When synovial fluid is aspirated, 1 ml or more should be placed into a sterile tube for possible culture and a similar quantity into a heparinized tube for cell count. The remainder can be used for other procedures. A cell count is performed on anticoagulated fluid using 0.9% saline as the WBC pipette diluent (the […]
Arthritis and arthralgia may be present in 4%-23% of patients with primary biliary cirrhosis. One report indicates that many more have radiologic abnormalities of erosive arthritis but have no symptoms. About 50% of patients with hemochromatosis and about 25% of patients with chronic active hepatitis develop arthritis or arthralgias; up to 40% of patients with […]
Septic arthritis is most often monoarticular but may affect more than one joint. Bacteria responsible for joint infection vary with age group, similar to the organisms producing meningitis. Haemophilus influenzae, Staphylococcus aureus, and gram-negative bacteria predominate in early childhood; S. aureus, pneumococci, and streptococci in later childhood; and S. aureus, pneumococci, streptococci, and gonococci in […]
Pseudogout is caused by calcium pyrophosphate crystal deposition. It clinically resembles gout to some degree but tends to affect large joints such as the knee rather than small peripheral joints. Joint x-ray films indicate some differences from classic gout but are frequently not a sufficient basis for diagnosis. Synovial fluid examination discloses calcium pyrophosphate crystals, […]
Gout usually involves single specific joints, usually including some of the small joints of the extremities. The most typical location is the metatarsal-phalangeal joint of the great toe, which is affected in about 75% of patients. The knee and ankle are involved in about 50% of patients. One third or more of patients have more […]
Increased bone turnover occurs during normal preadult growth; destruction of bone from accidental, metabolic, or neoplastic causes; and as an effect of certain medications. For many years skeletal x-ray was the only clinical method used to detect bone change. Unfortunately, significant change could not be seen until about 50% of bone density was lost. Later, […]
The category of idiopathic inflammatory myopathies includes several entities involving progressive muscle weakness due to muscle inflammation of known etiology, primarily involving proximal muscles with a typically symmetrical distribution. There are elevated levels of various muscle-associated enzymes such as creatine kinase (CK), certain electromyographic abnormalities, and microscopic chronic inflammatory infiltrate in the affected muscle. Because […]
Immune complexes involve the binding of antigen to specific antibody and form part of the normal host response to foreign antigens. In some cases, immune complexes apparently can be deposited in tissues or organs and produce tissue injury. Blood vessels are most frequently involved. Although immune complexes may involve IgG, IgA, or IgM antibody, immunoglobulin […]
This condition overlaps with temporal arteritis in many respects. Both occur in the same age group and both have the same general systemic symptoms and laboratory abnormalities, including elevated ESR, in about the same frequency. The major difference is that the principal symptom of polymyalgia is aching and stiffness in proximal joints such as the […]
Actually, temporal arteritis is a subdivision of giant cell arteritis. The disorder involves medium-sized and large arteries, including the aorta. There is a granulomatous inflammation with varying numbers of multinucleated giant cells that involves the vessel wall in a discontinuous, or “skip,” fashion and disrupts the artery internal elastic membrane. In temporal arteritis, most (but […]
