憝誹芫尺及失皿伕奈民
- 4. 1. 憝誹芫及偅井凶
- 6. 憝誹芫井卅???ˋ
- 8. 憝誹
- 10. 憝誹俋
- 11. 憝誹俋 踐 錎 鮕 葆覂窒
- 12. 憝誹俋 賑珘婦 錎в 々籌 朸磊
- 13. ㄠㄘ憝誹 vs 憝誹俋 Articular vs Nonarticular ㄢ勾及禾奶件玄 ? 芫戈黫灥福葡謅楔々滮擗忙券v誹眻奻ˋㄘ ? 綅r芫ㄩ茪咫楔々艉諴佯r芫ˋㄘ ? 壤ㄩ酘衵匹掀屯月ㄗ壤木化月ˋㄘ
- 14. ㄠㄘ憝誹 vs 憝誹俋 Articular vs Nonarticular 憝誹 憝誹俋 芫戈黫 憝誹眻奻 憝誹俋及窒弇 綅r芫 赻r芫ㄩ丐曰 坻r芫ㄩ丐曰 赻r芫ㄩ丐曰 坻r芫ㄩ卅仄 壤 嗣中 屾卅中
- 15. 憝誹俋匹反卅仁憝誹芫井卅???ˋ
- 17. ㄡㄘ朒痌俶 vs 準朒痌俶 Inflammatory vs Noninflammatory 朒痌俶 覜擁 趙俶 磐瞄俶 磐儒俶 芫餫 怤湛L 赻撩轎砮俶 憝誹伉它穴民 SLE 毀縟 伉它穴民 毀縟婩v誹朒 杻逃俶 準朒痌俶 俋 嘎殏 錎啣p 餇 餇恦婩v誹痌 嘎螹粕 壤俶 嘎痄 伎匼俶緬禱磐 俶賑臚朒 C夔俶 鋤踐芫痌 陑秪俶
- 18. ㄡㄘ朒痌俶 vs 準朒痌俶 Inflammatory vs Noninflammatory ㄢ勾及禾奶件玄 ? 朒痌及侐梣礗廎苤〢[﹜逃喪﹜构芫 ? 仇歹壬曰ㄩ陳卞仁墿中ㄗ60煦眕奻ㄘ ? 宥縭婧趼╯滌k寣Ｃ趼╞犎`市奈詢
- 19. 朒痌俶 準朒痌俶 构芫 陳﹜珗嶲卞中 欶苳中 壤 俶 嘎俶 逃喪?廎 丐曰 卅仄 陳及仇歹壬曰 墿中ㄗ>1hrㄘ 傻中ㄗ<45minㄘ 宥縪Ｉ 逃寣Ⅵ賮☆苤 极笭p屾 卅仄 CRP?ESR 奻N 淏都 ㄡㄘ朒痌俶 vs 準朒痌俶 Inflammatory vs Noninflammatory
- 21. ㄢㄘr嶲磊綎午煦票 Chronology and Distribution 噫賜反※ㄥ筥嶲§ 摹俶 鞣俶 覜擁 磐儒俶 毀縟 準朒痌俶 赻撩轎砮俶 憝誹俋痌袨
- 22. ㄢㄘr嶲磊綎午煦票 Chronology and Distribution 噫賜反※ㄣ憝誹§ g憝誹朒 (Monoarthritis)ㄩㄠ憝誹 屾憝誹朒 (Oligoarthritis)ㄩㄡ‵ㄢ憝誹 嗣憝誹 (Polyarthritis)ㄩㄣ憝誹眕奻
- 23. ㄢㄘr嶲磊綎午煦票 Chronology and Distribution g/屾憝誹 嗣憝誹 摹俶 摹俶g/屾憝誹朒 摹俶嗣憝誹朒 鞣俶 鞣俶g/屾憝誹朒 鞣俶嗣憝誹朒 ※♀俶♂憝誹朒§
- 24. 憝誹芫尺及失皿伕奈民 ㄠㄘ憝誹 or 憝誹俋ˋ ㄡㄘ朒痌俶 or 準朒痌俶ˋ ㄢㄘr嶲磊綎午煦票 摹 鞣 屾 g 嗣 俶 憝誹朒
- 25. Case 1: 85r 躓俶 酘洏憝誹芫 政瓷s 掛梜砟銴縒堣劼T竘卅仁酘洏芫互堤政﹝ 赽毛心化中凶互蜊囡仄卅中凶戶珗嶲卞寰摹俋懂毛忳偅﹝ 坻及窒弇卞憝誹芫卅仄﹝ 旯极垀 BT 38.2⊥ 酘洏憝誹ㄩ壤?R芫?廎苳═瞗Ａ玉w嘎泐迾俶﹜芫心及 凶戶赻?坻豗\茞遛 ㄠㄘ憝誹 or 憝誹俋ˋ ㄡㄘ朒痌俶 or 準朒痌俶ˋ ㄢㄘr嶲磊綎午煦票
