Download - CURS 1 - 2015-16
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CURSUL NR. 1 - 2
STRATEGII DE DIAGNOSTIC IN
REUMATOLOGIE
MG, ANUL IV, 2015 - 2016
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CURSUL 1 si 2
TEMA: STRATEGII DE DIAGNOSTIC INREUMATOLOGIE
CAPITOLUL :1. PRINCIPALELE SINDROAME IN REUMATOLOGIE
2. INVESTIGATIILE BIOLOGICE
3. INVESTIGATIILE IMAGISTICE
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STRATEGII DE DIAGNOSTIC IN REUMATOLOGIE
CAPITOLUL 1 : Principall !in"r#a$ alr%$al#'ii
SUBCAPITOLE :
1(1( Sin"r#$%l "%rr#! r'i#nal1(2( Sin"r#$%l "%rr#! 'nrali)a&1.3. Durerea vertebrala/sp!ala l"#bara$ %erv%ala
&LON'ALGIA(1.). S!*r"#ul art%ular + ar&r#)a, ar&ri&a in*la$ari
1(5( Sin"r#$%l " "ste"p"r",a1(6( Sin"r#$%l #!#!1(+( Sin"r#$%l $%!c%lar1(( Sin"r#$%l !i!&$ic
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STRATEGII DE DIAGNOSTIC IN REUMATOLOGIE
CAPITOLUL 2 : In!&i'a&iil .i#l#'ic
SUBCAPITOLE :
2(1( In*la$arii2(2( M%!c%lar2(/( O!li&ic2(( A%an&ic#rpii2(5( An&i'nl " i!c#$pa&i.ili&a&
2(6( Ea$n%l lici"%l%i !in#ial
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STRATEGII DE DIAGNOSTIC IN REUMATOLOGIE
CAPITOLUL 3 :In!&i'a&iil i$a'i!&ic
SUBCAPITOLE :
/(1( Ea$n%l ra"i#l#'ic/(2( Ul&ra!#n#'ra*ia/(/( CT/(( RMN
/(5( O!"n!i$&ria
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CAITOLUL 1 + r!%paleles!*r"a#e ale reu#at"l"e
SUBCAPITOLE :
1.1. S!*r"#ul *urer"s re"!al1(2( Sin"r#$%l "%rr#! 'nrali)a&1.3. Durerea vertebrala/sp!ala l"#bara$ %erv%ala
&LOM'ALGIA(
1(( Sin"r#$%l ar&ic%lar 3 ar&r#)a, ar&ri&a in*la$ari1(5( Sin"r#$%l $%!c%lar
1(6( Sin"r#$%l !i!&$ic1(+( Sin"r#a$l p"ia&ric
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1.1. SINDROMUL DUREROS REGIONAL
4 De!te +"%rr car a*c&a)a # !in'%ra ari$%!c%l#!cl&ala ( %$ar, $ana !a% 'n%nci
4 Clas%are#ri'in37 D%rr priar&ic%lara pr"#$inan& la %$ar !i c#&
7 D%rr ar&ic%lara 'n%nci, pici#r 3 MT8, IP
7 D%rr n%r#'na (!cia&ica, !in"r#$%l " canalcarpian
7 D%rr ira"ia&a
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1.1.1. Durerea perart%ulara
4 De!te +a*c&ara !&r%c&%ril ana$ic i$plica& in$i!caril ar&ic%lar "ar !i&%a& in a*ara cap!%li ar&ic%lar.%r!, &n"#an, li'a$n&,&c
4 M"r"pat"l"e +in*la$a&ia .%r!l#r, a &n"#anl#r !a% ain!r&ii li'a$n&l#r .%r!i& , &n"ini&-&n#!in#i&
4 Et"l"e +7 Tra%$a&i!$l l#cal, incl%!i !%pra!#lici&ara
7 Mani*!&ari l#cal al .#lil#r r%$a&i!$al !i!&$ic!in#ial PR9 a*c&ara rc%rn&a !a% $%l&ipla3 SpA7 8ara # ca%)a i"n&i*ica.ila
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1.1.1. Durerea perart%ulara
4 Ma!estar %l!%e &s#pt"#e( +
7 Apari&ia:a'raara "%rrii la an%$i& $i!cari
!lc&ii&a&a $i!caril#r "%rr#a!car i$plica !a%c#$pri$a !&r%c&%ril in*la$a&
7 Carac&r%l $canic "!i l)i%nil !%n& " na&%rain*la$ar3 accn&%a& " $i!car, a$li#ra& "rpa%!, r"#ar a.!n&a
7 Apari&ia:a'raara "%rril#r in p#)i&ii car in"%cc#$pr!ia !&r%c&%ril#r in*la$a&("c%.i&%l la&ral p%$ar%l "%rr#! in &n"ini&a r#&aril#r
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1.1.1. Durerea perart%ulara
4 Ma!estar %l!%e &se#!e(+
7 Mi!caril ac&i !%n& $ai "%rr#a! "ca& cl pa!i
7 Mi!caril pa!i n% !%n& li$i&a& in l)i%nil ar&ic%lar"%rra ar in&n!i&a& !i$ilara la a$.l &ip%ri "$i!cari
7 M#.ili)ara c% r)i!&n&a in&n!i*ica "%rril
7 Palpara "irc&a a !&r%c&%ril#r in*la$a& !& "%rr#a!a
7 S%n& a.!n& !$nl l#cal " in*la$a&ic% cp&iain*la$a&ii .%r!l#r !%pr*icial
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1.1. SINDROMUL DUREROS REGIONAL
1.1.1. Durerea perart%ulara
1(1(1(1(;%r!i&l1(1(1(2( Tn#!in#i&l
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1.1.1.1. 'urstele
4 ;%r!a 3 !&r%c&%ra " &ip !ac%lar c c#n&in lici"!inn#ial car pr#&
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1.1.1.1. 'urstele;%r!i&l !#l"%l%i
Bursita trohanteriana
Bursita iliopsoasului
Bursita ischiatica
(ischiogluteala)
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1.1.1.1. 'urstele;%r!i&l !#l"%l%i 3 .%r!i&a &r#an&riana
4 'URSATRO0ANTERIANA
7 In&r $arl&r#an&r al*$%r%l%i !i&n"#n%l $%!ci%l%i
*!ir $ar.%r!i&a&r#an&rianapr#*%n"a
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1.1.1.1. 'urstele
;%r!i&l !#l"%l%i 3 .%r!i&a &r#an&riana
4 Este %ea #a re%ve!ta %au,a *e *urere as"l*ulu
4 8acri " ri!c 3 !%l *$inin, ar!&a
$"i:inain&a&a
4 Cau,a #a"ra + tulburar ale #ersulu7 a*c&i%ni l#$.#!acra&3 !c#li#)a l#$.ara, ar&r#)a7 in'ali&a&a $$.rl#r7 a*c&ara ar&ic%la&iil#r !acr#iliac7 ar&ri&a 'n%nci%l%i
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1.1.1.1. 'urstele
;%r!i&l !#l"%l%i 3 .%r!i&a &r#an&riana
4 D%rr !p#n&ana !i lapalpar l#cali)a&a la nil%l&r#an&r%l%i, c% ira"irp *a&a la&rala a c#ap!i
4 D%rra !& accn&%a&a" 3
7 $r!,
7 "c%.i&%l la&ral paca!i par&,
7 $i!cara " r#&a&i&rna !i a."%c&ic#n&ra r)i!&n&i
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BURSITA TROHANTERIANA
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Mi!cara " r#&a&i &rnaA."%c&i c#n&ra r)i!&n&i
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1.1.1.1. 'urstele
;%r!i&l !#l"%l%i 3 .%r!i&a &r#an&riana
4 Dia'n#!&ic 37 Ana$n)a 3 *acri
*a#ri)an&i, l#cali)ara"%rrii, c#n"i&ii "acr.ar !ia$li#rar in*il&ra&il#cala c% ilina
7 Ea$n%l clinic7 Ea#e! ra*"l"% al
ba,!ulu + *e e%lusle,u! "ste" -art%ulare as"%ate
7 RMN 3 "ia'n#!&ic"i*rn&ial
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1.1.1.1. 'urstele
;%r!i&l !#l"%l%i 3 .%r!i&a &r#an&riana
4 Dia'n#!&ic "i*rn&ial 3
7 8rac&%ra " !&r!!
