Ebook hospital for special surgery manual of rheumatology and outpatient orthopedic disorders - Diagnosis and therapy (5th edition): Part 2
➤ Gửi thông báo lỗi ⚠️ Báo cáo tài liệu vi phạmNội dung chi tiết: Ebook hospital for special surgery manual of rheumatology and outpatient orthopedic disorders - Diagnosis and therapy (5th edition): Part 2
Ebook hospital for special surgery manual of rheumatology and outpatient orthopedic disorders - Diagnosis and therapy (5th edition): Part 2
206 Part IV: Diagnosis and TherapyE.Anti-inflammatory drugs1NSAIDs in appropriate doses arc used for acute inflammation.2Corticosteroids, given system Ebook hospital for special surgery manual of rheumatology and outpatient orthopedic disorders - Diagnosis and therapy (5th edition): Part 2mically or locally as injections with a local anesthetic, can also be beneficial in certain cases. The injected area should be cooled with ice for 24 hours after injection, and adequate analgesics should be prescribed to counteract the pain experienced when the local anesthetic wears off. The use of Ebook hospital for special surgery manual of rheumatology and outpatient orthopedic disorders - Diagnosis and therapy (5th edition): Part 2 a long-acting local anesthetic such as bupivacaine can minimize the pain associated with corticosteroid injections. A suspension of 20 to 40 mg of meEbook hospital for special surgery manual of rheumatology and outpatient orthopedic disorders - Diagnosis and therapy (5th edition): Part 2
thylprednisolone acetate is the most frequently used preparation. Not more than three injections should be administered over weeks or months. Steroid 206 Part IV: Diagnosis and TherapyE.Anti-inflammatory drugs1NSAIDs in appropriate doses arc used for acute inflammation.2Corticosteroids, given system Ebook hospital for special surgery manual of rheumatology and outpatient orthopedic disorders - Diagnosis and therapy (5th edition): Part 2y unresponsive to “blind” injections.F.Surgery is the treatment of choice when nonoperative therapy has failed. It involves repair of a degenerative tendon, as in tennis elbow; release of fibro-osseous tunnels, as in de Quervain’s disease; and tenosynovcctomy for chronic wrist tenosynovitis, a commo Ebook hospital for special surgery manual of rheumatology and outpatient orthopedic disorders - Diagnosis and therapy (5th edition): Part 2n manifestation of RA.Diagnosis and TherapyKEY POINTS■Rheumatoid arthritis (RA) is a systemic inflammatory disease that affects predominantly the joinEbook hospital for special surgery manual of rheumatology and outpatient orthopedic disorders - Diagnosis and therapy (5th edition): Part 2
ts.■Proinflammatory cytokines tumor necrosis factor-™ (TNF-™) and interleukin-1 (IL-1) are major mediators of the disease.■Highly specific anti-cyclic206 Part IV: Diagnosis and TherapyE.Anti-inflammatory drugs1NSAIDs in appropriate doses arc used for acute inflammation.2Corticosteroids, given system Ebook hospital for special surgery manual of rheumatology and outpatient orthopedic disorders - Diagnosis and therapy (5th edition): Part 2ular manifestations should be recognized early and be treated aggressively.■Early initiation of treatment with an aim to achieve a stage of disease remission prevents future complications and improves prognosis.Chapter 29: Rheumatoid Arthritis 207INTRODUCTIONI.Rheumatoid arthritis (RA) is a chronic, Ebook hospital for special surgery manual of rheumatology and outpatient orthopedic disorders - Diagnosis and therapy (5th edition): Part 2 systemic, immune-mediated inflammatory disease that affects at least twice as many women as men. Although RA affects predominantly the joints, epidemEbook hospital for special surgery manual of rheumatology and outpatient orthopedic disorders - Diagnosis and therapy (5th edition): Part 2
iologic studies have unearthed disturbing information about the true potential of this disease: RA leads to joint damage within the first 2 years; cau206 Part IV: Diagnosis and TherapyE.Anti-inflammatory drugs1NSAIDs in appropriate doses arc used for acute inflammation.2Corticosteroids, given system Ebook hospital for special surgery manual of rheumatology and outpatient orthopedic disorders - Diagnosis and therapy (5th edition): Part 2inated peptide (anti-CCP): RE is an immunoglobulin M (IgM) antibody against the Fc portion of an IgC molecule, and is the main serologic marker of the disease found in 75% to 80% of patients. Another important disease-specific auto antibody, anti-CCP antibody has been recognized and serves as a sens Ebook hospital for special surgery manual of rheumatology and outpatient orthopedic disorders - Diagnosis and therapy (5th edition): Part 2itive and specific diagnostic and prognostic tool in the early stages of the disease, when patients may not yet have developed RF in their scrum.III.CEbook hospital for special surgery manual of rheumatology and outpatient orthopedic disorders - Diagnosis and therapy (5th edition): Part 2
