurta. Maraykanku wuxuu ku caawiyaa hagidda irbadda. Scintigraphy lafaha ayaa laga yaabaa in loo isticmaalo marmar haddii MRI la diidayo

Wadooyinka Wasakhda Wadajirka ah

 

• 1. Hematogenous (M/C)
• 2. Ka faafi goobta ku xigta
• 3. Tallaalka tooska ah
• M/C noolaha-Staph aureus
• NB Infakshanka Gonococcal wuxuu noqon karaa kala duwanaansho sare xaaladaha qaarkood
• Isticmaalayaasha daroogada IV: Pseudomonas, candida
• Unugga sickle: Salmonella
• Qaniinyada xayawaanka (bisadaha/eyyada): Pasteurella
• Mararka qaarkood wasakhowga fungal ayaa dhici karta

raajada

 

• Markii hore ST/ shuban wadajir ah oo aan gaar ahayn, madmadow/ qalloocin diyaaradaha dufanka leh. Sababtoo ah waxay qaadataa 30% isafgaradka iyo 50-75% lafaha trabecular in la burburiyo ka hor inta aan lagu arkin raajada, shucaaca waa dareen la'aan qaar ka mid ah isbeddelada hore. MR imaging waa habka la door bidayo
• Haddii MRI aan la heli karin ama la diiday. Scintigraphy lafaha oo leh Tc-99 MDT ayaa ku caawin kara
• Carruurta, Maraykanku wuxuu doorbiday inuu iska ilaaliyo shucaaca ionizing. Carruurta, Maraykanku aad ayuu uga nugul yahay dadka waaweyn sababtoo ah korriinka lafaha

Radiographic Dx

 

• Natiijooyinkii hore waa kuwo aan faa'iido lahayn. Astaamaha hore waxa ka mid noqon kara fidinta wadajirka ah ee d/t. Bararka jilicsan ee jilicsan iyo mugdiga / barokaca diyaaradaha baruurta
• 1-2 toddobaad: isbeddellada periarticular iyo kuwa ku xiga ee lafaha ayaa muujinaya sida demineralization pachy, aboor-cunida, burburka lafaha, luminta, iyo kala-baxa epiphyseal "line cortical line" oo leh korodhka bararka unugyada jilicsan. MRI waxay ku caawin kartaa hore Dx.
• Astaamaha dambe: burbur wadajir ah oo dhammaystiran iyo ankyloses
• NB Septic arthritis-ku wuxuu si degdeg ah u horumari karaa maalmo gudahood wuxuuna u baahan yahay antibiyootik IV hore si looga hortago burbur weyn oo wadajir ah

T1 & T2 MRI jilibka

 

• T1 (korka bidix) iyo T2 dufan-sat sagittal jilibka MRI jeexjeexyada ayaa muujinaya luminta calaamadda dhuuxa caadiga ah ee T1 waxayna kordhisaa T2 sababtoo ah bararka septic. sequestrum lafaha d/t osteomyelitis oo u gudbaya septic arthritis-ka ayaa la xusay. Dhiigbax wadajir ah oo calaamadeysan oo leh bararka nudaha jilicsan ee ku xiga ayaa la arkaa. Dx: OSM iyo arthritis-ka septic

• Sawirku wuxuu caawin karaa Dx ee wadajirka septic. Si kastaba ha ahaatee, Dx kama dambaysta ahi waxay ku salaysan tahay Hx, baadhis jidheed, baadhitaano dhiig iyo tan ugu muhiimsan ee hamiga synovial (arthrocentesis)
• Dheecaannada synovial waa in loo diraa midabaynta Gram, dhaqanka, baaritaanka gulukooska, tirada leukocytes, iyo go'aaminta kala duwan
• ESR/CRP waa la kordhin karaa
• Dheecaannada synovial: WBC waxay noqon kartaa 50,000-60,000/ul, oo leh 80% neutrophils oo leh heerar gulukoos oo daciifay: 75% gram-positive cocci. Wasaaqaynta garaamku aad ayay ugu nugul tahay infekshanka gonococcal oo leh 25% oo keliya dhaqamada +
• 9% kiisaska, dhaqamada dhiiga ayaa ah isha kaliya ee aqoonsiga cudur-sidaha waana in la helaa kahor daawaynta antibiyootiga
• Articles: www.aafp.org/afp/2011/0915/p653.html
• www.aafp.org/afp/2016/1115/p810.html

