n.

関節

WordNet

united or combined; "a joint session of Congress"; "joint owners"
marijuana leaves rolled into a cigarette for smoking (同)marijuana cigarette, reefer, stick, spliff
a disreputable place of entertainment
junction by which parts or objects are joined together
(anatomy) the point of connection between two bones or elements of a skeleton (especially if it allows motion) (同)articulation, articulatio
provide with a joint; "the carpenter jointed two pieces of wood" (同)articulate
affecting or involving two or more; "joint income-tax return"; "joint ownership"
fasten with a joint
fit as if by joints; "The boards fit neatly"
involving both houses of a legislature; "a joint session of Congress"
separate (meat) at the joint
of trade unions; "the union movement"; "union negotiations"; "a union-shop clause in the contract"
healing process involving the growing together of the edges of a wound or the growing together of broken bones (同)conglutination
the state of being joined or united or linked; "there is strength in union" (同)unification
the act of making or becoming a single unit; "the union of opposing factions"; "he looked forward to the unification of his family for the holidays" (同)unification, uniting, conjugation, jointure
a device on a national flag emblematic of the union of two or more sovereignties (typically in the upper inner corner)
an organization of employees formed to bargain with the employer; "you have to join the union in order to get a job" (同)labor_union, trade union, trades union, brotherhood
a set containing all and only the members of two or more given sets; "let C be the union of the sets A and B" (同)sum, join
a political unit formed from previously independent people or organizations; "the Soviet Union"
the occurrence of a uniting of separate parts; "lightning produced an unusual union of the metals"
having partial rights and privileges or subordinate status; "an associate member"; "an associate professor"
a person who joins with others in some activity or endeavor; "he had to consult his associate before continuing"
a person with subordinate membership in a society, institution, or commercial enterprise; "associates in the law firm bill at a lower rate than do partners"
any event that usually accompanies or is closely connected with another; "first was the lightning and then its thunderous associate"
make a logical or causal connection; "I cannot connect these two pieces of evidence in my mind"; "colligate these facts"; "I cannot relate these events at all" (同)tie_in, relate, link, colligate, link up, connect
cooperate as a traitor; "he collaborated with the Nazis when they occupied Paris"
work together on a common enterprise of project; "The soprano and the pianist did not get together very well"; "We joined forces with another research group" (同)join forces, cooperate, get together
a venture by a partnership or conglomerate designed to share risk or expertise; "a joint venture between the film companies to produce TV shows"
a long carpenters plane used to shape the edges of boards so they will fit together (同)jointer plane, jointing plane, long plane
a joint made by fastening ends together without overlapping (同)butt
come into the company of; "She joined him for a drink"
cause to become joined or linked; "join these two parts so that they fit together" (同)bring together
make contact or come together; "The two roads join here" (同)conjoin
become part of; become a member of a group or organization; "He joined the Communist Party as a young man" (同)fall_in, get together
the act of bringing two things into contact (especially for communication); "the joining of hands around the table"; "there was a connection via the internet" (同)connection, connexion
having joints or jointed segments;