78rac&%ril #c%l&
7M&a!&a)l
7D%rra ra"ic%lara
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BURSITA ISCHIOGLUTEALA
Localizare : intre marele fesier si
tuerozitateaisc!iatica
Cauze : ciclismul" se#erea
$relun%ita $esu$rafete tari
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BURSITA ISCHIOGLUTEALA
Caractere clinice :
#urerea see&acereaza in $ozitiasezan# si la $resiune$e tuerozitatea
isc!iatica'
$oate ira#ia $e fata$osterioara a coa$sei
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BURSELE GE(U(CHIULUI
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1.1.1.1. 'urstele;%r!l 'n%nci%l%i3 .%r!i&a p#pli&
In)amatia ursei $o$litee *ursele %astrocnemianuluisi a semimemranosului+ $ro#uce c!istul Ba,er *masaelastica $al$aila in s$atiul $o$liteu+
Orice suferinta a %enunc!iului care #etermina re-arsatsino-ial se $oate com$lica cu a$ritia unui c!ist $o$liteu
#ar
C!isturile foarte mari sunt su%esti-e $entru $rezenta sino-itei
Ru$tura c!istului Ba,er $oate #etermina as$ectul #e.$seu#otromo)eita/ *e#em al %amei" ec!imoza la ni-elulmaleolei me#iale cu a$aritie #u$a un e$iso# #e tumefactie a%enunc!iului
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1.1.1.1. 'urstele;%r!l 'n%nci%l%i3 .%r!i&a p#pli&
In)amatia ursei $o$litee *ursele %astrocnemianuluisi a semimemranosului+ $ro#uce c!istul Ba,er *masaelastica $al$aila in s$atiul $o$liteu+
Orice suferinta a %enunc!iului care #etermina re-arsatsino-ial se $oate com$lica cu a$ritia unui c!ist $o$liteu
#ar
C!isturile foarte mari sunt su%esti-e $entru $rezenta sino-itei
Ru$tura c!istului Ba,er $oate #etermina as$ectul #e.$seu#otromo)eita/ *e#em al %amei" ec!imoza la ni-elulmaleolei me#iale cu a$aritie #u$a un e$iso# #e tumefactie a%enunc!iului
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1.1.1.1. 'urstele;%r!l 'n%nci%l%i:
ursita $re$atelara su$er0ciala
Cea mai mare ursa a%enunc!iului
Localizare : intre $iele sirotula
1etermina #urere situmefactie su$er0ciala culocalizare $e fata antero2inferioara a rotulei3
A$aritia ei estefa-orizata #e statul
$relun%it si re$etat in%enunc!i *ursitamena4erelor+3
Infectia secun#ara este ocom$licatie frec-enta
In)amatia ei $oate 0secun#ara #e$unerii #e
urati
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1.1.1.1. 'ursts;URSELE GENUNC=IULUI 3 ;URSITA
SUPER8ICIALA PREPATELARA
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1.1.1.1. 'urstele;%r!i&l %$ar%l%i3.%r!i&a !%.acr#$iala
4 L#cali)ar 37 in&r ac#$i#n%l !cap%li
!i &n"#n%l $%!ci%l%i!%pra!pin#!
