Stuart S Kassan md

Clinical Professor of Medicine, University of Colorado Health Sciences Center Colorado Arthritis Associates, 4200 West Conejos Place, Denver, Colorado 80204 Robert P. Kimberly, m.d. Howard L. Holley Professor of Medicine and Director, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham School of Medicine Director, University of Alabama Arthritis and Musculoskeletal Center, Tinsley Harrison Tower, 1900 University Boulevard, Birmingham, Alabama 35294

Occupational Therapy

Volar Cock Wrist Splint

Occupational therapy provides assistance to persons whose functional level of performance has been affected by physical, psychological, or developmental disabilities. The role of occupational therapy in the treatment of rheumatoid arthritis is to improve or maintain the patient's maximum level of functioning. The overall goal of the treatment is to minimize the effects of pain, decreased mobility, and decreased endurance on a person's ability to perform activities of daily living ADL . To...

Textbooks

Campbell's operative orthopedics, 9th ed. St. Louis Mosby, 1998. Harris ED. Rheumatoid arthritis. Philadelphia WB Saunders, 1997. Kelley WN, et al. Textbook of rheumatology, 5th ed. Philadelphia WB Saunders, 1997. Klippel JH, Dieppe PA. Rheumatology, 2nd ed. London Mosby, 1998. Koopman WJ. Arthritis and allied conditions, 13th ed. Baltimore Williams amp Wilkins, 1997. Lahita RG. Systemic lupus erythematosus, 3rd ed. San Diego Academic Press, 1999. Maddison PJ, et al. Oxford textbook...

Stiffness and contracture

Stiffness of the elbow after trauma is quite common, and physical therapy is usually required to minimize it. The functional range of motion of the elbow is in an arc of approximately 30 to 130 degrees of flexion, and 50 to 150 degrees of pronation-supination range. Each patient must be examined individually to determine whether treatment should be tried and which specific modality is appropriate. Forced, sudden, passive motion can be deleterious. 2. Heterotopic bone...

History of diverticulitis

Patients with chronic constipation. Narcotics taken for pain relief after surgery will greatly aggravate bowel motility in this setting. H. Genitourinary conditions. Because of the effects of bed rest, the use of narcotics and epidural anesthesia, or the presence of prostatic disease, urinary catheters are frequently placed in patients after major joint and back surgery. Such catheters frequently remain in situ for up to 48 hours after surgery, increasing the risk for urinary tract...

Hydroxychloroquine Plaquenil

Potential actions include binding of nucleic acids, stabilization of lysosomal membranes, and trapping of free radicals. Selected Indications RA, SLE, cutaneous LE. Well absorbed from the gastrointestinal tract. The drug is concentrated and retained in body tissues. Excretion by the kidney is detectable months after therapy is discontinued. The most common side effects are allergic eruptions and gastrointestinal disturbances anorexia, nausea, cramps, diarrhea . The...

Arthritis Bibliographi

Etiopathogenesis of reactive arthritis and ankylosing spondylitis. Curr Opin Rheumatol 1995 7 290. Clegg DO, et al. Comparison of sulfasalazine and placebo in the treatment of reactive arthritis Reiter's syndrome . Arthritis Rheum 1996 39 2021. Cremers MCW, et al. Second-line treatment in seronegative spondyloarthropathies. Semin Arthritis Rheum 1994 24 71. Inman RD. Treatment of seronegative spondyloarthropathies. In Klippel J, Weyand CM, eds. Primer on the rheumatic...

The dosage is 150 mg daily Cotrimoxazole Bactrim Septra

Co-trimoxazole is a fixed combination of sulfamethoxazole SMX and trimethoprim TMP , both of which are synthetic folate antagonists. Although most widely used as an antiinfective agent, it has found use in some cases of limited Wegener's granulomatosis. Mild Wegener's granulomatosis, prophylaxis against Pneumocystis carinii infection. Metabolism Co-trimoxazole is rapidly absorbed after oral administration, and peak plasma levels of both components are reached within 4 hours. The liver converts...