Arthritis jilibka oo ay keentay Crystal

• Crystalline Arthritis: koox ka mid ah arthropathies oo ka dhashay dhigaalka crystal ee gudaha iyo hareeraha wadajirka.
• 2-m/c: Monosodium urate crystals (MSU) � iyo Calcium Pyrofosfate kiristaalo (CPPD) arthropathy
• Gout: Dhigista MSU gudaha iyo hareeraha kala-goysyada iyo unugyada jilicsan. Heerarka sare ee serum uric acid (UA) (>7mg/dL) oo ay sababto wax soo saarka xad-dhaafka ah ama dheecaanka uric acid
• Marka UA gaadho/ dhaafto 7mg/dL, waxay ku shubi doontaa unugyada durugsan. Gout aasaasiga ah: dheef-shiid kiimikaad khalkhalka leh ee acids nucleic iyo purines ayaa burbura. Gout-ka sare: korodhka wareegga unugyada: Psoriasis, leukemia, multiple myeloma, hemolysis, chemotherapy, iwm.
• Xididdada waxay soo bandhigtaa 5-dabeecadood:
• 1) hyperuricemia asymptomatic (sanado/toban sano)
• weerarrada ba'an ee gouty arthritis-ka (waxes iyo dhumucyada oo socda dhowr sano)
• Wejiga u dhexeeya weerarrada
• Gout korka daba-dheeraada
• Gouty nephropathy

 

Soo Bandhigida Caafimaadka

• Waxay ku xiran tahay marxaladaha
• Weeraro ba'an: xanuun kalagoysyo ah oo ba'an "marka hore iyo kan ugu xun" xitaa xanuun yar oo taabasho ah
• DDx: kala-goysyada septic-ga (labadaba way wada jiri karaan) bursitis iwm.
• Gouty arthritis-ku wuxuu caadi ahaan u soo bandhigaa sida monoarthropathy
• Marxaladda sare ee daba-dheeraatay: kaydka kala goysyada, pinna dhegta, qaababka indhaha, iyo gobollada kale. Nephrolithiasis iwm. Ragga>haweenka. Cayilka, cuntada, iyo da'da> 50-60.
• Shucaaca: Weerarrada hore waa kuwo aan la arki karin waxaana laga yaabaa inay soo baxaan sida dheecaan wadajir ah oo aan gaar ahayn
• Raadyogaraafka kore ee kore ee raaga: la feeray nabaad-guurka wareega-articular, goo-goysyada iyo gudaha gudaha Cirifka sifada ah ee sclerosis iyo caleenta gudaha, tophi unug jilicsan. Goobaha bartilmaameedka ah: cirifka hoose m/c
• Rx: allopurinol, colchicine (tus. ka hortagga xaaladaha degdega ah iyo dayactirka)

Hamiga Synovial

 

• Hamiga Synovial oo leh mikroskoob kala-sooc leh ayaa muujinaya kiristaalo Irbad u qaabaysan oo si xun u liidata oo leh PMN barar weyn. DDx: kiristaalo CPPD u qaabaysan oo si togan u birefringent (korka hoose ee midig) oo lagu arkay Pseudogout iyo CPPD

 

ST

 

• Cufnaanta iyo dheecaanka wadajirka ah ayaa feeray nabaad-guurka laf-dhabarta leh oo leh xad-dhaaf xad-dhaaf ah, ilaalinta guud ee cufnaanta lafaha, Calcifications gudaha Dx: gout dusha sare ee dabadheeraad ah

Tilmaamaha Rooda MRI

 

• Nabaad-guurka oo leh xad-dhaaf xad-dhaaf ah, calaamad hoose oo T1 ah oo sarreeya T2 iyo sawirro dufan-xakamaysan. Kordhinta isbarbardhigga durugsan ee kaydadka dushooda d/t unugga granulation
• Dx: final Dx; hamiga synovial iyo microscopy polarized

Maqaallo Dheeraad ah

• 10-xaqiiqo ku saabsan gout www.pharmacytimes.com/publications/issue/2013/july2013/a-bout-of-gout-a-region-of-pain
• www.aafp.org/afp/1999/0215/p925.html

Arthritis jilibka