Chapter 1 Scientific Basis of Rheumatic DiseasesInnate Immunity 3
Innate Versus Acquired Immunity 3
Specific,or Acquired,Immunity 6
Immune Cell-Surface Markers 7
B Cells 7
Autoantibody Production 14
T Cells 15
Inflammation 28
Inflammatory Cells 28
Neutrophils 28
Macrophages 29
Eosinophils 29
Mast Cells 29
Basophils 29
Adhesion Molecules 30
Cytokines and their Receptors 32
Mediators of the Acute-Phase Response 32
T-Cell Cytokines 34
Cellular Growth Factors 36
Mediators of Inflammation 37
Collagen 41
Structure and Biology 41
Types of Collagen 42
Collagen Metabolism 44
Annotated Bibliography 44
Chapter 2 Methodologies of Basic Research and Clinicol InvestigationMethodologles of Basic Research 49
Elisa 49
Immunofluorescence 50
Southern Blotting 50
Northern Blotting 51
Western Blotting 51
Polymerase Chain Reaction 51
Animal Models 52
Oral Tolerance 53
Transgenic and Gene Knockout Animals 54
Gene Therapy 55
Monoclonal Antibodies and Antibody Technology 56
Fluorescence Activated Cell Sorting 57
Methodology in Clinical Studies 58
Diagnostic Testing 60
Statistics 62
Meta-Analysis 62
Health Status Measurements 62
Annotated Bibllography 63
Chapter 3 Diagnostic Imaging of Rheumatologic DiseaseIntroduction 65
Plain Radiographs 65
Ultrasonography 67
Computed Tomography 68
Skeletal Scintigraphy 68
Magnetic Resonance Imaging 70
Summary 73
Annotated Bibllography 73
Chapert 4 Therapies For Rheumatic DiseaseNonsteroidal Anti-Inflammatory Drugs 74
Mechanisms of Action 74
Pharmacology 76
Toxic Effects 78
Corticosteroids 83
Pharmacology 83
Mechanism of Action 84
Effects of Corticosteroids 84
Pituitary-Adrenal Cortical Function 84
Efficacy and Utility in Specific Rheumatic Diseases 85
Antirheumatic Drugs 87
Purine Analogues 87
D-Penicillamine 89
Gold Compounds 89
Antimalarial Drugs 90
Sulfasalazine 91
Methotrexate 91
Immunomodulators 93
Cyclophosphamide 93
Chlorambucil 94
Cyclosporine 94
Investigational Agents 95
Anti-T-Cell Therapy 96
Cytokine-Directed Therapy 96
Miscellaneous Drugs 97
Colchicine 97
Allopurinol 98
Analgesics 99
Capsaicin 99
Acetaminophen 100
Antidepressants 100
Opioid Analgesics 100
Tramadol 101
Annotated Bibliography 101
Chapter 5 Rheumatoid Arthritis 107
Pathogenesis 107
Epidemiology 109
Classification Criteria 109
Clinical Features 110
Clinical Presentation 110
Cervical Spine 111
Pleuropulmonary Manifestations 111
Cardiac Manifestations 113
Feltv's Syndrome and Pseudo-Felty's Syndrome 113
RheumatoidNodules 113
Malignancy 114
Prognosis 114
Therapy 115
Background 115
General Approach to Treatment 115
Drug Therapy 116
Surgery 117
Outcome Assessment 117
Annotated Bibliography 119
Appendix 1 121
Chapter 6 Spondyloarthropathies 126
A Wider Clinical Spectrum 126
Etiopathogenesis 126
Ankylosing Spondylitis 129
Pathology 130
Clinical Features 130
Diagnosis 131
Differential Diagnosis 133
Management 133
Reactive Arthritis(Reiter's Syndrome) 134
Epidemiology 134
Clinical Featurs 134
Radiologic Findings 136
Diagnosis 136
Management 137
Psoriatic Arthritis 138
Diagnosis 138
Management 139
Enteropathic Arthritis 139
Annotated Bibliography 139
Chapter 7 Systemic Lupus Erythematosus',Antiphospholipid syndrome,and Sj？gren's SyndromeSystemic Lupus Erythematosus 142
Pathogenesis 142