4 Si$p$:!$n 37 "%rri la $i!caril
ac&i &! spe%alab*u%ta45ra*e($acr.ar n#c&%rna
4 Ca%) 3
7 &n"ini&a $an!&ir#&aril#r, p#li$ial'iar%$a&ica !&.ila&rala, PR
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1.1.1.1. 'urstele;%r!i&l c#&%l%i
4 Ca%)3&ra%$a&i!$,'%&a, PR, in*c&i!c%n"ara l)i%nil#r&'%$n&ar !a%cl%li&i, in*la$a&ia!p&ica "p#)i& "%ra&i
4 Si$p$:!$n 3"%rr, &%$*ac&il#cala
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1.1.1.1. 'urstele
4 DIAGNOSTICUL ;URSITELOR 9
7 Ea$n clinic
7 A!pira&ia !i a$n%l lici"%l%i a!pira& 3 cl%lari&a&,$icr#cri!&al, c#lara&ii Gra$, c%l&%ri
7 Ec#'ra*ia
4 TRATAMENTUL ;URSITELOR
7 In*il&ra&ii l#cal c% 'l%c#c#r&ic#i)i !i li"#caina7 A!pira&ia lici"%l%i !i an&i.i#&rapia in ca) "
!%prain*c&i .%r!i&a !p&ica
7 Eci)ia cir%r'icala
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1.1.1. Durerea perart%ulara
1(1(1(1(;%r!i&l
1.1.1.2. Te!"s!"vtele
1 1 1 2 Te!"s!"vtele
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1.1.1.2. Te!"s!"vtele,te!*!tele
1e0nitie : in)amatia tecii sino-iala aten#onului sau a ten#onului $ro$iu2zis
Cauze : su$rasolicitare" oli reumatismale #e ti$ in)amator *5R+" %uta sau
fara o cauza a$arenta *i#io$atice+3
sarcina " meno$auza" olile en#ocrine"amiloi#oza" infectiile" me#icamentele*)uoroc!inolone" GC" steroizii anaolizanti+ $ot 0asociate in s$ecial cu tenosino-itele mainilor3
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1.1.1.2. Tenosinovitele, tendinitele1.1.1.2.1.Te!*!ta #a!sete r"tat"rl"r
4 Repre,!ta %ea #a re%ve!ta %au,a a *urer*e u#ar !"!-trau#at%a
4 In*la$a&ia !i %)%ra &n"#anl#r&6#p!e#e!t7(prin c#$pr!ia $an!&ir#&aril#r in&r cap%l %$ral !i acr#$i#n in&i$p%l $i!carii 'ln#%$ral7 Cel #a ae%tat este te!*"!ul #us%8ulu
suprasp!"s7 Se as"%a,a re%ve!t %u bursta suba%r"#ala
7 Te!*"!ul b%epsulu p"ate *e ase#e!ea re%ve!tae%tata
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ANATOMIA UMARULUI
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ANATOMIA UMARULUI
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1.1.1.2.1. Te!*!ta #a!sete r"tat"rl"r
4 Dia'n#!&ic 37 a$n%l clinic 3
4 ar%ul *urer"s ee%tuat a%tv sau pasv &testNeer( ! p"rtu!ea super"ara &s!*r"#ul *e#p!e#e!t(
4 a."%c&ia ac&ia c% r)i!&n&a &n"ini&a "!%pra!pin#!,
4 r#&a&i &rna ac&ia c% r)i!&n&a &n"ini&ain*ra!pin#! !i r#&%n"%l $ic,
4 r#&a&i in&rna c% r)i!&n&a &n"ini&a "!%.!cap%lar,
7 in!&i'a&i i$a'i!&ica3 ra"i#'ra*ia plana,%l&ra!#n#'ra*ia, RMN
7 &!& " la.#rar3 =L,VS=, PCR, 'lic$ia, 8R, TS=, aci"%ric
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1.1.1.2.1. Te!*!ta #a!sete r"tat"rl"r
Testele clinice :
(umeroase
E&ecutii #eseori #iferite in functie #e sursa
Sensiilitate crescuta" s$eci0citate re#usa
1e re%ula este necesara o cominatie #e teste
$entru i#enti0carea ti$ului #e leziune
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Semnul arcului #ureros
4 S$n%l arc%l%i"%rr#! 3 la # $i!cara .ra&%l%i in&r 0-10'ra", "%rra aparin ca"r%l %n'i%l%i "5 'ra" *#r$a& !%. !ip!& plan%l #ri)#n&alal %$ril#r > $i"arc?
T t t i d l d i i t
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Testarea pentru sindromul de impingementsubacromial
Semnul Neer*arhiva personal DR. Albina+
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Testarea muchiului supraspinos.Em$t6 can test/ *arhiva personal DR. Albina+
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Testarea capului lung al bicepsuluibrahialTestul S$ee#*arhiva personal DR.
Albina+
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8#cal !%.acr#$ial &n"rn!!
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Tn"ini&a $an!&i r#&aril#r
4 Tn"ini&a c#$%na a %$ar%l%i &n"ini&l r#&aril#r%$ar%l%i3 !%pra!pin#!, in*ra!pin#!, !%.!pin#!, $ic%lr#&ar &r.%i "i*rn&ia& " 3
7 Cap!%li&a r&rac&ila 3 r"%cr n"%rr#a!a @ a$i!caril#r ac&i !i pa!i al %$ar%l%i
7 R%p&%ra c#a*i r#&aril#r 3 i$p#!i.ili&a&a " a-!i$n&in .ra&%l ri"ica&
7 Tn"ini&a .icp!%l%i 3 *lia "%rr#a!a a .ra&%l%i
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Cap!%li&a r&rac&ila
4 R"%cra "ra$a&ica a ra&i" $i!car p%&in !a% "l#c"%rr#a!a !%'ra)a #cap!%li&a r&rac&ila %$ar.l#ca&, %$ar in'&a&
4 E&i#l#'i 3 i"i#pa&ica,!c%n"ara !%*rin&l#r%$ar%l%i ar&ri&a'ln#%$rala, &n"ini&a.icipi&ala, &n"ini&acalci*ica&a "ar !i %n#r .#li
&raar&ic%lar c%$ ar *i&%$#ril p%l$#nar apicalT;C-%l !a% .#lil n"#crin(
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1(1(1(2(2(Tn#!in#i&l $ainil#r3Tn#!in#i&a " %rain
7A*c&a)a $%!cii !c%r& &n!#r !i l%n'a."%cr ai p#licl%i(
7D&r$ina "%rr !p#n&ana c% !a% *ara&%$*ac&i "a!%pra !&il#i"i ra"ial(
7D%rra !& accn&%a&a " 34 E&n!ia p#licl%i c% r)i!&n&a
4 A."%c&ia p#licl%i c% r)i!&n&a7P#a& apar !i in !arcina !a%
p#!&par&%$(
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Tn#!in#i&a " %rain
Durerea este agravata prin extensia si abductiacu rezistenta (abductia este miscarea policeluiperpendicular pe palma).
Durerea este agravata prin intinderea pasiva atendonului policelui peste stiloida radiala la flexiapolicelui (manevra Finelstein).
!xaminatorul roteste usor in sens ulnar pumnulpacientului in timp ce degetele pacientului suntpeste police
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1.1. SINDROMUL DUREROS REGIONAL
1(1(1( D%rra priar&ic%lara
1(1(1(1(;%r!i&l
1(1(1(2( Tn#!in#i&l1.1.2. Durerea !eur"e!a
1.1.2.1. s!*r"#ul *e %a!al %arpa!