Bibliography

Altman R, et al., and the OARS Task Force Osteoarthritis Research Society . Design and conduct of clinical trials in patients with osteoarthritis. Osteoarthritis Cartilage 1996 4 217. Buckland-Wright JC. Quantitative microfocal radiographic assessment of osteoarthritis of the knee from weight bearing tunnel and semiflexed standing views. J Rheumatol 1994 21 1734. Buckland-Wright JC, et al. Accuracy and precision of joint space width measurements in standard and macroradiographs of...

History of rheumatic diseases

Determine the mode of onset, inciting events, duration, and pattern and progression of the musculoskeletal complaints. 1. Acute onset is consistent with infectious, crystal-induced, or traumatic origin. It can also occur in the setting of a connective tissue disorder. Chronic complaints are seen with rheumatoid arthritis RA , seronegative spondyloarthropathies, and osteoarthritis or the chronic sequelae of traumatic or degenerative back problems. 2. The pattern of joint involvement is very...

Transient regional osteoporosis

Stroke Secondary Metastatic

They are marked by a sudden onset of pain that is intensified by weight bearing. As the names imply, transient regional osteoporosis is limited to a single joint or part thereof. Hip pain in middle-aged men or in women in the third trimester of pregnancy is a common presentation of transient regional osteoporosis. Transient migratory osteoporosis most often affects the knee, ankle, and foot. As the name implies, it attacks a variety of joints, most often...

Rheumatic manifestations of hematologic disorders

Hemophilia is an inherited, X-linked recessive disorder of blood coagulation found almost exclusively in males. Female heterozygotes are asymptomatic carriers of the disease. Hemophilia A is caused by a factor VIII deficiency and hemophilia B Christmas disease is caused by a factor IX deficiency. Recurrent joint hemorrhages resulting in a synovial proliferative response and chronic inflammation are responsible for the arthropathy associated with hemophilia....

Osteomyelitis caused by contiguous spread of infection

Plain roentgenograms of the suspect bones. CT if additional detail is needed. Serial roentgenography or CT at intervals during a 4-week period to observe any meaningful osseous changes. b. Indium-labeled leukocyte scan or sequential indium or technetium scan , if suspicion is not strong, for the negative predictive value of a negative scan result. A positive scan result would not be as diagnostic as meaningful osseous changes on serial roentgenograms. c. MRI with gadolinium and fat...

Aims of treatment

Lying External Hip Rotation

Increase proximal muscle strength. 2. Exercises. See Fig 56-10, Fig 56-11, Fig 56-12, Fig 56-13, Fig 56-14, Fig 56-15, Fig 56-16, Fig 56-17 and Fig.,56-23, Fig 56-24, Fig 56-25, Fig 56-26, Fig 56-2.7, Fig 5.6-2.8, Fig 5.6-29, Fig 5.6.-3.0, Fig ,5.6.-3.1 , Fig 56-32 for appropriate exercises used in the treatment of patients with polymyositis and FIG. 56-10. Neck flexion. Sitting or standing with your back straight, bend your head forward and tuck your chin in toward your chest. FIG. 56-11....

Warfarin Sodium Coumadin

Warfarin indirectly alters the synthesis of functional coagulation factors by interfering with vitamin K activity, which is required for t-carboxylation of factors II, VII, IX, and X. Prophylaxis and treatment of deep venous thrombosis, hypercoagulable states, and anti-phospholipid syndrome, and care after cerebrovascular accident. Metabolism Warfarin is generally well absorbed by the gastrointestinal tract, but the rate of absorption can be highly dependent on individual variability and the...

Radionuclide infection scanning

Bilateral Fluid Signal Masses

Scanning with gallium citrate 67 shows increased uptake at sites of infection in the bones or soft tissues. It has a high sensitivity for infection but is nonspecific, as it may show increased uptake associated with other causes of increased bone turnover, including fractures or tumors, and also shows increased uptake in noninfectious inflammatory conditions, such as inflammatory arthritis. The specificity of a gallium scan for infection may be increased if it is compared with a bone scan....

Colchicine ColBenemid ProbenC Col Probenecid

Inhibits the enzyme xanthine oxidase, which converts hypoxanthine to xanthine and xanthine to uric acid. Plasma Hypoxanthine, a more soluble product, and other purine metabolites are excreted in the urine rather than uric acid. inhibit de novo purine synthesis. The efficacy of allopurinol decreases when the creatinine clearance falls below 20 Colchicine inhibits microtubule assembly, which interferes with granulocyte mobility and the inflammatory response to precipitated crystals. Selected...

