sausage toe
Introduction
Introduction Typical reactive arthritis begins 2-4 weeks after genitourinary or intestinal infection. Most are young men. Reactive arthritis is typically asymmetrical arthritis, with an average of 4 joints, mainly in the lower extremities. Knee, hernia and metatarsophalangeal joints are the most common, and upper extremity joints can also be involved. Hip joint lesions are rare. Chest locks, shoulders, and ankle joints are seen in a small number of patients. Typical manifestations of reactive arthritic joints are swelling, fever, tenderness, and pain during active and passive conditions. When the toes or fingers are involved. The entire toe (finger) is diffusely swollen. This performance is called the sausage toe. The sausage toe is a clinical manifestation of reactive arthritis.
Cause
Cause
Common microorganisms that cause reactive arthritis include the intestinal tract, genitourinary tract, pharyngeal and respiratory infections, and even viruses, chlamydia and protozoa.
Most of these microorganisms are negative for Gram staining and have the property of adhering mucosal surfaces to host cells. Studies have found that the DNA and RNA of Chlamydia trachomatis, as well as the antigenic components of Shigella, can be detected in the synovial and synovial leukocytes of many patients with reactive arthritis. Chlamydia heat shock protein (HSP), Yersinia HSP60 and its polypeptide fragments can induce T cell proliferation in patients with reactive arthritis. These findings suggest that T cells in the peripheral blood of patients may be induced by the antigenic components of the above bacteria. Recently, studies have suggested that the tendon attachment point on the bone may be one of the sites where the initial immune and pathological reactions of reactive arthritis occur, and is the pathological basis of the occurrence of tendonitis.
Examine
an examination
1. Typical reactive arthritis: The diagnosis of reactive arthritis depends mainly on medical history and clinical features. Laboratory and imaging abnormalities are informative for diagnosis but not specific. For the asymmetrical lower extremity arthritis with acute onset, the possibility of reactive arthritis should be considered first. If the patient's history of pre-infection is combined and other arthritis is excluded, the diagnosis can generally be confirmed. Clinically, in addition to the characteristics of arthritis, it is necessary to pay attention to whether the patient has mucosal skin damage, nail lesions, ophthalmia and visceral involvement. The classification criteria for reactive arthritis proposed by Kingsley and Sieper in 1996 have implications for the diagnosis of this disease. HLA-B27 positive, extra-articular manifestations (such as conjunctivitis, iritis, skin, carditis and NS lesions) or the clinical manifestations of typical spondyloarthropathy (low back pain, tendonitis, etc.) are not necessary for reactive arthritis . In 1999, Sieper and Braun published the diagnostic criteria they recommended at the Third International Reactive Arthritis Symposium and proposed a multi-center collaborative study. The standard emphasizes laboratory tests for precursor infections.
2. Atypical reactive arthritis: The diagnosis of typical reactive arthritis is generally not difficult. However, for atypical cases, medical history and physical examination should be carefully asked. A history of intestinal and urinary tract infections or a history of unclean sexual contact in a transient or mild patient is often helpful in diagnosis and requires careful inquiry. The author found that many patients have no obvious knee pain, but physical examination has knee joint effusion. Explain that careful physical examination is meaningful for finding signs and prompting for diagnosis.
Diagnosis
Differential diagnosis
Differential diagnosis of sausage toe:
1. Finger (toe) swelling: refers to (toe) swelling refers to the increase in volume of tissue due to inflammation or congestion.
2. Giant finger (toe): Giant finger (toe) is a congenital malformation characterized by an increase in the volume of the fingers or toes. The incidence in congenital malformations of the extremities is very low, about 0.9%.
3, key finger (toe): Plummer-Vinson syndrome clinical manifestations of dysphagia, pharyngeal foreign body sensation, dysphagia is intermittent, without pain, often develops into persistence. More common iron deficiency anemia performance, such as loss of appetite, fatigue, palpitations, pale, spoon finger (toe) and hair loss. Plummer-Vinson syndrome, also known as Paterson-Kelly syndrome or iron deficiency dysphagia, is mainly characterized by iron deficiency anemia, dysphagia and glossitis. It occurs in white women aged 30-50 years, and males are rare. Chinese are rare.
4, and refers to (toe) deformity: the so-called toe (finger) deformity refers to the five toes (finger) between two or more sticking together and not separated, is born at birth innate Sexual abnormality.
5, clubbing (toe): refers to the (toe) end of the soft tissue thickening like a drum-like expansion, arched bulge, a longitudinal ridge and transverse ridges are highly curved, the surface is glassy, called the clubbing (acropachy. Clubbing finger). Also known as the faded finger. The angle between the side nail and the nail skin of the healthy person's finger is 160 degrees. With the occurrence of the forest finger, the angle can be gradually increased to 180 degrees or more. Pressing the root of the nail can have a noticeable elasticity and tenderness. The finger-like fingers appearing in different diseases have different fingertip colors. The forest finger of the congenital heart disease of the hair group, the finger is often purple and black, the nail arc is reddish brown, the capillary of the nail bed is increased, and the blood flow at the finger end is increased. In patients with lung disease, the fingertips of the forest finger are dry and not smooth, yellowish white, and the blood vessel proliferation is not significant. Oral refers to the more common symptoms of certain diseases in the internal medicine.
