Rheumatoid arthritis chronic autoimmune systemic inflammatory disease of

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Rheumatoid arthritis chronic autoimmune systemic inflammatory disease of connective tissue, mainly affecting the joints

Rheumatoid arthritis chronic autoimmune systemic inflammatory disease of connective tissue, mainly affecting the joints of the type of erosive-destructive progressive polyarthritis

Deforming osteoarthrosis chronic degenerative joints disease, starting with dystrophy and destruction of articular cartilage,

Deforming osteoarthrosis chronic degenerative joints disease, starting with dystrophy and destruction of articular cartilage, followed by changes of the bone and joint surfaces and joint deformity

Gout Metabolic disease with disturbance of purine metabolism and the accumulation of uric acid

Gout Metabolic disease with disturbance of purine metabolism and the accumulation of uric acid in the body flowing repeated attacks of acute arthritis

Complaints • pain in the joints - arthralgia • constraint movements in the morning

Complaints • pain in the joints - arthralgia • constraint movements in the morning • tender and limited articulation • joints deformation (shape change) • swelling of the joints • reddening skin and increase temperature over affected joint

ARTHRALGIA • location • intensity • duration • effect of exercise and other factors

ARTHRALGIA • location • intensity • duration • effect of exercise and other factors that can provoke pain Prevalence: § monoartrit § oligoarthritis § polyarthritis Symmetry of the affections Small or large joints

LOCATION Small joints Symmetrical affections Large joints Metatarsophalangeal joint of the big toe Intensity

LOCATION Small joints Symmetrical affections Large joints Metatarsophalangeal joint of the big toe Intensity Duration G RA DO G Connection with the physical load and movements Intensified at night to the morning, morning constraint of movements, decreased during movements Intensified to the evening after load and movements, decreased at rest Sudden night attacks after errors in diet

• limited articulation ankylosis duck gait INSPECTION • shape change: swelling deformation defiguration

• limited articulation ankylosis duck gait INSPECTION • shape change: swelling deformation defiguration • rashes of the nodular character: tophus rheumatoid nodus • reddening skin over affected joint • skin hyperpigmentation over affected joint

FORM CHANGE Inflammatory swelling of the synovial membrane Swelling Effusion in the joint cavity

FORM CHANGE Inflammatory swelling of the synovial membrane Swelling Effusion in the joint cavity periarticular soft tissue damage: periarthritis, bursitis

Defiguration Changing of the joint shape as a result of the gross changes of

Defiguration Changing of the joint shape as a result of the gross changes of the synovial membrane and periarticular tissues

Deformation Persistent change of the joint shape due to bony growths, destruction of the

Deformation Persistent change of the joint shape due to bony growths, destruction of the bones articular ends, ankylosis development

DO deformation Heberden's nodes - dense bony growths incipient from the base of the

DO deformation Heberden's nodes - dense bony growths incipient from the base of the terminal and head of middle hand joints phalanges Bouchard nodes - growths at the base of the middle fingers phalanges

Specific deformation of the joints, their subluxation and ankylosis are “visiting card” of the

Specific deformation of the joints, their subluxation and ankylosis are “visiting card” of the RA: q deviation of the hand in the ulna direction - seal's fin deformity q flexion contracture of proximal and hyper-distension of distal interphalangeal joints - button-hole deformity q flexion contracture of the metacarpophalangeal joint with hyperdistension in the proximal and flexion in the distal joint - swan-neck deformity of the finger

Rashes of the nodular character Tophus - whitish nodules containing amorphous mass of monosodium

Rashes of the nodular character Tophus - whitish nodules containing amorphous mass of monosodium urate Rheumatoid nodus - subcutaneous formation on the extensor surfaces (elbows)

• tenderness • swelling of tissues PALPATION surrounding the affected joint • overlying

• tenderness • swelling of tissues PALPATION surrounding the affected joint • overlying skin is hot to the touch • defiguration • muscular atrophy • deformation • calcifications, nodules, tophi • the presence of free fluid in the joint • limitation of the passive movements (goniometer) • crepitation

Additional methods examination X-ray § osteoporosis § osteosclerosis § osteophytes § changes of the

Additional methods examination X-ray § osteoporosis § osteosclerosis § osteophytes § changes of the joint space § state of the bone subchondral part § subluxations § ankylosis arthroscopy § degeneration of menisci and ligament apparatus § cartilage changes § synovial membrane state § biopsy

RА - osteoporosis (especially periarticular), in the future: joint space narrowing, uzuration, raceme like

RА - osteoporosis (especially periarticular), in the future: joint space narrowing, uzuration, raceme like restructuring of subchondral bone part, subluxations, ankylosis. Hands, feet

DO– osteophytes, joint space narrowing in the future: the deformation of the articular ends

DO– osteophytes, joint space narrowing in the future: the deformation of the articular ends of bones No ankylosis

Gout – intraosseous cystoid formation due to the formation of tophi, erosion in the

Gout – intraosseous cystoid formation due to the formation of tophi, erosion in the subchondral bone area, osteolysis The big toe

Laboratory diagnosis BA – inflammatory process RА Immunological examination - rheumatoid factor DO Biochemical

Laboratory diagnosis BA – inflammatory process RА Immunological examination - rheumatoid factor DO Biochemical examination G - СRP – uric acid in the blood - seromucoid, sialic acid - fibrin