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Samenvatting rheumatologie
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Samenvatting van rheumatologie. Voor de opleiding 3 bachelor revalidatiewetenschappen en kinesitherapie, 2de semester, VUB. Geslaagd in 1ste zit.
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Priscillia Angela Cosentino1.INLEIDING ............................................................................................................................................................. 3
1.Rheumatologie ................................................................................................................................................ 3
2.Belang van kiné ................................................................................................................................................ 3
3.Prognose .......................................................................................................................................................... 3
4.Anamnese en klinisch onderzoek .................................................................................................................... 3
5.Pijntypes .......................................................................................................................................................... 3
6.Klinisch onderzoek van het gewricht ............................................................................................................... 5
2.HET GEWRICHT..................................................................................................................................................... 6
1.Opbouw/elementen: ....................................................................................................................................... 6
2.Gewrichtskapsel............................................................................................................................................... 6
3.Synoviale vocht (examenvraag voor casus) ..................................................................................................... 6
3.Metabool – degeneratieve reuma ....................................................................................................................... 7
1.Osteoporose .................................................................................................................................................... 7
2.Osteoartrose .................................................................................................................................................... 9
4.FIBROMYALGIE ................................................................................................................................................... 14
1.Definitie ......................................................................................................................................................... 14
2.Symptomen.................................................................................................................................................... 14
3.Epidemiologie ................................................................................................................................................ 14
4.Diagnose ........................................................................................................................................................ 15
5.Pathogenese .................................................................................................................................................. 16
6.Behandeling ................................................................................................................................................... 16
7.Prognose ........................................................................................................................................................ 19
5.SPIERLETSELS ...................................................................................................................................................... 19
1.Soorten .......................................................................................................................................................... 19
2.Diagnose ........................................................................................................................................................ 19
3.Behandeling – acuut ...................................................................................................................................... 19
4.Prognose ........................................................................................................................................................ 20
6.Peesletsels .......................................................................................................................................................... 20
1.Terminologie .................................................................................................................................................. 20
2.Oorzaken........................................................................................................................................................ 20
3.Opbouw ......................................................................................................................................................... 20
4.Pathologenese ............................................................................................................................................... 21
5.Stadia peesletsels .......................................................................................................................................... 21
6.Diagnose ........................................................................................................................................................ 21
7.Locaties .......................................................................................................................................................... 21
8.Behandeling ................................................................................................................................................... 22
9.Evidentie ........................................................................................................................................................ 23
7.Bursitis................................................................................................................................................................ 23
1.Inleiding ......................................................................................................................................................... 23
2.Algemeen ....................................................................................................................................................... 23
1
,Priscillia Angela Cosentino
3.Symptomen.................................................................................................................................................... 23
4.Specifieke sympotmen................................................................................................................................... 23
5.Diagnose ........................................................................................................................................................ 23
6.Behandeling ................................................................................................................................................... 24
8.Inklemming neuropathie .................................................................................................................................... 24
1.Definitie ......................................................................................................................................................... 24
