חוברת ראומטולוגיה

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1 8002.1.32 1.1 , , ) .(synovium , ) .(synovitis . . )(, ) (, ) . 1

(. . , . . . : 1. : RA , , ) APL-( RF (Inflammatory muscle diseases (Poly/Dermatomyositis Seronegative arthritis (Ankylosing Spondylitis, Reiters syndrome, Psoriatic (arthritis, Enteropathic arthritis Crystal-related arthropathies 2. , . 3. soft tissue rheumatism , , , . : . o ) (peri-articular o , o - RA , -) gout( o , . . , FMF. o o . o , . o ) 2 - 3( , ) 1( . / ) "" .(morning stiffness . . , . swelling ), - SLE (. . .Drug induced SLE : : - , 2

: ) (entheses - . : /, , 4-2 , ' . / ) (/ )(/. ) /(RF/. , ) ( )( . -: TMJ . , , ) (. , . , . ) ( -.acromio-clavicular )-, -, ( . - 4( rotator cuff( ), (. , .frozen shoulder calcific tendonitis . , . - ) (tennis elbow ) (golf elbow , , -.gout . , , - ) (MCP ) .(PIP/DIP . ) , (. Peri-ungal erythema . . , . . . , ) , '(. . . 3

, ) (patella . . , , . ) .(suprapatellar bursa . , . baker's .cyst -) DVT (pseudothrombophlebitis " US ) DVT ; baker's cyst (. -3 : - o - o - o . " . -metatarsal phalangeal joint , . . " , , " , . - sacro-iliac joint , , , . , : , ,TB , ,acromegalism, : . CT/MRI . EMG " . , , . . : ) septic arthritis (, ) , ( ) (. : ) (baker's cysts ,

4

8002.1.32 2.1 ) (collagen vascular disease " ' . . , . : 4. " - N - C- .Fc-receptor . , . 5. ) - ( . , . 6. ) T B (. APC ,T . . , ) / (. : ) (. ) (. / ) (. /. / ), , ...(. . DD , . " , )( , , " / o . . 5 ,ANA . , . ELISA )" /(. o . o , ) .(Ig FACS , . o " . ,T 8.CD4:CD . " o . . . . o T .NK o 5

, . , ) (. , ) (acute phase reaction . - 3C , . 4C . / . 3 : LM o IF o EM o work up , , Assays T /. 4:8CD . ,HIV , ,GVHD. B . B, , , . , .NK , . , . assays. .

8002.1.32 3.1 : CT MRI US CT/MR-arthrography CT/conventional angiography . . ).(staging 6

: 1. ) ( 2. 3. - - 4. 5. : ,sacroiliac joint, TMJ atlanto-axial joint , )3(, )2( )1, (, . : ) (radioopque ) (radiolucent / )5( osteophytes/syndesmophytes )3( - alignment : , . ) ,RA ( , periarticular .osteoporosis , / periarticular sclerosis . . , , ) ( . , ) MRI(. -sacroiliac

- -/. . . , , (. ) - .CT .

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/: . . , . . - CT ) (, .

: . ) , "(, . , . - plantar fascia . -. , , ". Bamboo spine - ankylosing spondylitis ", . : , . , . , , . , -, ,RA. , ) (, , . , . :Alignment . Subloxation , . , . -2 C1/C . " . Impaction . : ) (, . ) (gout , - . ,US .acromio-clavicular , .

8

- " , , ) CPPD (. ) ( ) (. , .

- 8002.1.42 4.1 : - , . /.cancelous : /shaft , metaphisal growth plate, . . , )" (. ) (osteoprogenitors . : - , ) (I . . . . - ) ( . , . . . . : Woven bone ) , .(nonmineralized . . , . . Paget's disease . , . ) ( ) (. 3 : - . 1. - . 2. burnt out osteosclerotic stage , 3. . . , . . ,paramyxovirus / . ) , (. , %51 ) .(monostotic - XR ) ( ) (. 9

: . , . . - . . : , . . , %51 , high output . . . , , . %01 , . ' Osa o o . o . ) ( . . Avascular necrosis . . . : , /. . . . - " . ) , (. -, , - ) (.