- 26. Case 1: 85r 躓俶 酘洏憝誹芫 政瓷s 掛梜砟銴縒堣劼T竘卅仁酘洏芫互堤政﹝ 赽毛心化中凶互蜊囡仄卅中凶戶珗嶲卞寰摹俋懂毛忳偅﹝ 坻及窒弇卞憝誹芫卅仄﹝ 旯极垀 BT 38.2⊥ 酘洏憝誹ㄩ壤?R芫?廎苳═瞗Ａ玉w嘎泐迾俶﹜芫心及 凶戶赻?坻豗\茞遛 摹 g 俶 憝誹朒 ㄠㄘ憝誹 or 憝誹俋ˋ ㄡㄘ朒痌俶 or 準朒痌俶ˋ ㄢㄘr嶲磊綎午煦票
- 27. 摹俶g憝誹朒及醀e ? 趙俶憝誹朒 Medical Emergency!! ? 磐儒俶憝誹朒ㄗ芫餫﹜怤湛Lㄘ ? 毀縟婩v誹朒 ? 伉它穴民 ? 憝誹悛壤 ? 隙Ｂ唹磪戎犍
- 28. 趙俶憝誹朒 Bacterial arthritis ? 憝誹及歷覜擁 ? 嗣仁反瓷埻峚汜昜及悛俴俶汃票卞方曰逃痌允月 ? 埻秪歷反酴伎皮玉它⑩歷互郔嗣 ? Medical emergency匹丐曰﹜笥及綈木反汜韜支C夔軑摽卞憝 歹月 ? 厒支井卅偅剿?笥午淕倛俋褪尺及戊件扔伙玄互斛猁
- 29. 芫餫 Acute gout ? 續呫磐儒互憝誹囀卞昴堤允月仇午卞方勻化汜元月 ? 詢續呫悛痌互適仁岈卞方曰憝誹瞎卞續呫磐儒互匎搪仄化逃痌卞勾卅互 月 ? 媼棒俶及埻秪午仄化失伙戊奈伙﹜瞳續犿囀督卞蛁砩 ? 場逃反狟眱及摹俶g憝誹朒午仄化逃痌仄﹜杻卞1MTP憝誹互嗣中 ? 笥ㄩNSAIDs﹜旦氾伕奶玉﹜戊伙甲民件 Rheumatology. Dalbeth, Nicola; McLean, Lachy. Published January 1, 2019. Pages 1598-1609. ? 2019 https://www.mayoclinic.org/diseases- conditions/gout/symptoms-causes/syc-20372897
- 30. 怤湛L Pseudogout ? 疋伕伉件呫市伙扑它丞磐儒互憝誹囀卞昴堤仄化汜元月 ? 詢h氪﹜躓俶卞嗣中 ? 圉杅反洏憝誹卞汜元﹜忒?潛?逋?紵憝誹卞手汜元丹月 ? 伊件玄必件匹反洏支忒憝誹﹜u嘎磐磁卞嘎坒閡趙 (Chondrocalcinosis) 毛庲戶月 Kelley＆s Textbook of Rheumatology Ninth Edition, Saunders New England Journal of Medicine. 2009;360(1):71
- 31. 摹俶g憝誹朒及醀e ? 趙俶憝誹朒 ? 磐儒俶憝誹朒ㄗ芫餫﹜怤湛Lㄘ ? 毀縟婩v誹朒 ? 伉它穴民 ? 憝誹悛壤 ? 隙Ｂ唹磪戎犍 醀e卞反憝誹珘煦昴互斛猁
- 32. 憝誹援棧 羥 ? 憝誹朒及偅剿ㄩ啞悛⑩杅﹜磐儒﹜峚汜昜 ? 趙俶憝誹朒卞允月玉伊瓜奈斥 ? 憝誹朒卞允月痌袨睿ㄗ㊣憝誹蛁扞ㄘ 輦暴 ? 憝誹葆輪及覜擁╯牠x. 瑚睜朒ㄘ ? 々籌瓷鉹洶═貒諺誘帤庖怗牠x. ヲ起ㄘ ? 眢堤悛俶ㄗ蕨覽嘐楊笢匹手假咫中丹騤璊滮═磩
- 33. 憝誹援棧 磁蜣 ? 覜擁╯0.01%-0.05% ? 憝誹蛁扞摽憝誹朒ㄩ1-6%﹜杅r嶲摽方曰逃痌 ? 錎剿蹊ㄩ失平伊旦錎﹜逋菁踐臚﹜媼螹踐錎匹詢伉旦弁 ? 旦氾伕奶玉及宥縭堋斜壧瓊瘍R散腔卞觳卞卅月及反洁 ? 々狟眲溝瞎及峸窺 ? 々籌伎匼迕囮 ? 朸磊pㄩ杻卞忒跦奪痌緊 ? 嘎螹粕嚏╞馴ぁ磳丰扙v誹痌﹜嘎ぢ產福T掊丐曰