PrepTutorEJDIC

『関節』 / 『継ぎ目』,接合箇所,合わせ目 / 継ぎ目と継ぎ目の間の部分,節 / (二つの部分を継いだり支えたりするのに用いる)継ぎ手,ジョイント / (枝や葉の)つけ根,節 / (骨付きの)肉の大切り身 / 《俗》安酒場,とばく宿,アヘン窟(くつ) / 『共同の』,共有の;連帯の,連合の / 両院合同の;二院制議会の両院の / …‘を'継ぎ合わせる;…‘を'継ぎ目(関節)でつなぐ / …‘を'継ぎ目で分ける;〈鳥・肉など〉‘を'関節で切り分ける
〈U〉(…の,の間の)『結合』,合同,合併;調和,一致《+of(between)+名》 / 〈C〉『結合したもの』,結合体,統一組識 / 《the U-》アメリカ合衆国;(南北戦争時に)連邦政府側についた北部諸州 / 《the U-》英連合王国(1706年イングランドとスコットランドが合併) / 〈C〉『労働組合』同盟,ユニオン / 〈C〉〈U〉結婚[生活] / 〈C〉連合旗章(米国国旗の白星;英国国旗の3本十字の三国連合旗章など) / 〈C〉(機械の部品をくなぐ)接合管
〈人〉'を'(…の)『仲間に加える』,(…に)連合させる《+『名』〈人〉+『with』+『名』》 / (…と)…'を'結びつけて考える(起こす)《+『名』+『with』+『名』》 / (…と)『仲間になる』,交際する《+『with』+『名』》 / (…と)合体する,提携する《+『with』+『名』》 / 『仲間』,『同僚』;組合員 / 準会員 / 付属物;連想されるもの / 連合した;仲間の,同僚の / 補助の,準…
(…と…について)共同して働く,共同研究する《+『with』+『名』+『in(on)』+『名』(do『ing』)》 / (占領軍・敵などに)協力する,内通する《+『with』+『名』》
〈二つ以上のもの〉‘を'『つなぐ』,結合する《+『名』+『together』(『up』)》;(…に)…‘を'つなぐ《+『名』+『to』(『onto』)+『名』》 / (線などで)〈二つ以上のもの〉‘の'間を結ぶ(つなぐ)《+『名』+『by』(『with』)+『名』》 / (友情・結婚などで)〈人〉‘を'結びつける《+『名』+『in』+『名』》 / 〈川・道などが〉…‘と'いっしょになる,合流する / 〈会など〉‘に'『加入する』 / (…で)〈人〉‘の'『仲間に入る』,‘と'いっしょになる《+『名』〈人〉+『in』(『for』)+『名』,+『名』〈人〉+『in』do『ing』》 / (…に)『加わる』《+『in』+『名』〈事〉/+『in』『with』+『名』〈人〉》 / (人と…を)『ともにする』《+『with』+『名』〈人〉+『in』+『名』(doing)》 / 〈川・道などが〉『いっしょになる』,合流する / 接合箇所(点,面,線);継ぎ目
継ぎ目のある;関節のある

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/10/24 15:15:21」(JST)

wiki en

[Wiki en表示]

A joint or articulation (or articulate surface) is the location at which bones connect.^[1]^[2] They are constructed to allow movement (except for skull, sacral, sternal, and pelvic bones) and provide mechanical support, and are classified structurally and functionally.^[3]^{[page needed]}

Classification

Joints are mainly classified structurally and functionally. Structural classification is determined by how the bones connect to each other, while functional classification is determined by the degree of movement between the articulating bones. In practice, there is significant overlap between the two types of classifications.

Terms ending in the suffix -sis are singular and refer to just one joint, while -ses is the suffix for pluralization.

An articulate facet is generally seen as a small joint, especially used when speaking of the joints of the ribs.^[4]^[5]

Structural classification (binding tissue)

Structural classification names and divides joints according to the type of binding tissue that connects the bones to each other.^[6] There are three structural classifications of joints:^[7]

fibrous joint – joined by dense regular connective tissue that is rich in collagen fibers ^[8]
cartilaginous joint – joined by cartilage
synovial joint – not directly joined – the bones have a synovial cavity and are united by the dense irregular connective tissue that forms the articular capsule that is normally associated with accessory ligaments.^[8]

Functional classification (movement)

Joints can also be classified functionally according to the type and degree of movement they allow:^[6]^[9]

synarthrosis – permits little or no mobility. Most synarthrosis joints are fibrous joints (e.g., skull sutures).
amphiarthrosis – permits slight mobility. Most amphiarthrosis joints are cartilaginous joints (e.g., intervertebral discs).
diarthrosis – freely movable.^[6]^[9] All diarthrosis joints are synovial joints (e.g., shoulder, hip, elbow, knee, etc.), and the terms "diarthrosis" and "synovial joint" are considered equivalent by Terminologia Anatomica.^[10] Diarthroses can in turn be classified into six groups according to the type of movement they allow: arthrodia, enarthrosis, ginglymus, rotary diarthrosis,^[11]^[12] condyloid articulation and articulation by reciprocal reception.^[13]