Epidemiology 146
Criteria and Approach to Diagnosis 147
Clinical Features 147
Clinical Course and Prognosis 151
Treatment 151
Antiphospholipid Syndrome 153
Case Study 153
Pathogenesis 154
Clinical Features 154
Diagnostic Tests 155
Treatment 155
Sj？gren's Syndrome 156
Pathogenesis 156
Clinical Features 157
Diagnosis and Classification 158
Treatment 158
Annotated Bibliography 159
Chapter 8 Vasculitis 161
Pathogenesis 161
C？nical and Pathologic Descriptions 163
Hypersensitivity Vasculitis 163
Sch？nlein-Henoch Purpura 163
Central Nervous System Vasculitis 163
Polyarteritis Nodosa 164
Microscopic Polyangiitis 164
Wegener's Granulomatosis 164
Giant Cell Arteritis 165
Polymyalgia Rheumatica 166
Takayasu's Arteritis 166
Churg-Strauss Vasculitis 166
Mixed Cryoglobulinemia 166
Treatment 167
Annotated Bibliography 167
Chapter 9 Scleroderma and Inflammatory MyopathiesScleroderma 169
Epidemiology 169
Pathogenesis 169
Clinical Features 170
Treatment 173
Other Diseases with Skin Sclerosis 174
Inflammatory Myopathies 174
Epidemiology 174
Pathophysiology 175
Differential Diagnosis and Evaluation 178
Polymyositis and Dermatomyositis 179
Inclusion Body Myositis 180
Diagnostic Testing 180
Treatment 181
Annotated Bibliography 182
Chapter 10 Pediatric Rheumatic DiseasesJuvenile Rheumatoid Arthritis 185
Incidence and Pathophysiology 185
Onset Subtypes 185
Evaluation of Children with Jra 188
Management of Chronic Arthritis 189
Nonsteroidal Anti-Inflammatory Drugs 189
Corticosteroids 189
Slow-Acting Antirheumatic Drugs 190
Differential Diagnosis of Childhood Arthritis 190
Mechanical Disorders 190
Acute and Chronic Infections 190
Malignancy 190
Juvenile Spondyloarthropathies 191
Inflammatory Disorders 192
Noninfectious Arthritis 192
Sch？nlein-Henoch Purpura 192
Kawasaki Disease 192
Systemic Lupus Erythematosus 192
Neonatal Lupus Syndrome 192
Juvenile Dermatomyositis 192
Psychogenic Rheumatism 193
Annotated Bibliography 193
Chapter 11 Infection and Arthritis 195
Nongonococcal Septic Arthritis 195
Epidemiology 195
Pathophysiology 195
Pathogenic Organisms 196
Risk Factors 196
Clinical Manifestations 197
Diagnosis 197
Prostheric Joint Infections 198
Disseminated Gonococcal Arthritis 199
Treatment of Disseminated Gonococcal Infection 199
Treatment and Prognosis 199
Mycobacterial Arthritis 201
Fungal Arthritis 201
Hiv and Aids 201
Arthralgia 201
Fibromyalgia Syndrome 201
Reiter's Syndrome 201
Psoriatic Arthritis 202
Nonspecific Oligoarthritis 202
Septic Arthritis 202
Myositis 202
Sj？gren's-Like Syndrome 202
Vasculitis 203
Autoantibodies 203
Hepatitis B and Parvovirus 204
Lyme Disease 204
Epidemiology 204
Clinical Features 205
The Three Stages of Lyme Disease 205
Confirming The Diagnosis With Testing 206
Treatment 207
Prevention 209
Annotated Bibliography 209
Chapter 12 Other Arthropathies 211
Hemophilic Arthropathy 211
Sickle Cell Disease 211
Poems 212
Pigmented Villonodular Synovitis 212
Hypertrophic Osteoarthropathy 213
Amyloid Arthropathies 213
Al Amyloid 214
Aa Amyloid 214
Sarcoidosis 214
Annotated Bibliography 214
Chapter 13 Rheumatic Disease and ReproductionIntroduction 216
Sexuality and Arthritis 216
Contraception 217
Pregnancy 218
Physiologic Changes of Normal Pregnancy 218