1.1.2.2. *urerea ra*%ulara
1.1.2.3. #erala pareste,%a1(1(/( D%rra ira"ia&a
1(1(( M#n#ar&r#pa&ia
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1.1.2. Durerea !eur"e!a
4 E&i#l#'i 3 c#$pr!ia !a% iri&a&ia %ni ra"acini nr#a! !a%a %n%i nr pri*ric
4 Cl $ai *rcn& 3 !cia&ica, !i"r#$%l " canal carpian,!in"r#$%l " nr %lnar
4 E( n%r#l#'ic !& nc!ar ROT,&c4 Mani*!&ari clinic &ipic 37 "i!!&)ia ar!%ra, *%rnica&%ra, a$#r&ala, !#c lc&ric
l#cali)a&a in aria !n)i&ia " pr#ic&i a nr%l%i7 "%rra ra"ic%lara !& acr.a&a " $#.ili)ara
!'$n&%l%i !pinal a*c&a& !a% prin $anra Val!ala
%n#ri7 a&r#*ia $%!c%lara !i ip#!&)ia:an!&)ia !%n& !$n
&ar"i in c#$pr!ia ra"ic%lara !a% a nr%l%i pri*ric
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ANATOMIA PUMNULUI
"!#$"%#$&' !*%#$+' +'
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"!#$"%#$&' !*%#$+' +'
!#&'&$ -!D$+
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HAND-SYMPTOM DIAGRAM FOR CARPAL
TUNNEL SYNDROME
T!& l Paln
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T!&%l Paln
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The HoffmanTinel test
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CAU9ELE SINDROMULUI DE CANAL CARIAN
4 I"i#pa&ic 7 /B4 8rac&%ra C#ll! !a% al& &ra%$a&i!$ al c#&%l%i 1/( B4 Ar&ri&a r%$ai"a !i al& .#li r%$a&i!$al in*la$arii
6(5 B
4 Mn#pa%)a 6(B4 Dia.& 6(1 B4 Ar&r#)a p%$n%l%i 5(/B4 Sarcina (6B4 Mi"$%l 1( B
4 Al& .#li 3 acr#$'alia, a$il#i"#)a, *i.r#$ial'ia, &%$#ri.ni'n l#cal +(/B4 O.)i&a&a, !%pra!#lici&ari #c%pa&i#nal,pr"i!p#)i&ia
'n&ica, !%l *$inin
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Dia'n#!&ic%l !in"r#$%l%i " canal carpian
4 Mani*!&ari clinic &ipic
4 T!& lc&r#"ia'n#!&ic in ca) "
!i$p$al#'i a&ipica 37 lc&r#$i#'ra*i
7 !&%"i%l c#n"%crii nr#a!
4 C#$.ina&ia !i$p$al#'ii carac&ri!&ic !ic#n*ir$ara prin &!& lc&r#"ia'n#!&ic a!i'%rac% ac%ra& "ia'n#!&ic%l
E$pl% " "%rr c#$.ina&3 rnia " "i!c c
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!e"te#"$lom#a"$
He"nie de dis%
A%tiva"ea no%i%e&to"ilo" &e"ife"i%i %a'(a %om&onentei no%i%e&tive a d'"e"ii
)om&"esi'nea *i inflama+ia "$d$%inii ne"v'l'i,%a'(a %om&onentei ne'"o&ate a d'"e"ii
E$pl% " "%rr c#$.ina&3 rnia " "i!c cpr#"%c l#$.al'i i ra"ic%l#pa&i l#$.ar
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#+D$&'%/+"$$ '%-B+#!
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#+D$&'%/+"$$ !#$+'!
-a0oritatea radiculopatiilor cervicalesunt secundare modificarilor despondilartroza , altele decat hernia dedisc (Radhakrishnan K et al, 1976)
'eziunile cervicale superioare (1, 2,3) sunt neobisnuite si de regula nudetermina deficit motor
#adacina 4 este cel mai frecventafectata (567)8 5 (97), ; (9
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Testing for lumbar nerve root compromise
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-eralgia parestezica
Durere si disestezie pe
fata anterolaterala a
coapsei prin compresia
nervului femurocutanat
(nerv pur senzitiv) petraseu sau din plexul
lombosacrat, cavitatea
abdominala, pe sub
ligamentul inghinal si ietesutul subcutanat al
coapsei.
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1.1. SINDROMUL DUREROS REGIONAL
1(1(1( D%rra priar&ic%lara
1(1(1(1(;%r!i&l
1(1(1(2( Tn#!in#i&l1(1(2( D%rra n%r#'na
1(1(2(1( Sin"r#$%l " canal carpian
1(1(2(2( D%rra ra"ic%lara
1(1(2(/( Mral'ia par!&)ica
1.1.3. Durerea ra*ata
1(1(( M#n#ar&r#pa&ia
1 1 Sin"r#$%l "%rr#! r'i#nal 3
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1(1((Sin"r#$%l "%rr#! r'i#nal 3"%rra ira"ia&a
4 Apar la "i!&an&a " #ri'ina i ana$icai!cr in&rn, &c
4 M#.ili)ara ar&ic%la&ii n% !& "%rr#a!a
4 Ri&$%l "%rrii n% !& carac&ri!&ic4 Ea$n%l l#cal !& in li$i& n#r$al
4 E$pl 3 %$ar IMA, !%pra!cap%lar )ica.iliara, l#
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-ost common sites and origins of referred pain
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1.1. SINDROMUL DUREROS REGIONAL
1(1(1( D%rra priar&ic%lara
1(1(1(1(;%r!i&l
1(1(1(2( Tn#!in#i&l1(1(2( D%rra n%r#'na
1(1(2(1( Sin"r#$%l " canal carpian
1(1(2(2( D%rra ra"ic%lara
1(1(2(/( Mral'ia par!&)ica
1(1(/( D%rra ira"ia&a
1.1.). M"!"artr"pata
-onoarthropath= :
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-onoarthropath= :
Ar&ri&a 'n%nci%l%i
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Ar&ri&a 'n%nci%l%i
-arginile patelei sunt
estompate si spatiul
suprapatelar disparut
la nivelul genunchiuluistg. ourtes= of Filip
de >e=ser.
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Joint line palpation
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+&*!'! &F!#$"!$
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+&*!'! &F!#$"!$
-%%+#"$&'+#!9. $F!"$$'! : "B, '&!, $F!"$$ B+"!#$!! ?%%%$! +&
%?%%%$! ("+F$'%%),
1. D!/&!#$'! D! -$#%#$"+'! : +"&' -%%%D$ (?&"+)
2. "#+&-+"$-!'!
3. +#"#%*!'!'!
6. B%'$'! #!&-+"$-+'! $F'+-+"%#$$ : +#"#$"!'! #!+"$!+%$+"! & @'+AB14
5. "&-%#$'! /#$-+#! +& !&D+#!
CAITOLUL 1 + r!%palele
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CAITOLUL 1 + r!%paleles!*r"a#e ale reu#at"l"e
SUBCAPITOLE : 1(1( Sin"r#$%l "%rr#! r'i#nal
1.2. S!*r"#ul *urer"s e!eral,at1(/( D%rra r&.rala:!pinala l#$.ara, cricala1(( Sin"r#$%l ar&ic%lar 3 ar&r#)a, ar&ri&a in*la$ari1(5( Sincr#$%l " #!p#r#)a1(6( Sin"r#$%l #!#!