: , ) (. . , .

. .

01

) (. -%09-08 , ,E.coli : Pseudomonas, Klebsiella o urinary infection o o ' ,B 3 : 1. . ' 2. - / 3. . . : sequestrum . , " " ) (. woven bone involucrum - . Brodie abcess - small intraosseous (often cortical) abscess Osteomyelitis of Garre - in the jaw with extensive new bone formation ' ) ( , " : ' : - )( sinus tract -squamous cell carcinoma

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discitis osteomielitis ' , ) ( " . TUBERCULOUS OSTEOMYELITIS . " , . " , : - )( ) (. %57 , , , ) (, . ! , , ) - RBG . RBG ( : ) ( 1. . , . 2. Mixed 3. . 3-1 ) (. " : ) distal femur, proximal tibia ( . . - Osteogenic sarcoma - .OsA . , - DD : ' ewing Sa , giant cell tumor of bone 02 .mature skeleton . " / / . ' - - 21

Plain radiograph CT / , , , , MRI " , : , ", . ! . : : : , . . ' . ) gardner , , .(familial IS polyposis ? :osteoid-osteoma - / , . ) (nocturnal pain ) ( .nidus osteoid-osteoma - ) (. / DD - osteoid-osteoma / .osteoid-osteoma . -: osteoid-osteoma " " osteoid-osteoma" 2 PG -osteoid .osteoma . 31

' ' -woven bone , .

:OS - Osteogenic sarcoma , %04 . . - )%57, ( - - ,paget's, . - Rb-35.p : . . : - ) ( / ) ( , . : , , , . - Intramedullary high grade ' ' . / , . - " , . . %02 . -5 : %06 41

- % o -%59 good responder o bad responder : chondroma . , ) - (. ,expansive . : 1. - ollier's disease 2. ) mafucci's disease ( . . . ' .well-differentiated

Chondrosarcoma CS . II . - . 05-03. . , , , . , ' . , ' -. . 01 " ) -.(grade : 1- , %09 -5 . 2 3 . ' . . %04 -5 . DD 51

/ chonndrobalstic osteogenic sarcoma . 61 .OS Giant cell tumor GCT . -. ) OS (. locally aggressive-%01 . . , , . - %01 %06 ,en block , , , , . , ", . )/(/ ) (, / . , ) (, , , . 04-02, , - GCT

' 8002.1.92 5.1 , , . . ,RA, SA, ) CSS' (, . AS , . 61

, . . ' , .

' 1 54, 4 . . , . . . , , .RA : . , - . . - . . . - MCPS, PIPS". MCPS . . . - .MTPS . .RA : )7/4( -3 41 1. 2. 3. 4. 5. RF 6. 7. RF ) - (CRP . . . : -09. CRP. -11 %. -0086 . 000,054 -. ) ,RA( ,AS . 02. : , 2 o , +01 o : RF . ANA. IgG. .72HLA-B . .anti CCP , . ' 2 84, . . IV NSAID ) (. , )02.(antiTNF, antiCD 71

5.73, , , 6 ". - . charg-strauss , , , , . , . , ) (, , . : . - 42 . 801 , . -4.83. . - . . - . . . . . - , . - DROP FOOT : -001. CRP -11 %. 006,21. : -%56. -%51 - %41 - %6 -5.1 % 06 %. - 1+. . . . . RF, ANA, 27HLAB .P ANCA . C ANCA . , IgE. ) (, . EMG. . ' 3 23, 3 . , IV . . . .APL, SLE , , -.SLE : . 5.73. . , . - . . . - , . - , .MCPS . , - ,MTPS - . , . - RA - SLE . ', . : )11/4( 1. .malar rash 81

2. .discoid rash 3. . 4. . 5. 6. 7. 8. - 9. ) ] - 0004[ ] - 0051[ ] - 000,001[( ) (.