Joints can also be classified, according to the number of axes of movement they allow, into monoaxial (uniaxial), biaxial and multiaxial.^[14] Another classification is according to the degrees of freedom allowed, and distinguished between joints with one, two or three degrees of freedom.^[14] A further classification is according to the number and shapes of the articular surfaces: flat, concave and convex surfaces.^[14] Types of articular surfaces include trochlear surfaces.^[15]

Biomechanical classification

Joints can also be classified based on their anatomy or on their biomechanical properties. According to the anatomic classification, joints are subdivided into simple and compound, depending on the number of bones involved, and into complex and combination joints:^[16]

Simple joint: two articulation surfaces (e.g. shoulder joint, hip joint)
Compound joint: three or more articulation surfaces (e.g. radiocarpal joint)
Complex joint: two or more articulation surfaces and an articular disc or meniscus (e.g. knee joint)

Anatomical

The joints may be classified anatomically into the following groups:

Articulations of hand
Elbow joints
Wrist joints
Axillary articulations
Sternoclavicular joints
Vertebral articulations
Temporomandibular joints
Sacroiliac joints
Hip joints
Knee joints
Articulations of foot

Joint disorders

A joint disorder is termed an arthropathy, and when involving inflammation of one or more joints the disorder is called an arthritis. Most joint disorders involve arthritis, but joint damage by external physical trauma is typically not termed arthritis.

Arthropathies are called polyarticular (multiarticular) when involving many joints and monoarticular when involving only a single joint.

Arthritis is the leading cause of disability in people over the age of 55. There are many different forms of arthritis, each of which has a different cause. The most common form of arthritis, osteoarthritis (also known as degenerative joint disease), occurs following trauma to the joint, following an infection of the joint or simply as a result of aging. Furthermore, there is emerging evidence that abnormal anatomy may contribute to early development of osteoarthritis. Other forms of arthritis are rheumatoid arthritis and psoriatic arthritis, which are autoimmune diseases in which the body is attacking itself. Septic arthritis is caused by joint infection. Gouty arthritis is caused by deposition of uric acid crystals in the joint that results in subsequent inflammation. Additionally, there is a less common form of gout that is caused by the formation of rhomboidal-shaped crystals of calcium pyrophosphate. This form of gout is known as pseudogout.

History

Etymology

Joint

The English word joint is a past participle of the verb join, and can be read as joined.^[17] Joint is derived from Latin iunctus,^[17] past participle of the Latin verb iungere, join together, unite, connect, attach.^[18] In classical Latin, a similar name, derived from the verb iungere, exists that clearly is related to the meaning of the (anatomical) joint in the English language.^[18]^[19] Iunctura as joint is attested in the writings of Celsus^[19] and Ovidius.^[18]^[19] Celsus used besides the term iunctura also articulus and rarely nodus to refer to joints.^[19] The term iunctura was in classical Latin not a very precise designation as it could refer to all kinds of connections between bones^[19] as the sutures of the skull were also referred to as the iuncturae serratae.^[19] Ovidius refers to the knee joint as the iunctura genuum ^[18]^[19] and to the cervical joints as the iuncturae verticis.^[19] Besides the ascribed anatomical meaning, iunctura could also refer to a relationship or to consanguinity.^[18] In English, jointure^[17] and juncture ^[17] are both derived from classical Latin iunctura. In the Romance languages, French jointure,^[20]^[21]^[22] Italian giuntura ^[21] and Spanish juntura^[21] are used to refer to a joint with the first similarly derived from Latin iunctura.^[23]^[24]

In the anatomic Latin of the Nomina Anatomica, rebaptized in 1998 as Terminologia Anatomica, numerous expressions can be found that utilize the noun junctura, including junctura ossium ^[25]^[26]^[27] to refer to connection between bones (in general), and translated as joining of bones ^[28] in the English translation of the Basle Nomina Anatomica, junctura fibrosa ^[29]^[30]^[31] to refer to a fibrous joint, junctura cartilaginea ^[29]^[30]^[31] for a cartilaginous joint, juncturae ossium thoracicae ^[26]^[27] for the joints of the arms, and the juncturae ossium pelvinae ^[26]^[27] for the joints of the legs.