1(+( Sin"r#$%l $%!c%lar1(( Sin"r#$%l !i!&$ic
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1.2. SINDROMUL DUREROS GENERALIZAT
1urerea afecteaza #iferite $arti ale cor$ului" este #ifuza siim$recis #elimitata" focalizarea $e articulatii estere#usa7asenta
8iromial%ia este cea mai comuna cauza #e #urere
%eneralizata *.#urere $este tot/77toate ma #or77 ce nu ma#oare9/+'
Alte oli reumatismale cu sin#rom #ureros #ifuz : 5R" LES"SA" $olimial%ia reumatica" $olimiozita" oli en#ocrine*!i$otiroi#ism" !i$er$aratiroi#ism+
Asocierea 0romial%iei cu olile reumatismale #e ti$in)amator este frec-enta si re$rezinta o situatie %reu #e#ia%nosticat
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Ce este br"#ala:
4D%rr "i*%)a cr#nica $%!c%l#!cl&alan#nar&ic%lara 3 $%!ci, li'a$n&, &n"#an
4O &%l.%rar a pr#c!l#r " r'lar a"%rrii prin $cani!$l !n!i.ili)ariicn&ral @
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Ce este br"#ala:
4 E&i#l#'i nprci)a&a !i pa'ni incr&a3
7 re*sp",te e!et%a3 'nl i$plica& in $&a.#li!$%l!r#nini !i ca&c#la$inl#r
7 Alterarea #e%a!s#el"r *e pr"%esare al *urer +s%a*erea praulu pe!tru *urere"r'lari al n%$ar%l%i !i*%nc&ii rcpril#r pn&r% #pi#i)i, cr!&ra nil%l%i!%.!&an&i P, ac&iara c!ia a )#nl#r !n)i&i "in crir
70perrea%tvtate la stress &trau#ats#$ e#"t$ !e%t(
prin an#$alii al a%l%i ip#&ala$#-ip#*i)#-c#r&ic#!%prarnal
7 Dsu!%te a sste#ulu !erv"s aut"!"#
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1.2.1. ;br"#ala
Caracteristici : 1urere a#eseori mi%ratorie
5ot e&ista sim$tome #ominante' $ot 0 %resit #ia%nosticati cu
5R" SA" !ernie #e #isc E&acerata mai #e%raa #u$a efort #ecat in tim$ul efortului
E&$unerea la fri% si stressul sunt factori a%ra-anti
Se asociaza cu alte manifestari : mi%rena"intestinul iritail"o$resiune toracica" #e$resia" insomnia
In-esti%atiile ima%istice si analizele #e laorator sunt inlimite normale
E&ista criterii #e clasi0care *#ia%nostic+" #ar -aloarea loreste limitata mai ales in ceea ce $ri-este numarul $unctelortri%er
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8i.r#$ial'ia 3pi"$i#l#'i
4 Ca $ai *rcn&a ca%)a " !in"r#$ "%rr#! "i*%)la *$il c% ar!& in&r 20-55
4 Rap#r& 8:; 3 6:1
4 Praln&a cr!& c% ar!&a 3 2B la *$il " 20" ani la B la *$il " +0ani
4 A*c&a)a B "in p#p%la&ia 'nrala37 / 7 6 $ili#an " a$ricani a% 8M
4 In 50B "in ca)%ri !i$p$l apar "%pa %nni$n& $arcan&3 &ra%$a *i)ica !a% p!iica
8i.r#$ial'ia3
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8i.r#$ial'ia3$ani*!&ari clinic
3 ;anifestari clinice #e ti$ musculosc!eletal:
1. ureri di!u"e nonarticulare*musculare" osoase+ :
3 cronice si $ersistente #ar -ariaile ca intensitate
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8i.r#$ial'ia3$ani*!&ari clinic
2( Mani*!&ari n#n-$%!c%l#!cl&al 3
1( D%rri a."#$inal " &ip c#l#n iri&a.il2( D%rri racic an&ri#ar/( D%rri plin !i *n#$n %rinar p#laci%ri, $ic&i%ni
i$pri#a!. ;atabltate5( S#$n n#"inir !i a!&ni $a&inala6( C*al
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8i.r#$ial'ia 3 "ia'n#!&icCri&rii ACR
4 I!ric " "%rr "i*%)a c% "%ra&a " p!& /l%ni in pa&r% ca"ran al #r'ani!$%l%ic#nc#$i&n& c% "%rr !cl&ala aiala
4 D%rr in 11 "in cl 1 p%nc& "!cri! !pci*icla &n"r p#in&!?
Nota: Tender points portiuni cutanate sensibile lapresiune aplicata local.
8i.r#$ial'ia 3 "ia'n#!&ic
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8i.r#$ial'ia 3 "ia'n#!&ic
Ea$inara ! *ac c% p#licl car aplica # *#r&a
cialn&a cli car al.!& pa&%l %n'ial ':1(c$2
?!!#+'$*!D /+$
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?!!#+'$*!D /+$F$B#%-+'?$+ : tender points
8i. i l i "i &i
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8i.r#$ial'ia 3"ia'n#!&ic
4 Ea$n clinic 37 ip#&n!i%n #r!&a&ica,
7 &aicar"i #r!&a&ica p#!&%rala,
7 an#$alii al &!&l#r n%r#c#'ni&i- !%'ra)a!ri&a&a .#lii(
7 a$n%l clinic al apara&%l%i #!$%!c%lar, !&a&%!-%l
$n&al,a$n%l n%r#l#'ic 3 n#r$al
4 In!&i'a&iil paraclinic .i#l#'ic, i$a'i!&ic,
i$%n#l#'ic 3 n#r$al4 N% i!&a &!& !&an"ar" car !a $a!#ar
!ri&a&a .#lii
1 2 1 ;b l
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1.2.1. ;br"#ala
1IAG(OSTICUL 8IBRO;IALGIEI :
e&amen clinic : criteriile #e clasi0care ale 0romial%iei inclu##urerea %eneralizata $ersistenta #e cel $utin = luni $lus minim $uncte #ureroase *#in ?+
teste iolo%ice : HL"@SH" %licemia" creatininina" e&amenul #e
urina" TG5"TGO"TSH" anti%enul HBs" anti2H@C
TRATA;E(TUL 8IBRO;IALGIEI
tratament farmacolo%ic sim$tomatic *anal%ezice #e ti$$eriferic sau anal%ezice narcotice" anticon-ulsi-ante+ si
neurotro$ *anti#e$resi-e" an&iolitice" miorela&ante+ tratamente to$ice cu AI(S" acu$unctura tratamente alternati-e: !i$notera$ia" ,inetotera$ia
8i.r#$ial'a 3
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8i.r#$ial'a 3"ia'n#!&ic%l "i*rn&ial
4 Supras"l%tare #e%a!%a
4 Me*%a#e!te +7 S&a&in !i *i.ra&i
7 An&i$alaric4 E!*"%r!"pat +
7 =ip#&ir#i"i!$7 =iprpara&ir#i"i!$7 Sin"r#$ C%!in'7 Dia.& )aara&
4 '"l !eur"l"%e +7 Sclr#)a $%l&ipla7 Mia!&nia 'rai!