ytokines and immune cell networks have been identified as important mediators in the pathogenesis and perpetuation of inflammation in RA. This informa206 Part IV: Diagnosis and TherapyE.Anti-inflammatory drugs1NSAIDs in appropriate doses arc used for acute inflammation.2Corticosteroids, given system Ebook hospital for special surgery manual of rheumatology and outpatient orthopedic disorders - Diagnosis and therapy (5th edition): Part 2actor-a (TNF-a) and interleukin-1 (IL-1) antagonists.I.NO CLEAR ETIOLOGY HAS BEEN DEFINED. I here is substantial experimental evidence that the initiation of RA is a T-ccll-mediatcd, antigen-specific process. The arlhritogenic antigen has not yet been defined but it could be either an exogenous anti Ebook hospital for special surgery manual of rheumatology and outpatient orthopedic disorders - Diagnosis and therapy (5th edition): Part 2gen, such as a viral protein, or an endogenous protein such as citrullinated peptides.II.The synovial membrane in patients with RA is characterized byEbook hospital for special surgery manual of rheumatology and outpatient orthopedic disorders - Diagnosis and therapy (5th edition): Part 2
hyperplasia, increased vascularity, and an infiltrate of inflammatory cells, primarily CD4+ T cells, which arc the main orchestrators of cell-mediate206 Part IV: Diagnosis and TherapyE.Anti-inflammatory drugs1NSAIDs in appropriate doses arc used for acute inflammation.2Corticosteroids, given system Ebook hospital for special surgery manual of rheumatology and outpatient orthopedic disorders - Diagnosis and therapy (5th edition): Part 2uch as psoriatic arthritis. One characteristic feature of RA is the invasion of and damage to cartilage, bone, and tendons by an infiltrating inflammatory synovial tissue mass called the pannus.III.CELLULAR IMMUNITYA.CD4+ T cells constitute most T cells in the rheumatoid synovium. Often they form ly Ebook hospital for special surgery manual of rheumatology and outpatient orthopedic disorders - Diagnosis and therapy (5th edition): Part 2mphoid aggregates in the subintimal area. B lymphocytes are also present in the synovium, where they arc surrounded by T cells in follicle formation.Ebook hospital for special surgery manual of rheumatology and outpatient orthopedic disorders - Diagnosis and therapy (5th edition): Part 2
B cells process autoantigen and contribute to the inflammatory process. B cells can differentiate into plasma cells and produce RE under the influence206 Part IV: Diagnosis and TherapyE.Anti-inflammatory drugs1NSAIDs in appropriate doses arc used for acute inflammation.2Corticosteroids, given system Ebook hospital for special surgery manual of rheumatology and outpatient orthopedic disorders - Diagnosis and therapy (5th edition): Part 2nd dendritic cells, both important in antigen presentation, are also found and are important sources of proinflammatory cytokines such as TNF-a and IL-1. Neutrophils arc found predominantly in the synovial fluid, and are important mediators of tissue damage via the release of various enzymes.IV.CYTO Ebook hospital for special surgery manual of rheumatology and outpatient orthopedic disorders - Diagnosis and therapy (5th edition): Part 2KINES AND OTHER SOLUBLE MEDIATORS. Cytokines are local protein mediators involved in cell growth and activation, inflammation, immunity, and differentEbook hospital for special surgery manual of rheumatology and outpatient orthopedic disorders - Diagnosis and therapy (5th edition): Part 2
iation. The important role of cytokines in the pathogenesis of RA has been demonstrated by the effectiveness of therapies that target TNF-a and IL-1, 206 Part IV: Diagnosis and TherapyE.Anti-inflammatory drugs1NSAIDs in appropriate doses arc used for acute inflammation.2Corticosteroids, given system Ebook hospital for special surgery manual of rheumatology and outpatient orthopedic disorders - Diagnosis and therapy (5th edition): Part 2mainly by monocytes/macrophages and are potent stimulators of mesenchymal cells such as synovial fibroblasts, osteoclasts, and208 Part IV: Diagnosis and Therapychondrocytes that release tissue-destroying matrix metalloproteinases (MMPs). TNF-a is considered to he the master regulator of the inflamma Ebook hospital for special surgery manual of rheumatology and outpatient orthopedic disorders - Diagnosis and therapy (5th edition): Part 2tory cascade in rheumatoid synovium.B. A number of anti-inflammatory cytokines such as IL-10, IL-4, and TGF-B arc also detected in the rheumatoid synoEbook hospital for special surgery manual of rheumatology and outpatient orthopedic disorders - Diagnosis and therapy (5th edition): Part 2