- 34. 憝誹援棧及忒 援棧及 ? 秏馮蚚禾疋玉件亥奈玉 ? 扑伉件斥ㄩ洏卅日20mL ? ㄩ洏卅日20-21G ? ь旦疋永汁 ? 忒渝ㄗ準ьㄘ ? 布奈未 ? 瞌詮 ? 犿ㄗ旦氾伕奶玉﹜平扑伕市奶件ㄘ毛扑伉件斥卞柲勻化云仁
- 35. 憝誹援棧及忒 呣醴ㄗ喪趼反斛ㄘ ? 憝誹珘及講ㄩ赻煦匹市伙氾卞徭 ? 俋紝ㄞ梜喱僅ㄩ赻煦匹屾仄扑伉件斥井日晶日仄化復庲 ? 婉杅ㄩ斛醴分互悵羥縡滮吨峇в藉陘侅_庲毛 ? 續呫ㄞ疋伕伉件呫市伙扑它丞磐儒ㄩぇ嫖峚蔉互丐木壬赻煦匹復 庲褫夔 ? 珨啜歷T蘑ㄞ鑠璵 ? 蕨呫歷T蘑ㄞ鑠璵ㄞPCR (optional)ㄩ磐瞄俶毛疶丹r ? 婉偅 (optional)ㄩ壤俶毛疶丹r
- 36. 憝誹援棧及忒 蛁砩岈 ? 援棧允月窒弇及賤て悝毛抇眭仄化云仁 ? ь紱釬毛郩忐允月 援棧 1. 援棧窒弇毛Q隅仄﹜矢件珂毛尬{仄凶示奈伙矢件及珂匹穴奈平件弘 2. 踽謅冾馮ㄗㄡ隙眕奻ㄘ↗仇仇井日珂反援棧窒支卞揖木卅中 3. 籵都反擁垀鎊匰反俴歹卅中 4. ь紱釬匹﹜扑伉件斥卞R毛井仃卅互日援棧 5. 坋煦卞齬珘仄凶日﹜反公及引引匹犿毛柲勻凶扑伉件斥卞勾仃井 尹化犿芘迵
- 37. 準朒痌俶 朒痌俶 ×肯Ｂ 悛俶 俋 酴伎芵隴 酴伎髦 俶髦 悛俶髦 梜喱僅 詢中 腴中 腴中 〝 婉杅/mm3 200 - 2000 3000 - 75000 >60000 RBC>>WBC %嗣瞄⑩ <25% >50% >80% 〝 撞遞 餇恦婩v誹痌 俋 嘎螹粕 SLE 憝誹伉它穴民 磐儒俶 毀縟 它奶伙旦俶 淩歷俶 磐瞄俶 歷俶 磐儒俶 俋 嘎殏 鮕p 悛衭瓷 扑乓伙戊奈憝誹 壤俶 憝誹珘煦昴 http://www.rheumaknowledgy.com/synovial-fluid-analysis/
- 38. Case 1: 85r 躓俶 酘洏憝誹芫 政瓷s 掛梜砟銴縒堣劼T竘卅仁酘洏芫互堤政﹝ 赽毛心化中凶互蜊囡仄卅中凶戶珗嶲卞寰摹俋懂毛忳偅﹝ 坻及窒弇卞憝誹芫卅仄﹝ 旯极垀 BT 38.2⊥ 酘洏憝誹ㄩ壤?R芫?廎苳═瞗卄握艉峇縣戧?坻豗\ 茞遛 摹 g 俶 憝誹朒 ?憝誹援棧 ㄠㄘ憝誹 or 憝誹俋ˋ ㄡㄘ朒痌俶 or 準朒痌俶ˋ ㄢㄘr嶲磊綎午煦票
- 39. Case 1: 85r 躓俶 酘洏憝誹芫 Assessment 詢h躓俶卞悾竘卅仁逃痌仄凶酘洏憝誹及摹俶嗣憝誹朒匹丐曰﹜趙 俶憝誹朒?怤湛L及醀e及凶戶憝誹援棧囥俴 憝誹援棧 俋ㄩ酴伎髦嶀斪v誹珘30ml毛柲竘 梜喱僅ㄩ腴狟 婉杅ㄩ45000 cell/mm3 煦賒ㄩ嗣瞄⑩ 90%﹜g瞄⑩ 10% ぇ嫖峚蔉ㄩCPPD磐儒ㄚ 弘仿丞導咯獐歷ㄜ ?怤湛L
- 40. 2. 忒?忒硌芫及偅井凶
- 42. 忒憝誹午忒硌憝誹 Human Anatomy Atlas 2021匹釬傖
- 43. 忒憝誹午忒硌憝誹 忒憝誹 Wrist ?儮в硌憝誹 ?罫弇鼣蝍v誹 Human Anatomy Atlas 2021匹釬傖
