The Foot and Ankle in Rheumatology最新文献_第2页

Crystal arthritis 水晶关节炎

The Foot and Ankle in Rheumatology

Pub Date : 2019-03-01 DOI: 10.1093/med/9780198734451.003.0005

K. Rome, E. Roddy

Many different crystal types can form in the body and potentially cause acute synovitis, chronic arthropathy, or periarticular syndromes. The most common and clinically relevant crystals are monosodium urate, the causative agent in gout, and calcium pyrophosphate, both of which commonly affect the foot and ankle. Foot involvement, particularly the first metatarsophalangeal joint, is the clinical hallmark of gout.

许多不同类型的晶体可以在体内形成，并可能导致急性滑膜炎，慢性关节病或关节周围综合征。最常见和临床相关的晶体是尿酸钠盐(痛风的病原体)和焦磷酸钙，两者通常影响足部和踝关节。足部受累，特别是第一跖趾关节，是痛风的临床标志。

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Osteoarthritis 骨关节炎

The Foot and Ankle in Rheumatology

Pub Date : 2019-03-01 DOI: 10.1093/med/9780198734451.003.0004

A. Keenan, S. Munteanu

In this chapter, we will cover osteoarthritis. First we will provide an overview, with definitions, pathogenesis and risk factors, and clinical features, followed by recommendations for holistic management of the disease. A detailed discussion on the prevalence and impact of foot disease is then given, by area of the foot. Specific non-pharmacological and pharmacological management are described, and surgical options are outlined. Finally, clinical trials and the future direction of research are covered.

在本章中，我们将讨论骨关节炎。首先，我们将提供概述，包括定义，发病机制和危险因素，以及临床特征，然后是对疾病整体管理的建议。详细讨论了流行和影响的足病，然后给出了，按面积的脚。描述了具体的非药物和药物管理，并概述了手术选择。最后介绍了临床试验和未来的研究方向。

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Spondyloarthropathies

The Foot and Ankle in Rheumatology

Pub Date : 2019-03-01 DOI: 10.1093/med/9780198734451.003.0007

D. Turner, P. Helliwell

The spondyloarthropathies include ankylosing spondylitis and psoriatic arthritis. The hallmark clinical features are inflammatory spinal disease, dactylitis, and enthesitis, together with an asymmetrical oligoarthritis, often of the lower limbs. Psoriaform skin and nail changes are also frequently seen, and, less commonly, but characteristically, a mutilating arthritis with severe deformity of the toes. These unique features often allow a diagnosis to be made purely on clinical examination of the lower limbs. However, these features also provide challenges for local treatments as skin disease may complicate the use of orthoses and percutaneous steroid injections. However, the importance of mechanical factors in the pathogenesis of these disorders almost mandates a combined mechanical and pharmacological approach to treatment.

脊椎关节病包括强直性脊柱炎和银屑病关节炎。典型的临床特征是炎症性脊柱疾病、趾炎和腰炎，并伴有不对称的寡关节炎，通常发生在下肢。牛皮癣状的皮肤和指甲变化也很常见，并且，不太常见，但具有特征性，致残性关节炎伴严重的脚趾畸形。这些独特的特征通常允许仅通过下肢的临床检查进行诊断。然而，这些特征也为局部治疗提供了挑战，因为皮肤病可能使矫形器和经皮类固醇注射的使用复杂化。然而，机械因素在这些疾病发病机制中的重要性几乎要求机械和药物治疗相结合的方法。

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Juvenile idiopathic arthritis 幼年特发性关节炎

The Foot and Ankle in Rheumatology

Pub Date : 2019-03-01 DOI: 10.1093/med/9780198734451.003.0010

G. Hendry

The impact of foot problems in adults with rheumatic and musculoskeletal diseases is generally well established. However, in contrast, the impact of foot problems in children with rheumatic diseases has received relatively little attention. Therefore this chapter provides an overview of the most common rheumatic disorder of childhood: juvenile idiopathic arthritis (JIA), with a focus on how it affects the foot, how it impacts on foot function, gait, and activities of daily living, and its associated assessment and management strategies. We acknowledge that other rheumatic disorders of childhood such as (but not limited to) juvenile systemic lupus erythematosus and dermatomyositis may occasionally present with foot-related impairments; however, these are less likely to affect the foot and ankle in the same way or to the same extent as JIA, and podiatrists are often less involved in management of these conditions. Therefore this chapter will focus on JIA, which frequently affects the foot and ankle and often requires podiatric contributions to the overall management strategies implemented by a multidisciplinary team.

成人风湿病和肌肉骨骼疾病的足部问题的影响通常是很确定的。然而，相比之下，患有风湿性疾病的儿童的足部问题的影响受到的关注相对较少。因此，本章概述了儿童最常见的风湿性疾病:青少年特发性关节炎(JIA)，重点介绍了它是如何影响足部的，它是如何影响足部功能、步态和日常生活活动的，以及相关的评估和管理策略。我们承认，其他儿童风湿性疾病，如(但不限于)青少年系统性红斑狼疮和皮肌炎，可能偶尔会出现足部相关损伤;然而，这些不太可能以与JIA相同的方式或程度影响足部和踝关节，并且足科医生通常较少参与这些疾病的管理。因此，本章将重点关注JIA，它经常影响足部和踝关节，通常需要足科医生参与多学科团队实施的整体管理策略。

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Pathomechanics and gait analysis 病理力学和步态分析

The Foot and Ankle in Rheumatology

Pub Date : 2019-03-01 DOI: 10.1093/MED/9780198734451.003.0013

G. Chapman, P. Helliwell

Gait analysis is the systematic study of human walking. This chapter summarizes currently available gait analysis techniques that are available to the clinician and researcher. Gait analysis can be used alongside clinical history and examination and other special investigations to gain a better understanding of the relationship between joint disease, impairment, and compensatory gait mechanisms. Abnormal pathology leads to abnormal biomechanics, and tools that demonstrate these changes can lead to insights into the effects of the disease on function, in disease progression, and the impact of physical treatments. Plantar pressure measurement techniques yield valuable information on structure and function and are probably the most likely tool to be used in clinical practice. Three-dimensional joint kinematic and kinetic analyses are more difficult to perform and interpret and are likely to remain largely research tools. Gait analysis techniques will drive experimental work to further advance core knowledge and inform future development of customized approaches to conservative therapies such as footwear and orthosis manufacture, as well as foot surgery.

步态分析是对人类行走的系统研究。本章总结了目前可供临床医生和研究人员使用的步态分析技术。步态分析可以与临床病史、检查和其他特殊调查一起使用，以更好地了解关节疾病、损伤和代偿步态机制之间的关系。异常病理导致异常的生物力学，证明这些变化的工具可以深入了解疾病对功能，疾病进展和物理治疗影响的影响。足底压力测量技术提供了关于足底结构和功能的宝贵信息，可能是最有可能在临床实践中使用的工具。三维关节运动学和动力学分析更难以执行和解释，可能主要是研究工具。步态分析技术将推动实验工作，进一步推进核心知识，并为未来定制保守疗法的发展提供信息，如鞋类和矫形器制造，以及足部手术。

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