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    The Rheumatic Hand
    The Rheumatic Hand
    The Rheumatic Hand
    Ebook74 pages23 minutes

    The Rheumatic Hand

    By Raphael Micheroli, Giorgio Tamborrini and Diego Kyburz

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    About this ebook

    Many rheumatic diseases cause changes that are visible in the hands. This book provides an overview of the most common rheumatic diseases with a focus on their hand manifestations and includes the following topics: Epidemiology, Etiology and Pathogenesis; Hand Manifestations; Further Clinical Manifestations; and the Diagnosis and Therapy of Each Disease. The rheumatic diseases addressed are osteoarthritis, rheumatoid arthritis, gout, calcium pyrophosphate dihydrate deposition disease, psoriatic arthritis, reactive arthritis, systemic sclerosis and dermatomyositis/polymyositis.
    The non-rheumatic diseases included are diabetic cheiroarthropathy, endocarditis, secondary hypertrophic osteoarthropathy and chronic regional pain syndrome. The roles of clinical evaluation, X-ray, MRI and high-resolution ultrasonographic images are also discussed.
    LanguageEnglish
    PublisherBooks on Demand
    Release dateApr 15, 2015
    ISBN9783735707338
    The Rheumatic Hand
    Author

    Raphael Micheroli

    Raphael Micheroli is a resident physician in training for the board certification of Rheumatology in Switzerland. In November 2015 he will have completed the mandatory two-year period in internal medicine, practicing at the district hospital of Glarus. Thereafter, he will work at the Rheumatology Department of University Hospital of Zurich.

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      Book preview

      The Rheumatic Hand - Raphael Micheroli

      INTRODUCTION

      Many rheumatic diseases show changes that are visible in the hands. Fundamental information on these diseases is revealed by the pattern of distribution in the relevant joints, soft-tissue changes, skin manifestations, neurological and vascular symptoms, and clinical findings. Imaging and lab results provide diagnostic support.

      In this book, these common diseases are presented in terms of their clinical expressions in the hands: osteoarthritis, rheumatoid arthritis, gout, calcium pyrophosphate dihydrate deposition disease, psoriatic arthritis, reactive arthritis, systemic sclerosis and dermatomyositis/polymyositis. Furthermore, we discuss the pathological findings in the hands as a result of diabetic cheiroarthropathy, endocarditis, secondary hypertrophic osteoarthropathy and chronic regional pain syndrome.

      R. MICHEROLI

      G. TAMBORRINI

      D. KYBURZ

      RHEUMATIC-DISEASES

      OSTEOARTHRITIS (OA)

      1a Clinical image showing swelling and deformity of the distal and proximal interphalangeal joints

      1b X-ray image with joint space narrowing (arrowhead), subchondral cyst (arrow), osteophytes (star) and deformities of the distal and proximal interphalangeal joints

      2a-c Ultrasound of the volar longitudinal DIP joint (at the top) and of the longitudinal PIP joint (at the bottom, 2D and 3D) with osteophytes (arrows) and joint effusion (stars)

      EPIDEMIOLOGY

      Osteoarthritis is the most common joint disease. The incidence of coxarthrosis (hip OA) is 40-80/100,000 inhabitants/year, that of gonarthrosis (knee osteoarthritis) is 160-240/100,000 inhabitants/year, and that of finger osteoarthritis is 100/100,000 inhabitants/year. In general, women are affected approximately 1.7 times more frequently. The prevalence in 34-year-olds is as high as 17% but increases to over 90% in people aged 65 and over.

      ETIOLOGY AND PATHOGENESIS

      The causes of primary idiopathic osteoarthritis are unclear. However, genetic predisposition (association with HLA-A1,-B8), endocrine factors and metabolic disorders seem to have an influence.

      Risk factors for secondary osteoarthritis include age, gender (women aged 55 and over are especially affected), joint trauma, obesity, dietary factors, biomechanical malalignment, deformity, inflammatory diseases and diseases of the nervous system. Chondrozytic dysfunction, which is associated with an inadequate synthesis capacitiy, leads to an overall degradation of the cartilage and to a secondary loss of tissue surrounding the joint.

      HAND MANIFESTATIONS

      Osteoarthritis of the finger joints is usually a primary, polyarticular osteoarthritis with an affinity for the distal interphalangeal (DIP)

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