Medial elbow pain

Inflammation of the medial side of the elbow is less common than inflammation of the lateral side. Overuse at work or throwing sports can initiate the process. As in lateral epicondylitis, there may be some tearing of the fibers of the muscle that originate from the medial side of the elbow. a. Diagnosis. Direct palpation over the medial epicondyle usually elicits pain. This tenderness can be accentuated by resisted active flexion of the wrist. The zone of tenderness in...

Lateral elbow pain 1 Lateral epicondylitis

Tennis elbow or lateral epicondylitis associated with racquet sports is common in amateurs and professionals. Onset can be rather acute or build slowly over months. 1. The diagnosis is made by palpating the area of the lateral epicondyle with the elbow in nearly full extension and asking the patient to extend the wrist against resistance. This usually reproduces pain. 2. Proper racquet size and proper backhand technique can lessen the severity of pain. The first line of...

Inspection

Patients with an acute ligamentous injury often walk with a limp, a flexed knee, or both. b. Swelling effusion. Is there suprapatellar fullness in the standing or prone position Is the joint taut with fluid c. Ecchymosis. Collateral ligament injuries often show external signs of hemorrhage into soft tissue, which can present along the calf or ankle secondary to gravitational flow along muscle sheaths. 2. Range of motion is frequently limited secondary to pain. Lack of extension...

Muscle Pain and Weakness

Kagen y.pper mo.to.r ,n.e,u.ro.n., d.i.s.e.a.s., Nerve. root dlse.as, peripheral nerve diseas Myoneural junction .disease., Myopathic. .Causes Toxin and. dru.g in.du.c.ed m.y.opathy, inflammatory myopathies, infectious. myositis and, .myopathy, Miscellaneous. disorders .presenting as. myopathy HematolofliLstu.dies y.rin.a ry st u.d,i s Electromyography and. electroneurography, Other modalities of imaging or assessing muscle Muscle pain and weakness are commonly...

Monarthritis Polyarthritis Differential Diagnosis

Differential Diagnosis For Polyarthritis

Beary, III Acute monarthritis Chronic., monarthritis Acute .polyarthritis Chronic polyarthritis The number of joints and the time course during which a joint disorder develops guide the approach to differential diagnosis. Acute monarthritis may represent septic arthritis, which is a rheumatologic emergency. Prompt diagnosis and treatment of a potentially septic process are required. The single abnormal joint that persists beyond 2 months presents a different...

Biochemical studies

Determination of synovial fluid glucose, when interpreted with a simultaneous serum value, is helpful in diagnosing infectious arthritis. In bacterial infection or tuberculosis, the synovial fluid glucose will be less than half the serum value. Occasionally, low values may be seen in rheumatoid arthritis RA . 2. Protein determination does not provide additional useful information and should not be routinely ordered. 3. Complement may be decreased in RA, but the test is rarely...

Myopathic Causes

The major causes of myopathy are drugs, toxins, metabolic disturbances, inflammatory syndromes, endocrinopathies, infections, and muscle dystrophies. I. Toxin and drug-induced myopathy A. Steroid myopathy. The insidious onset of proximal muscle weakness in a patient on steroids should suggest steroid myopathy. Myopathy can occur while a patient is on low or high doses of steroids, frequently after a recent increase in dose. The duration of steroid treatment does not correlate with the time of...

Wrist and hands

Thumb Joint Dip Pip

Inspect and palpate wrists metacarpophalangeal MCP , proximal interphalangeal PIP , and distal interphalangeal DIP joints of fingers and carpometacarpal CMC , MCP, and interphalangeal IP joints of thumbs Fig 1-4 . Note shape and deformities boutonniere, swan neck, and ulnar FIG. 1-4. Finger and thumb joints. MCP, metacarpophalangeal PIP, proximal interphalangeal DIP, distal interphalangeal CMC, carpometacarpal IP, interphalangeal. b. Soft-tissue swelling has a spongy consistency and should...