4 Ca!%ere4 Sin"r#$ "%rr#! r'i#nal
4 I!e%t +7 =pa&i&i! C7 =%$an i$$%n#"*i cincH ir%!
=IV7 LH$ "i!a!
4 '"l reu#ats#ale +7 PR7 LES7 Sin"r#$ S
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8i.r#$ial'ia 3 pr#'n#!&ic
7 N% i!&a l)i%ni "i!&r%c&i $%!c%l#!cl&al7 N% i!&a "*#r$ari, ancil#), an"icap
*%nc&i#nal $#r
4 DAR,
7 D%rra !& cr#nica, pr!i!&n&a, n% ra!p%n"
la an&ial'icl %)%al7 8a&i'a.ili&a&a, "pr!ia, ani&a&a !%n&pr)n&
1 3 DUREREA SPINALA
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1.3. DUREREA SPINALA
!ste foarte frecventa in practica medicala
$n marea ma0oritate a cazurilor etiologia ramane
neclarificata chiar dupa invetigatii amanuntite :complexitatea structurilor anatomice implicate(coloana,musculatura, ligamentele, nervii sau tesutulmoale) si slaba corelatie cu metodele imagisticesofisticate
&tilizarea inadecvata a investigatiilor imagistice creeazamai degraba confuzii decat solutii ale problemei
1 3 DUREREA SPINALA
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1.3. DUREREA SPINALA
9. 2.9. D!#!+ /$+'+ -!+$+ :C Declansata de miscare, ameliorata de repaus (spondiloartroza este cea mai
frecventa)C cauze : +#"#%*+ !#"!B#+'+ (artroza interapofizara, spondiloza,
discartroza, spondiloza hiperostozanta), contractura musculara dureroasa
9. 2.1. D!#!+ D! "$/ $F'+-+"%# :C Debut 3
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1. 3. 1. Durerea sp!ala %u se#!e *e alar#a
emne de alarma :
C Durere de tip inflamatorC Durere localizataC Durere nocturna
C imptome viscerale sauconstitutionaleC Durere la miscarile in orice
directieC $storic de neoplasnC Factori de risc pentru
osteoporozaC -anifestari neurologice
acroileita
pondilodiscita
-etastaze
Fractura osteoporotica
Durere neurogena
Durere iradiata
'igamentita interspinoasa
. l
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L#$.al'ia cr#nica
4DE;INITIE$ EIDEMIOLOGIE
7 DURERE LOM'ARA ERSISTENTA 3LUNI
7 A "#%a ca%)a " a"r!a.ili&a& ca&r $"ic la nil
$#n"ial
7 Principala ca%)a " "i)a.ili&a& p &r$n l%n'
7 Ca $ai i$p#r&an&a a*c&i%n pn&r% li.rara "c#nc"ii $"ical la pr!#anl ac&i " ar!&a &anara
7 60B75B praln&a p in&ra'a "%ra&a a i&ii
7 C#!&%ri in"irc& &al in SUA3 J// $iliar" ann%al
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4 ;I9IOATOLOGIE
7 Ac&iara !i !n!i.ili)ara ra"acinil#r nr#a!
prin c#$pr!i !i &rac&i%n7 Sn!i.ili)ara n#cicpril#r "in an%l%! *i.r#!a,
ar&ic%la&ii in&rap#*i)ar, !&r%c&%ril pri#!&al!pinal, li'a$n& "%pa in*la$a&i ac%&a,!&a&%! p#!& &ra%$a&ic,$#"i*icari "'nra&i&c(
('oesser et al, 1
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ps!*r"a#e ale reu#at"l"e
SUBCAPITOLE : 1(1( Sin"r#$%l "%rr#! r'i#nal1(2( Sin"r#$%l "%rr#! 'nrali)a&1(/( D%rra r&.rala:!pinala l#$.ara, cricala
1.). S!*r"#ul art%ular + artr",a$ artrta!la#at"re
1(5( Sin"r#$%l " #!p#r#)a1(6( Sin"r#$%l #!#!1(+( Sin"r#$%l $%!c%lar1(( Sin"r#$%l !i!&$ic
1 4 SINDROMUL ARTICULAR
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1. 4. SINDROMUL ARTICULAR
Boala articulara 9 *artro$atia oala ce afecteazaarticulatiile+
;anifestarile clinice:Toate miscarile sunt #ureroase
1urerea este localizata
1urerea are intensitate similara $entru miscarileacti-e si $asi-e
5al$area limitelor articulare $ro#uce #urere
5ot 0 $rezente cre$itatii" cal#ura locala"tumefactie
+#"#%*++#"#$"+
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+#"#%*++#"#$"+
+#+"!#$"$$ +#"#%*+ +#"#$"+VARSTA INNAINTATA
REDOARE MATINALA
ACTIVITATE 8IKICA
AMELIORARE PRINREPAUS
MODI8ICARI LOCALE
DA
/0 $in%&
Ac&ii&a&a *i)ica #accn&%a)a, !&$ai$a la !*ar!i&%l )ili
Da
Crpi&a&ii, "%rr lapalpara $ar'inil#rar&ic%lar::#!*i&l#r
:-
/0 $in%&
:-
D%rr n#c&%rna*ara l'a&%ra c%$#.ili)ara
T%$*ir "c#n!i!&n&a la!&ica,"%rr l#cala,r#!a&a '%&a, ar&ri&a!p&ica, ar&ri&ap!#ria)ica
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1.).2. Reu#ats#ele !la#at"r
1urere #e ti$ in)amator tumefactie elastica asociata sau nucu roseata si cal#ura locala
(r3 articulatiilor afectate: mono" oli%o2 *
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1.).2.1. M"!"artrta a%uta s %r"!%a
;onoartrita acuta : %uta" artrita$osttraumatica" se$tica
Artrita se$tica: E-olutie ra$i# #istructi-a" $otential amenintator
#e -iata
1eut ra$i#
Semne $re%nante #e in)amatie : te%umenterosii" etc
Semne sistemice: fera
1 ) 2 1 M"!"artrta a%uta s %r"!%a
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1.).2.1. M"!"artrta a%uta s %r"!%a
&uta ' Cea mai frec-enta cauza #e monoartrita 5rimul e$iso# este localizat in F #in cazuri la I2a
articulatie metatarsofalan%iana *o alta articulatie esteafectata la 0ecare al
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1 ) 2 1 M"!"artrta a%uta s %r"!%a
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1.).2.1. M"!"artrta a%uta s %r"!%a