Drug Therapy and Reproduction 219
Pregnancy and Specific Rheumatic Diseases 220
Lactation 224
Musculoskeletal Disorders 224
Annotated Bibliography 225
Chapter 14 Crystal Disorders 226
Crystal Identiffcation 226
Gout 226
Etiopathogenesis of Hyperuricemia 226
Pathophysiology of Gouty Arthritis 228
Polyarticular Gout 228
Gout in Elderly Persons 228
Precocious Familial Gout 229
Drug-Induced Hyperuricemia and Gout 229
Risk Factors for Acute Gout 229
Gout as a Risk Factor for Coronary Disease 229
Hyperuricemic Treatment 229
Treatment of Acute Gout 229
Treatment to Lower Serum Urate 230
Calcium Pyrophosphate Dihydrate Deposition Disease 230
Pathophysiology 230
Familial(Hereditary)Articular Chondrocalcinosis 231
Secondary Calcium Pyrophosphate Dihydrate Disease 231
Hydroxyapatite (Basic Calcium Phosphate Disease) 231
Other Crystals Associated with Arthritis 232
Joint Problems Associated with Chronic Renal Failure 232
Crystal-Induced Arthritis 232
Septic Arthritis 233
B2-Microglobutin Amyloidosis 233
Osteonecrosis 235
Annotated Bibliography 235
Chapter 15 Bone and Cartilage DisordersOsteoarthritis 237
Epidemiology 237
Classification 238
The Components of Cartilage 238
Tissue Charges 240
Clinical Manifestations 240
Diagnosis 241
Treatment 241
Paget's Disease of Bone 242
Etiology 242
Histopathology 242
Biochemical Markers 242
Clinical Features 244
Therapy 244
Osteoporesis 245
Differential Diagnosis 245
Pathophysiology 245
Clinical Manifestations 247
Diagnosis 249
Management 251
Summary 254
Annotated Bibliography 254
Chapter 16 Soft Tissue and Regional Pain DisordersAxial Pain Syndromes:Back and Neck Pain 258
Mechanism 258
Clinical Evaluation 259
Treatment 265
Sports Medicine 266
Upper Extremities 267
The Shoulder 267
The Elbow 271
The Wrist 271
Lower Extremities 271
The Hip 271
Ischiogluteal Bursitis 272
The Knee 272
The Foot 276
Reflex Sympathetic Dystrophy Syndrome 279
Fibromyalgia Syndrome 280
Epidemiology 280
Natural History 280
Diagnosis 280
Association with Other Conditions 281
Pathophysiology 281
Association with Psychological Disturbance 281
Studies of Regional Cerebral Blood Flow 283
Treatment 283
Annotated Bibliography 285
Chapter 17 Total Joint Replacement and ArthroscopyTotal Joint Replacement 288
Indications and Contraindications 288
Preoperative Planning 288
Postoperative Care 289
Total Hip Replacement 289
Total Knee Replacement 295
Total Shoulder Replacement 298
Total Elbow Replacement 298
Total Ankle Replacement 299
F？ture Directions for Total Joint Replacement 299
Arthroscopy 300
The Knee Joint 300
The Shoulder Joint 301
Elbow,Wrist,and Hip 301
Complications of Arthroscopy 302
Annotated Bibliography 302
Chapter 18 Rehabilitation 305
Introduction 305
Methods of Rehabilitation 305
Exercise 305
Rest and Splinting 305
Thermal Therapy 306
Transcutaneous Electrical Nerve Stimulation 306
Mobilization Techniques 306
Spa Therapy 306
Aids and Appliances 307
Rehabilitation of Specific Joints 307
Knee 307
Ankle/Foot 307
Shoulder 307
Elbow 308
Hand/Wrist 308
Cervical Spine 308
Annotated Bibliography 308
Self-Assessment Test 311
General Instructions 311
Multiple-Choice Questions 312
Answers and Critiques 349
Instructions for Scoring 409
Normal Laboratory Values 410
Index 412