- 44. 忒憝誹午忒硌憝誹 菴ㄠ忒跦笢忒憝誹 1st CMC joint Human Anatomy Atlas 2021匹釬傖
- 45. 忒憝誹午忒硌憝誹 笢忒硌嶲憝誹 MCP joint Human Anatomy Atlas 2021匹釬傖
- 46. 忒憝誹午忒硌憝誹 輪弇硌嶲憝誹 PIP joint 菴ㄠ硌嶲憝誹 1st IP joint Human Anatomy Atlas 2021匹釬傖
- 47. 忒憝誹午忒硌憝誹 罫弇硌嶲憝誹 DIP joint Human Anatomy Atlas 2021匹釬傖
- 48. 餇恦婩v誹痌及疑逃窒弇 PIP joint 1st IP joint DIP joint 1st CMC joint Human Anatomy Atlas 2021匹釬傖 MCP反簸今木卞仁中
- 49. 憝誹伉它穴民及疑逃窒弇 PIP joint 1st IP joint Wrist 1st CMC joint MCP joint 忒跦嶲憝誹 Human Anatomy Atlas 2021匹釬傖 DIP反簸今木卞仁中
- 50. Case 2-1: 79r 躓俶 忒硌憝誹芫 政瓷s 10爛眕奻ヶ方曰忒硌憝誹及芫心毛赻仄化中凶﹝憝誹互 餇峇楔々迨褡瞻搕豸吨糐嗩\仄凶﹝陳卞廣30煦厥適允 月忒及仇歹壬曰丐曰﹝
- 51. Case 2-1: 79r 躓俶 忒硌憝誹芫 政瓷s 10爛眕奻ヶ方曰忒硌憝誹及芫心毛赻仄化中凶﹝憝誹互 餇峇楔々迨褡瞻搕豸吨糐嗩\仄凶﹝陳卞廣30煦厥適允 月忒及仇歹壬曰丐曰﹝ 憝誹垀 ㄠㄘ憝誹 or 憝誹俋ˋ ? 憝誹 ㄡㄘ朒痌俶 or 準朒痌俶ˋ ? 準朒痌俶 ㄢㄘr嶲磊綎午煦票 ? 鞣俶 嗣憝誹ㄗ備俶ㄘ 1IP, 2-5PIP, 2-5DIP 餇恦婩v誹痌疶中
- 52. 餇恦婩v誹痌 DIP憝誹ㄩ Heberden磐 PIP憝誹ㄩ Bouchard磐 Kelley＊s Textbook of Rheumatology
- 53. 餇恦婩v誹痌 ? 嘎憔 ? 憝誹蹊炩狫苤趙 ? 嘎偽 ? ※Gull-wing§餇 Kelley＊s Textbook of Rheumatology
- 54. Case 2-2: 41r 躓俶 忒?忒硌憝誹芫 政瓷s 圉爛ヶ方曰I忒憝誹午忒硌憝誹及芫心毛赻仄化中凶﹝ 1仳堎ヶ方曰憝誹芫互趙仄模岈手嬪褣卞卅勻凶凶戶忳 偅仄凶﹝陳卞廣2r嶲厥適允月忒及仇歹壬曰丐曰﹝
- 55. Case 2-2: 41r 躓俶 忒?忒硌憝誹芫 政瓷s 圉爛ヶ方曰I忒憝誹午忒硌憝誹及芫心毛赻仄化中凶﹝ 1仳堎ヶ方曰憝誹芫互趙仄模岈手嬪褣卞卅勻凶凶戶忳 偅仄凶﹝陳卞廣2r嶲厥適允月忒及仇歹壬曰丐曰﹝ 憝誹垀 ㄠㄘ憝誹 or 憝誹俋ˋ ? 憝誹 ㄡㄘ朒痌俶 or 準朒痌俶ˋ ? 朒痌俶 ㄢㄘr嶲磊綎午煦票 ? 鞣俶 嗣憝誹ㄗ備俶ㄘ Wrist, 2-3MCP, 2-3PIP 憝誹伉它穴民疶中
- 57. 憝誹伉它穴民 婌ぶ笥及笭猁俶 憝 ぢ 逃痌井日及ぶ嶲 Window of opportunity 婌ぶ笥 o笥
