toe joint pain
Introduction
Introduction Joint pain is mainly caused by arthritis or joint disease. Joint pain involves a wide range and a wide variety, so the differential diagnosis of joint pain is crucial. Joint pain is a category of limb pain, limb swelling, pain, phlegm and gout in Chinese medicine. Another joint pain can be found in "Lingshu·Hundred Diseases": "The six limbs are not able to pass the limbs, the limbs are painful, and the lumbar spine is strong."
Cause
Cause
Examine
an examination
Related inspection
Bone and joint soft tissue CT examination bone and joint MRI examination anti-rheumatoid arthritis 33 antibody mammography X-ray examination of limbs and joint plain film
First, laboratory inspection
Laboratory tests are an indispensable diagnostic step when diagnosing joint disease. There are many inspection items, and their clinical significance is different.
1. Rheumatoid factor (RE) is an antibody (autoantibody) that directly opposes natural or denatured gamma globulin. It appears as IgM, IgG, IgA immunoglobulin and is specific for the adhesin of the crystallizable part of human IgG. There are many ways to check rheumatoid factor, but the basic principles are the same. In addition to systemic lupus erythematosus, the positive rates of other joint diseases and joint lesions are low (<50%). Therefore, this experiment is of great significance in differential diagnosis.
Positive rates of other diseases: 1 positive rate of rheumatic fever and other collagen diseases, according to Ziff report, rheumatic fever is 20%, systemic lupus erythematosus is 34%, nodular arteritis is 21%, systemic sclerosis is 28%, dermatomyositis is 12%. 2 The positive rate of non-rheumatic disease, according to Barffeld's report, infectious hepatitis is 20%, subacute endocarditis is 27%, syphilis is 4%, sarcoma is 18%, cancer is 11%, leukemia is 4 %, multiple myeloma is 4%. 3 The positive rate of ankylosing spondylitis is 10%-20%, and the positive rate in 4 normal population is about 4%.
2, lupus cell test
It is a phagocytic cell that has taken in denatured nucleoplasm. The phenomenon of lupus erythematosus is divided into two phases. In the first phase, nuclear proteins that appear in the nucleus are altered by antinuclear factors. In the second phase, phagocytosis of destroyed cells or dead cells occurs. The significance of lupus erythematosus is the significance of lupus erythematosus cells: depending on the careful treatment of the trial, approximately 80% of patients with systemic lupus erythematosus can find lupus erythematosus cells. 18% of patients with rheumatoid arthritis can be seen, chronic active hepatitis, drug allergy, progressive systemic sclerosis, polyarteritis and dermatophytosis, and sometimes lupus erythematosus cells.
3, erythrocyte sedimentation rate
ESR is the easiest and most important means of detecting various rheumatic and inflammatory diseases. ESR can be seen in acute rheumatic fever, acute infection, active tuberculosis, rheumatoid arthritis, systemic lupus erythematosus, dermatomyositis, malignant tumors and other diseases. Regular examination of the erythrocyte sedimentation rate can help to infer the progression of the disease or gradually heal itself. It is helpful to identify certain diseases.
4, anti-streptolysin "O" test
For example, the anti-streptolysin "O" titer is as high as 500 U or more, indicating that the patient has recently been infected with hemolytic streptococcus, and is commonly used to diagnose rheumatic fever. It must be noted that if there is hemolysis, hypercholesterolemia, jaundice and serum contamination or bacterial infection, the anti-streptolysin "O" can be increased.
5, children's reaction protein
Elevated C-reactive protein in the blood is often used to understand the activity of acute rheumatic fever and rheumatoid arthritis.
6, anti-nuclear antibodies
This type of test is often used for the diagnosis of connective tissue disease, especially in systemic lupus erythematosus, where antibody titer and positive rate are the highest, and the diagnostic specificity is the strongest.
7. Immunoglobulins and complements
The assay can be used to observe the status of immune function, and is helpful for the diagnosis of connective tissue diseases such as liver diseases, autoimmune diseases, chronic bacteria, viruses and parasitic infections, and tumors.
8, HLA-B27 detection
It can be known that HIA-B27 is cleared, and the lymphocytes of the testee are mixed, and then human complement is added. If the specific antiserum binds to the corresponding HLA antigen of the lymphocyte membrane, complement can be activated to cause cell membrane damage. Damaged cell membranes can be stained with reactive dyes and can be identified under a microscope. If more than 50% of the cells are stained, the lake cells are considered to have the corresponding HIA-B27 antigen and are judged to be positive. HIA-B27 positive patients are most common in ankylosing spondylitis, with a positive rate of 86%-96%.
9, uric acid
Uric acid is fully diffused throughout the body fluid, uric acid metabolism disorders, formation of hyperuricemia, joint urate deposition, causing acute exacerbation of arthritis, that is, gout. The blood uric acid and uric acid content were measured.
10, the inspection of synovial fluid is first of all appearance, the normal joint fluid color is yellowish, clear, and effective. The degree of hyaluronic acid is determined by the concentration and degree of polymerization. Partial protein test; acetic acid can be condensed into a protein clot in normal or near normal synovial fluid. Acute inflammatory joint fluid, showing a sparse flocculent protein clot. White blood cells, degenerative joint disease, the number of white blood cells is (0~1) / L, rheumatoid arthritis is (3-15) x109 mine, and even more. Rheumatoid factor; sometimes synovial fluid can be positive before a positive reaction to blood, which is helpful for diagnosis. If crystals appear, the crystals can be examined by polarized wet micromirrors.
Second, arthroscopy
Arthroscopy is a new surgical technique that has been shown to be advanced and accurate for the diagnosis and treatment of joint disorders. It has been widely used in knee, shoulder, elbow, hip, ankle, and even Examination and treatment of wrist and interphalangeal joints. Arthroscopic technique is less injurious, and it is possible to directly observe the structural changes in the joint with the naked eye, which is more accurate than imaging examination. Mirror value: 1 Early detection of injuries that can be treated by surgery. 2 Give the patient and the surgeon a basis for not requiring surgical treatment. 3 As early as possible to understand and study the possible progress of certain lesions. Small arthroscopy can avoid unnecessary surgery, and the planned surgical plan can be changed. 5 identified an unexpected diagnosis.
Third, imaging examination
X-ray filming of joint diseases is one of the routine examination methods. It mainly looks at the changes of bone, especially the bone tumors in the joints, bone destruction, deformity, swelling of joint exudate, and has obvious diagnostic significance. CT and MRI are also new methods for examining joint lesions. In addition to bone imaging, the cartilage and soft tissue structure in the joint can be visualized. It has advanced features for the diagnosis of meniscus injury. This is a common X-ray film. The disadvantage is that it is more expensive.
Diagnosis
Differential diagnosis
Need to be differentiated from gout arthritis, the toe swelling is not painful, it is paroxysmal pain. X-ray manifestations of wind arthritis: soft tissue swelling shadows near the joints in the acute phase, worm-like or perforation-like defects appear at the edge of the joints at the later stage, and the surrounding bone density is increased. Finally, typical arthritis images are present, and bone destruction can cause deformities. Strong.