;onoartrita cronica: $oate a-ea o e-olutiein#olora *9+ sa$tamani sau luni
5rinci$alele cauze :
Infectii *tuerculoza+ Artrita in#usa #e cristale
1eutul monoarticular a unei oli%o2"$oliartrite
1ia%nosticul #iferential : Artroza
Hi#artroza recurenta
Tumori
1ia%nosticul etiolo%ic necesita io$sie sino-iala
%steoarthritis: @eberdenGs and BouchardGs nodes
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#heumatoid arthritis: fusiform sHelling, hand
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/soriatic arthritis: hands
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/soriatic arthritis: nail changes, rash, and arthritis, hands
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/soriatic arthritis: as=mmetric s=no=itis,nees
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CAITOLUL 1 + r!%palele
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s!*r"a#e ale reu#at"l"e
SUBCAPITOLE :
1(1( Sin"r#$%l "%rr#! r'i#nal1(2( Sin"r#$%l "%rr#! 'nrali)a&
1(/( D%rra r&.rala:!pinala l#$.ara, cricala1(( Sin"r#$%l ar&ic%lar 3 ar&r#)a, ar&ri&a in*la$ari
1.>. S!*r"#ul *e "ste"p"r",a1(6( Sin"r#$%l #!#!1(+( Sin"r#$%l $%!c%lar
1(( Sin"r#$%l !i!&$ic
O!p#r#)a 3 "*ini&i
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O!p#r#)a 3 "*ini&i
4 ;#ala !i!&$ica a !cl&%l%i 37carac&ri)a&a prin !ca"ra $a!i
#!#a! !i "&ri#rara $icr#ari&c&%rii
&!%&%l%i #!#!,7 cr!&ra *ra'ili&a&ii #!%l%i
c#$pr#$i&ra r)i!&n&i #!%l%i
7 ri!c cr!c%& " *rac&%ra
1 5 Sin"r#$%l " #!p#r#)a
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1(5( Sin"r#$%l " #!p#r#)a
4 Carac&ri)a& prin pr)n&a *acril#r " ri!c 37 P#!&$n#pa%)a7 Mn#pa%)a prc#c7 Mnara &ar)i7 Gr%&a&a c#rp#rala r"%!a7 C#r&ic#&rapia prl%n'i&a
7 S"n&ari!$%l7 I!ric *a$ilial " *rac&%ra #!p#r#&ica
4 O!p#r#)a !c%n"ara 37 =ipr&ir#i"i!$
7 =iprpara&ir#i"i!$7 Alc##li!$7 ;#li pa&ic
O!p#r#)a 3 pi"$i#l#'i
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O!p#r#)a 3 pi"$i#l#'i
afectiune cronica cu prevalenta crescuta la varstnici(femei si barbati)8
asociata cu risc crescut de fractura (de 1A2 ori mai marela femei)8
evolutie silentioasa : primul simptom clinic este durereaacuta sau cronica secundara unei fracturi8
identificata prin scaderea B-D sau prezenta unei fracturisecundare unei traume minime
O!p#r#)a 3 "ia'n#!&ic
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O!p#r#)a 3 "ia'n#!&ic
4 O!p#r#)a 37$a!%rara "n!i&a&ii #!%l%i
7a.!#r.&i#$&ria "%ala c% ra) DA
!& ca $ai %&ili)a&a $"a>!&an"ar"%l " a%r?
7Sc#r%l T -2,5
O!p#r#)a 3 l#cali)ara
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*rac&%ril#r r&.ral
oloana vertebrala
oldul !xtremitatea distala a radiusului
OSTEOPOROKA 38RACTURA VERTE;RALA
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8RACTURA VERTE;RALA
este cea mai frecventa fractura osteoporotica 8
reprezinta un factor de risc pentru orice alta fracturaosteoporotica 8
este un motiv crestere a morbiditatii si a mortalitatii la
populatia varstnica 8
OSTEOPOROKA 38RACTURA VERTE;RALA
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8RACTURA VERTE;RALA
D#ar %na "in pa&r% *rac&%ri r&.ral!& i"n&i*ica&a clinic 3
4 !i$p$al#'i a.!n&a 9
4 &i#l#'ia c#$pla a "%rrii !pinal 9
4 a.!n&a &ra%$a&i!$%l%i
;RACTURA ?ERTE'RALA +MOR'IDITATE
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MOR'IDITATE
)ifo(a
Pie"de"e in inaltime
Ma"i"ea a#domen'l'i
-'"e"e a%'ta si %"oni%a
T'l#'"a"i "es&i"ato"ii sim&tome de "efl'/ si alte
sim&tome 0ast"ointestinale
-e&"esie
)alitate a vietii s%a('ta
TIPURI -E RA)TURA !ERTEBRALA
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TIPURI -E RA)TURA !ERTEBRALA
wedge fracture-fractura n pan fractura biconcava cruch fracture fractura de zdrobire
Modif 'soa"e Modif seve"eModif 'soa"e Modif seve"e
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1
1
1(( Sin"r#$%l #!#!
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1(( Sin"r#$%l #!#!
4 D%rr 37 pr#*%n"a, "i*%)a, c#n&in%a,
7 *ara rla&i c% $i!cara
7 acr.ar n#c&%rna
7 l#cali)ar pr*rn&iala 3 c#l#ana, pli!%l !i!'$n&l pr#i$al al $$.rl#r
4 Ea$n%l l#cal 3 in li$i& n#r$al
1(( Sin"r#$%l #!#!
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1(( Sin"r#$%l #!#!
4 Ca%) 3
7 T%$#ril #!#a! 3 &%$#ril $&a!&a&ic !%n&cl $ai *rcn& n#pla)ii #!#a!, iar #!%l!& a /-a l#cali)ar pn&r% $&a "%pa pla$an!i *ica&
7 ;#lil $&a.#lic #!#a! 3 .#ala Pa'&
7 In*la$a&ia pri#!&%l%i
1(6( Sin"r#$%l $%!c%lar
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1(6( Sin"r#$%l $%!c%lar
4 S carac&ri)a)a prin 37 !la.ici%n $%!c%lara pr#'r!ia 3
7 "%rri $%!c%lar
7 a&r#*i $%!c%lara
7: ar&ral'ii:ar&ri& in a*c&ara $%!c%lara "in .#lil "
c#la'n !clr#)a !i!&$ica, .#ala $i&a " &!%&c#n.#"H incl%!i#n?
