polytendinopathy
Introduction
Introduction to multiple tendon end diseases In recent years, it has been recognized that polymyelopathy is one of the common and characteristic manifestations of spinal joint disease such as undetermined spondyloarthropathy, ankylosing spondylitis, Wright syndrome, psoriatic arthritis and reactive arthritis. The diagnosis of this type of disease has a suggestive value. It is particularly important to note that children with multiple tendon end-stage disease or seronegative tendon end disease and arthrosis syndrome are markers for juvenile spinal joint disease and the best predictor of the disease. Although it has not been classified as a disease in the classification of spondyloarthropathy, it is closely related to many spondyloarthropathy, and many patients go to the orthopedics after the illness. basic knowledge The proportion of illness: 0.005% Susceptible people: no specific people Mode of infection: non-infectious Complications: oral ulcers, diarrhea
Cause
Cause of multiple tendon end disease
Cause:
The pathogenesis of this disease is still unclear. Pathological examination: biopsy tissue is taken from the external iliac crest, sputum or Achilles tendon attachment point, and the tissue thickening, hardening, yellowing, edema and granulation formation are generally visible. Learn to change granulation tissue with mononuclear cell infiltration, small blood vessel hyperplasia, fibrotic or metaplastic tissue and chronic granulation tissue formation.
Prevention
Multi-muscle end disease prevention
1. Eliminate and reduce or avoid the disease factors, improve the living environment, develop good living habits, prevent infection, pay attention to food hygiene, and rational diet.
2, pay attention to exercise, increase the body's ability to resist disease, do not fatigue, excessive consumption, quit smoking and alcohol.
3. Maintain balance and overcome anxiety and tension. Early detection and early diagnosis and treatment of the primary disease, establish confidence in the fight against disease, adhere to treatment.
4. Keep a light diet. Eat more fresh vegetables and aquatic products, such as vegetables, radishes, kelp, seaweed, etc., should eat less meals.
5, fasting fat and animal offal, can not eat stimulating onions, peppers, coffee and so on. Eat less refined sugar, honey, fruit candy, cakes, etc.
Complication
Multiple tendon end disease complications Complications, oral ulcers, diarrhea
The disease can be complicated by diarrhea, conjunctivitis or recurrent oral ulcers, children with multiple tendon end disease or seronegative tendon end disease and joint disease syndrome, may be early in childhood spondyloarthropathy.
Symptom
Symptoms of multiple tendon end symptoms Common symptoms Diarrhea Oral ulcers Muscle soreness Joint swelling Moderate pain
The males are obviously more common, the ratio of male to female is 9:2, the average age of onset is 32.3 years old (14-55 years old), mostly acute onset. The patient complains of pain at the end of multiple tendons, most of which are moderate pain, a few Severe pain, affecting activity, nighttime pain is seen in almost all patients, and some patients may be associated with diarrhea, conjunctivitis or recurrent oral ulcers.
The onset of the tendon at the end of the lesion showed swelling, reddish, palpation micro-heat, tenderness is extremely obvious, and even refused to press. The affected parts may include: ankle joint, upper humerus, calcaneus attached to the tibia or aponeurosis, condyle, upper and lower humerus, humerus, scapular ganglion, humeral end, femur trochanter, iliac crest The epiphysis and the sacral spine, the joint of the rib and the cartilage, the spinous process of the cervical vertebrae, the thoracic vertebrae and the lumbar vertebrae, etc., the end of the affected tendon reaches 5-20, with an average of 9.8, a small number of patients with oligoarthritis or monoarthritis, lower limbs The joints are more common than the upper limbs, but they are all self-limiting. They usually resolve in 1 week to 2 months. There are indications that the disease seems to have a tendency to affect several members of the family.
Examine
Examination of multiple tendon end diseases
1, the patient lacks systemic inflammatory response indicators, such as erythrocyte sedimentation rate does not increase, in a case of 11 cases, all patients were negative for HLA-B27, and another report in the People's Liberation Army General Hospital, 3 cases The patient's HLA-B27 was also negative, and individual patients were positive for rheumatoid factor or antinuclear antibody, which appeared to be unrelated to the disease.
2, the radiological changes seen in this disease are not specific, X-ray films have no signs of sputum arthritis, bone scan shows increased activity of radioactive concentration at the end of inflammatory tendon, high-resolution ultrasound examination, adhesion in tendon The most common change in point is edema, and half of them are clinically asymptomatic.
Diagnosis
Diagnosis and diagnosis of multiple tendon end diseases
Diagnostic criteria
The diagnosis points of the multiple tendon end disease proposed by Shichikawa et al are as follows:
1 There are spontaneous pain and tenderness at the end of the tendon of at least 5 parts of the limb or body, such as the condyle, the upper epicondyle of the humerus, the ankle joint, the lower part of the tibia, the attachment point of the Achilles tendon to the calcaneus, and the humerus. .
21 or more tendon ends are swollen.
3 no systemic inflammation and X-ray film ankle arthritis.
4 Exclude any disease associated with spondyloarthropathy.
The key to the diagnosis of multiple tendon end-stage disease should be based on a detailed physical examination, which distinguishes tendonitis around or near the joint from synovitis of the joint. The former has only limited swelling or swelling, but the tender point is extremely Obviously, there are no swelling and tenderness in the adjacent joints, and the active and passive movements of the joints are all barrier-free. It is only to avoid the pain at the end of the tendon when the joints are active. The patient is often in a braking state; the latter has joints due to joint synovitis. Swelling, effusion, tenderness and dyskinesia, but there is no abnormality at the end of the tendon near it. Clinically, due to medical history and inadvertent physical examination, patients with multiple tendon end diseases are misdiagnosed as other arthritis, and the time of misdiagnosis is long. For months, even years, it is not a rare case. If the clinical identification ability can be improved, multiple tendon end disease is not a rare disease.
Differential diagnosis
The disease needs to be differentiated from other arthritis, synovitis, and juvenile spondyloarthropathy.