2.Diagnose ........................................................................................................................................................ 24
3.Lokalisatie ...................................................................................................................................................... 24
4.Behandeling ................................................................................................................................................... 25
9.CRPS = complex regional pijn syndroom ............................................................................................................ 25
1.Epidemiologie ................................................................................................................................................ 25
2.Terminologie .................................................................................................................................................. 25
3.Kliniek ............................................................................................................................................................ 25
4.Diagnose ........................................................................................................................................................ 26
5.Pathofysiologie .............................................................................................................................................. 26
6.Behandeling ................................................................................................................................................... 27
7.Prognose ........................................................................................................................................................ 28
8.Preventie........................................................................................................................................................ 28
9.CRPS bij kinderen ........................................................................................................................................... 28
10.Systeemziekten of bindweefselaandoeningen ................................................................................................ 28
1.Lupus.............................................................................................................................................................. 28
2.Intermezzo corticosteroïden ......................................................................................................................... 31
3.Intermezzo Raynaud ...................................................................................................................................... 31
4.Sjögren syndroom .......................................................................................................................................... 32
5.Sclerodermie (systemische sclerodermie) ..................................................................................................... 33
6.Polymyositis dermatomyositis ....................................................................................................................... 36
7.Ehlers danlos .................................................................................................................................................. 37
11.Inflammatoire reuma ....................................................................................................................................... 38
1.Reumatoide artritis ........................................................................................................................................ 38
2.Spondylartropathiëen .................................................................................................................................... 44
2.1.Psoriasis artritis ...................................................................................................................................... 44
2.2.Ziekte van Bechterem............................................................................................................................. 45
2.3.Infecties en artritis ................................................................................................................................. 49
3.Juventiele artritis ........................................................................................................................................... 52
12.Stofwisselingsreuma ........................................................................................................................................ 53
1.Jicht (la goutte) .............................................................................................................................................. 53
2.Chondrocalcinosis .......................................................................................................................................... 56
3.Ziekte van paget ............................................................................................................................................ 57
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,Priscillia Angela Cosentino
1. INLEIDING
1. Rheumatologie
= Reumatologiehoudtzichbezigmet aandoeningenvan bindweefsels,
gewrichtenengerelateerdestructuren, die gekarakteriseerdwordendoor inflammatie,
degeneratie, of metabolestoornissen
Gewrichten / bot / spieren / pezen
2. Belang van kiné
• Informatie en advies
• Ondersteunen in (heropname van) lichamelijke activiteit en actieve levensstijl
• Aanpakken van primaire stoornissen en beperkingen
• Secundaire preventie van met reuma samenhangende klachten (pijn,
verminderde spierkracht, verminderde aerobe capaciteit, verminderd evenwicht,
afgenomen mobiliteit, valangst, beperkingen in activiteiten en participatie etc.)
• Instrueren bij gebruik hulpmiddelen
3. Prognose
• Afhankelijk van:
o Medische toestand en specifieke diagnose
o Functionele toestand (anamnese en klinisch onderzoek)
o Psychosociale factoren (gele vlaggen!)
• Een patiënt met een goede medische en functionele prognose kan toch slecht
herstellen omwille van psychosociale factoren die het herstel in de weg staan.
4. Anamnese en klinisch onderzoek
o Onset en verloop symptomen
o Lokalisatie symptomen (lokaal/veralgemeend, symmetrisch, etc.)
o Familiale achtergrond
o Beïnvloedende factoren: wat maakt de klachten erger of minder erg?
o Impact op functie, activiteiten en participatie
o Co-morbiditeiten
o Pijntypes
o Andere onderzoeken
5. Pijntypes
• Nociceptieve pijn
Inflammatoire pijn Mechanische pijn
Dolor- rubor – calor – tumor Pijn bij belasting
Nachtelijke pijn Geen nachtelijke pijn
Pijn bij rust Pijn verdwijnt in rust
Aanhoudende ochtendstijfheid (> 1 uur) Kortdurende ochtendstijfheid
Beter bij inspanning
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, Priscillia Angela Cosentino
• Neuropathische pijn
o Sensorische testing (hyper/hypo-esthesie, paresthesie, hyper/hypo-algesie,
allodynie)
o Spiertesting (functioneel of bv EMG)
o Vragenlijsten (LANSS, painDETECT)
o Testen, doe druk zetten op zenuw
• Centrale sensitisatie pijn
o Criteruim 1: disproportionele pijndistributie
▪ Ernst van pijn en gerelateerd dysfunctioneren (intolerantie voor dagelijkse
activiteiten) disproportioneel tot de hoeveelheid en/of ernst van
weefselschade
o Criterium 2: diffuse pijndistributie
▪ Bilaterale pijn/ mirror pain (i.e. symmetrisch pijnpatroon)
▪ Pijn variërend in (anatomische) locatie
▪ Groot pijngebied met niet-segmentale verdeling
▪ Allodynie buiten segmentaal gebied van primaire nociceptie
o Criterium 3: hypersensitiviteit voor allerlei prikkels
▪ Reuk, smaak, licht, geluid, tast, medicatie, koude/warmte, etc.
▪ Central Sensitization Inventory
▪ Cutoff = 40
▪ Geassocieerde symptomen
• Huid, nagels
• Ogen
• Mond, keel
• Lymfeklieren
• Vaatstelsel
• Lever, milt
• Spijsverteringsstelsel
• Genitaliën
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