1(6( Sin"r#$%l $%!c%lar
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1(6( Sin"r#$%l $%!c%lar
4 Dia'n#!&ic%l "i*rn&ial al p#li$i#)i&i 3
7 Mi#pa&ia "in ip#&ir#i"i, !arc#i"#)a !i#!$alaci
7 D%rra !i r"#ara cn&%ril#r "in p#li$ial'iar%$a&ica, ar&ri&a c% cl%l 'i'an&
7 Mi#pa&ia $"ica$na!a 3 'l%c#c#r&ic#i)i,i"r#icl#r#cin, c#lcicina, cicl#!p#rina,!&a&in !i *i.ra&i
7 Mi#pa&iil n#nin*la$arii 3 .#lil n%r#l#'ic($ia!&nia 'rai!
CAITOLUL 1 + r!%palele * l t l
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s!*r"a#e ale reu#at"l"e
SUBCAPITOLE :
1(1( Sin"r#$%l "%rr#! r'i#nal1(2( Sin"r#$%l "%rr#! 'nrali)a&
1(/( D%rra r&.rala:!pinala l#$.ara, cricala1(( Sin"r#$%l ar&ic%lar 3 ar&r#)a, ar&ri&a in*la$ari1(5( Sin"r#$%l " #!p#r#)a1(6( Sin"r#$%l #!#!1(+( Sin"r#$%l $%!c%lar
1.=. S!*r"#ul sste#%
1. 8. SINDROMUL SISTEMIC1 = 2 M t t t
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1.=.2. Ma!estar %uta!ate
8otosensiilitate
Rash cutanat%L(S
Ras! #iscoi#
Sclero#erma 5ur$ura
Li-e#o reticularis
Ulcere
Alo$ecieTelan%ictazia
1. 8. SINDROMUL SISTEMIC1 = 2 M t t t
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1.=.2. Ma!estar %uta!ate
8otosensiilitate
Ras! cutanat
Rash discoid%L(S
Sclero#erma
5ur$ura
Li-e#o reticularis
Ulcere Alo$ecie
Telan%ictazia
1. 8. SINDROMUL SISTEMIC1 = 2 M t t t
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1.=.2. Ma!estar %uta!ate
8otosensiilitate
Ras! cutanat
Ras! #iscoi#
Sclero#erma 5ur$ura
Li)edo reticularis%L(S
Ulcere
Alo$ecie
Telan%ictazia
1. 8. SINDROMUL SISTEMIC1 = 2 M t t t
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1.=.2. Ma!estar %uta!ate
8otosensiilitate
Ras! cutanat
Ras! #iscoi#
Sclero#erma
5ur$ura
Li-e#o reticularis
Ulcere
Alo$ecie
Telan%ictazia
Sindrom Ra*naud%SS
1.8. SINDROMUL SISTEMI1 = 3 M t
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1.=.3. Ma!estar #u%"ase
C+fte genitale si orale
C ?ura, ochii uscati
C %chii rosii
C Balanita
#eactive arthritis: con0unctivitis
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+n=losing spond=litis: iridoc=clitis Hith
s=nechiae
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s=nechiae
#eactive arhtritis: erosions, tongue
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I(@ESTIGATII UTILIATE I(REU;ATOLOGIE
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REU;ATOLOGIE
In-esti%atii iolo%ice : HL" sin#romul iolo%ic #ein)amatie" sin#romul muscular" #e osteoliza
In-esti%atii imunolo%ice : autoanticor$ii"
com$lementul seric" anti%enele #e!istocom$atiilitate
E&amenul lic!i#ului sino-ial
In-esti%atii ima%istice : ra#iolo%ice"ultrasono%ra0a" scinti%ra0a" CT" R;(" artrosco$ia
In-esti%atii !istolo%ice : io$siile
I(@ESTIGATII BIOLOGICE
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Hemoleuco%rama *HL+ : Anemie
Cronica sim$la *#e ti$ in)amator+ : 5R" SA" LES
Hemolitica autoimuna : LES
8eri$ri-a : r3a la AI(S
Leucocitoza : artrita se$tica" atacul acut #e%uta
Leuco$enie : LES" r3a me#icamentoase" oli
asociate *CH+Tromocitoza : reacti-a la in)amatie sau
anemie feri$ri-a
I(@ESTIGATII BIOLOGICE
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Sin#romul iolo%ic #e in)amatie : @SH : creste mai lent si ramane crescut o
$erioa#a mai in#elun%ata Cresteri nonin)amatorii : -arsta" se&" sarcina" olile
%lan#ei tiroi#e" #isli$i#emiile" !i$er%ama%loulinemii 5CR : creste si sca#e ra$i#
@alori usor crescute in stari nonin)amatorii:oezitate" alcool" fumat" 1
@alori f3 crescute in infectii se-ere *JFm%7#lFFm%7l+
8irino%en : #inamica lenta
I(@ESTIGATII I;U(OLOGICE
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Electroforeza Imuno%rama
Com$lementul seric
;oleculele HLA : HLA2B
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8actorul reumatoi# : 5R" alte oli #e cola%en"infectii
5roteinele citrulinate *anti CC5+ : 5R
Anticor$ii antinucleari Anti A1(#c" anti Sm" anti Ro : LES Anti Ro" anti La : sin#rom S4o%ren Anti U2R(5 : sin#rom o-erla$ Anti o2 *antisintetaza+: miozita
Anti Scl KF *anti to$oizomeraza+" anti2centromer :SS
A(CA *ac3 anti cito$lasma neutro0lica+ : -asculite
$!"$?+"$$ $-+?$"$!
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Ra#io%ra0i musculosc!eletale in < inci#ente*antero2$osterior si lateral+ : os" cartila4
Eco%ra0i : structurile $eriarticulare *ten#oane"
li%amente" musc!i+" sino-iala" cartila4ul" osul Scinti%ra0e cu te!netiu: leziune #e os" articulara
Tomo%ra0a com$uterizata : os
R;( : os" sino-iala" structuri $eriarticulare
Osteo#ensitometria : #%3osteo$oroza
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I(@ESTIGATII I;U(OLOGICE
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Com$lementul seric : C=" C
Crescut in in)amatie
Scazut in LES acti- cu afectare renala"afectiuni !e$atice se-ere
I(@ESTIGATII BIOLOGICE
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ENA;E(UL LICHI1ULUI SI(O@IAL :
(r3 #e leucocite
#e 5;( Culturi
Cristale #e urat " $irofosfat #e calciu
I(@ESTIGATII HISTOLOGICE
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Sino-iala
5iele
5ulmon
@asele #e san%e
In-esti%atii ima%istice
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Ra#io%ra0i musculosc!eletale in