- 60. 嗣憝誹芫及醀e Polyarticular Inflammatory Noninflammatory Acute Viral arthritis Septic arthritis Rheumatic fever Serum sickness Reactive arthritis Sickle cell crisis Chronic RA, JIA, SLE, Psoriatic arthritis Enteropathic arthritis Crystal arthritis MCTD, Scleroderma Lyme Osteoarthritis Hemochromatosis Hypertrophic osteoarthropathy Widespread periarticular Acute Enthesitis PMR Relapsing polychondritis Sickle cell disease Chronic PMR PM/DM Myasthenia gravis Eosinophilic faciitis Enthesitis Fibromyalgia Chronic fatigue syndrome Myxedema Drug-induced disorders Osteoporosis Paget＊s disease Psychogenic rheumatism http://www.rheumaknowledgy.com/evaluation-of-musculoskeletal-complaints/ g反仇氏卅卞g刓丐月
- 61. ACR及憝誹伉它穴民煦價呁1987爛ㄘ 1. 1r嶲眕奻厥適允月陳及仇歹壬曰 2. PIP﹜MCP﹜忒憝誹﹜紵?洏?逋憝誹﹜MTP及丹切3井垀眕奻及憝誹 壤 3. 忒及憝誹及蹌遞 4. PIP﹜MCP﹜忒憝誹﹜紵?洏?逋憝誹﹜MTP及丹切1井垀眕奻及肮r 備俶壤 5. 伉它穴玄奶玉磐 6. 悛ь伉它穴玄奶玉秪赽俶 7. 忒媥砉匹嘎太日氏支憝誹笚鴗庣ё挪s砉 1‵7及丹切4醴眕奻匹憝誹伉它穴民午偅剿允月﹝ Established RA毛煦允月凶戶卞釬傖今木凶價吨リ═ 婌ぶ憝誹朒及偅剿卞反祥砃五
- 62. 憝誹伉它穴民煦價 (ACR/EULAR, 2010爛) ? 1眕奻及憝誹壤引凶反R芫互丐月 ? 坻及撞遞反瘁隅腔 煦價 萸 蹌遞憝誹* 湮憝誹2‵10市垀 1 苤憝誹1‵3市垀 2 苤憝誹4‵10市垀 3 11市垀眕奻ㄗ苤憝誹1仳垀眕奻ㄘ 5 悛ь悝腔 RF纋俶引凶反ACPA纋俶 2 RF俶引凶反ACPA俶 3 摹俶ぶ毀縗旛| CRP都引凶反ESR都 1 痌袨及厥適ぶ嶲 6筥眕奻 1 磁旦戊失6萸眕奻匹RA午煦 *蹌遞憝誹及復庲卞賒砉豸藣瓣中々滮銴 Aletaha D. Arthritis Rheum. 2010
- 64. ? 嗣憝誹芫毛傘允月撞遞反嗣嶊卞歹凶月 ? 憝誹伉它穴民及煦價吨珆\剿卞妏丹手及匹反卅中 ? 憝誹伉它穴民毛疶勻凶日﹜岆準嬡瓟卞畿賡毛ㄐ
- 65. 引午戶 ? 憝誹芫毛偅月r反 Ｋ 憝誹ˋ Ｌ 朒痌ˋ Ｍ r嶲 磊綎午煦票ˋ 及楓匹復庲允月 ? 摹俶g憝誹朒及醀e卞反憝誹援棧互斛猁 ? 忒?忒硌及憝誹芫匹反煦票互禾奶件玄 ? 憝誹伉它穴民及偅剿反氘笭卞