vium and synovial fluid, hut are unable to downregulate the inflammatory response cither because they arc present in low concentrations or (heir actio206 Part IV: Diagnosis and TherapyE.Anti-inflammatory drugs1NSAIDs in appropriate doses arc used for acute inflammation.2Corticosteroids, given system Ebook hospital for special surgery manual of rheumatology and outpatient orthopedic disorders - Diagnosis and therapy (5th edition): Part 2cipate in acute inflammation, arc effector molecules that mediate tissue destruction.V.AUTOANTIBODIESA.RFs arc antibodies that bind to the Fc portion of IgG. The mechanisms initiating RT production and its exact role in disease pathogenesis have still not been established. RE is found in the serum o Ebook hospital for special surgery manual of rheumatology and outpatient orthopedic disorders - Diagnosis and therapy (5th edition): Part 2f 75% to 80% of patients with RA (who are therefore called “seropositive”), is locally produced in the synovial membrane, and may be present in the scEbook hospital for special surgery manual of rheumatology and outpatient orthopedic disorders - Diagnosis and therapy (5th edition): Part 2
rum of patients with other diseases characterized by B cell or immune hyperactivity, such as chronic hepatitis c infection, bacterial endocarditis, an206 Part IV: Diagnosis and TherapyE.Anti-inflammatory drugs1NSAIDs in appropriate doses arc used for acute inflammation.2Corticosteroids, given system Ebook hospital for special surgery manual of rheumatology and outpatient orthopedic disorders - Diagnosis and therapy (5th edition): Part 2d nodules, other extra-articular disease manifestations, and human leucocyte antigen (HLA)-I)R4 positivity.B.Anri-CCP antibodies are detected in up to two-thirds of patients with RA sera and in less than 5% of controls. Anti-CCP antibodies show the highest disease specificity (95%) for RA of any ant Ebook hospital for special surgery manual of rheumatology and outpatient orthopedic disorders - Diagnosis and therapy (5th edition): Part 2ibody known. They arc already present in patients w ith early RA and predict the development of more severe disease. I heir sensitivity is comparableEbook hospital for special surgery manual of rheumatology and outpatient orthopedic disorders - Diagnosis and therapy (5th edition): Part 2
to RE occurring in 50% to 75% of patients with established disease. Their role in the pathogenesis of RA is unknown.VI.GENETIC FACTORSA.Twin and famil206 Part IV: Diagnosis and TherapyE.Anti-inflammatory drugs1NSAIDs in appropriate doses arc used for acute inflammation.2Corticosteroids, given system Ebook hospital for special surgery manual of rheumatology and outpatient orthopedic disorders - Diagnosis and therapy (5th edition): Part 2hen compared with unrelated individuals. Studies of mono- and dizygotic twins have shown disease concordance rates of 12% to 15% and 4%, respectively. These twin concordance figures show that the risk of disease in relatives of affected individuals is conferred by shared genetic factors but also emp Ebook hospital for special surgery manual of rheumatology and outpatient orthopedic disorders - Diagnosis and therapy (5th edition): Part 2hasizes that genetics is not the sole determinant.B.The major histocompatibility complex (MHC). In genetic studies, RA is strongly linked to haplotypeEbook hospital for special surgery manual of rheumatology and outpatient orthopedic disorders - Diagnosis and therapy (5th edition): Part 2
s containing the MI IC class II antigens IILA-DR4 and IILA-DR1. On further molecular characterization, the association was confined to a short sequenc206 Part IV: Diagnosis and TherapyE.Anti-inflammatory drugs1NSAIDs in appropriate doses arc used for acute inflammation.2Corticosteroids, given system Ebook hospital for special surgery manual of rheumatology and outpatient orthopedic disorders - Diagnosis and therapy (5th edition): Part 2LA-DRỊ31 *0401, *0404, and *0408, in general populations and some others in specific ethnic groups) are RA-associared alleles. The main function of MHC class II molecules is to present antigenic peptides to CĐ4-I- I cells. These MHC genes are related not only to the initiation of the disease but als Ebook hospital for special surgery manual of rheumatology and outpatient orthopedic disorders - Diagnosis and therapy (5th edition): Part 2o to its course and severity.PREVALENCEGọi ngay
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