Musculoskeletal Key

In 2004, major changes were made to the classification of children with JIA. Based on expert consensus, children with JIA were subclassified into seven subtypes: oligoarticular (either persistent or extended),…

The leukocyte count helps determine if the joint effusion reflects an inflammatory or noninflammatory process. Synovial fluid is usually heparinized before the cell count to reduce clumping. Leukocyte counts greater…

The clarity of the fluid is assessed by experienced clinicians in the syringe but more reliably can be done by expressing a small amount of fluid out of the plastic…

Although arthrocentesis can be performed by experienced clinicians using clinical landmarks, aspiration and injection of deeper joints (hip), complicated joints (wrist), and even large joints such as the knee and…

The first agents in this category were inhibitors of TNF-α (anti–TNF-α agents). Currently, five of these drugs have been approved by the U.S. Food and Drug Administration: • Adalimumab (fully…

Nonsteroidal Anti-inflammatory Drugs (NSAIDs). NSAIDs interfere with the production of prostaglandins and thus are effective in the reduction of inflammation and, therefore, pain. Many patients will require these agents along…

These goals include: • Education of the patient • Relief of pain • Preservation and restoration of function • Modification of disease progression and damage With the acquired understanding of…

These studies have proposed a sequence of events in the development of rheumatoid arthritis: (1) An unknown causative factor (antigen), carried to the joint by the circulation, initiates synovitis. (2)…

Thrombocytosis, elevated erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) usually correlate with the rheumatoid disease activity rather than disease severity. These laboratory tests are thus of some value in…

Ocular Changes. About 30% patients with rheumatoid arthritis have features of Sjögren syndrome, called secondary Sjögren syndrome. Keratoconjunctivitis is commonly associated with rheumatoid arthritis. Granulomatous scleritis occurs less often but…