Articulation

The English term articulation is derived from Latin articulatio.^[17] The usage of this term, akin to its equivalents in Romance languages, like French articulation,^[20]^[22]^[32] Spanish articulación,^[32] Italian articolazione,^[32] and Portuguese articulação,^[33] that are similarly derived from the same Latin word,^[24] can be considered as a barbarism,^[19] in the sense that an incorrect meaning is ascribed to this word.^[19] The term articulatio can be found in the writings of Pliny the Elder as "the putting forth of new joints or knots" ^[18] or could refer to a "disease of the vine at the joints óf the tendrils".^[18]^[19] Articulatio as articulation or joint is not attested in classical Latin.^[19] As mentioned earlier, in Roman antiquity, various terms like iunctura, nodus and articulus were used to refer to a joint or articulation.^[19]

The first edition of the official Latin nomenclature, Basle Nomina Anatomica, used in 1895 the incorrect form articulatio. In the subsequent edition, authorized in 1935 in Jena,^[26]^[27] hence the name Jena Nomina Anatomica, the editor clearly objected to the use of the incorrect form articulatio and thought it was self-evident that this barbarism had to be replaced by the classical Latin articulus.^[27] The edition of the Nomina Anatomica approved by the nomenclature committee in 1955 in Paris however reverted this correction to the incorrect form articulatio.^[29] In each subsequent edition,^[29]^[30]^[34]^[35]^[36]^[37] the incorrect form articulatio was favored.

Although not common, English article^[22]^[32] can also be found to refer to a joint. In the Romance languages, similar words with the same meaning, like French article,^[20]^[32] also derived from Latin articulus,^[24] Spanish articulo ^[32] and Italian articolo,^[32] can also be found.

References

^ "Joint definition". eMedicine Dictionary. 27 April 2011. Retrieved 27 January 2012.
^ "Articulation definition". eMedicine Dictionary. 30 October 2013. Retrieved 18 November 2013.
^ Ellis, Harold; Susan Standring; Gray, Henry David (2005). Gray's anatomy: the anatomical basis of clinical practice. St. Louis, Mo: Elsevier Churchill Livingstone. p. 38. ISBN 0-443-07168-3.
^ "Medilexicon - Medical Dictionary - Articular Facet". Retrieved December 19, 2013.
^ "Foundational Model of Anatomy". Retrieved December 19, 2013.
^ ^a ^b ^c Whiting, William Charles and RuggDynatomy, Stuart (2006) Dynamic Human Anatomy, Volume 10 p.40
^ "Introduction to Joints (3) - Joints - Classification by Tissue Joining Bones". anatomy.med.umich.edu. Archived from the original on 2011-06-08. Retrieved 2008-01-29.
^ ^a ^b Principles of Anatomy & Physiology, 12th Edition, Tortora & Derrickson, Pub: Wiley & Sons
^ ^a ^b "Introduction to Joints (2) - Joints - Classification by Movement". anatomy.med.umich.edu. Archived from the original on 2011-07-18. Retrieved 2012-10-06.
^ "synovial joint" at Dorland's Medical Dictionary
^ Samuel George Morton (1849) An Illustrated System of Human Anatomy p.119
^ Henry Gray (1859) Anatomy, descriptive and surgical p.136
^ Henry Gray (1887) Anatomy, descriptive and surgical p.220
^ ^a ^b ^c Platzer, Werner (2008) Color Atlas of Human Anatomy, Volume 1, p.28
^ Armen S Kelikian, Shahan Sarrafian Sarrafian's Anatomy of the Foot and Ankle: Descriptive, Topographic, Functional p. 94
^ "Introductory Anatomy: Joints". Retrieved 2008-01-29.
^ ^a ^b ^c ^d ^e Klein, E. (1971). A comprehensive etymological dictionary of the English language. Dealing with the origin of words and their sense development thus illustration the history of civilization and culture. Amsterdam: Elsevier Science B.V.
^ ^a ^b ^c ^d ^e ^f ^g Lewis, C.T. & Short, C. (1879). A Latin dictionary founded on Andrews' edition of Freund's Latin dictionary. Oxford: Clarendon Press.
^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j ^k ^l ^m Hyrtl, J. (1880). Onomatologia Anatomica. Geschichte und Kritik der anatomischen Sprache der Gegenwart. Wien: Wilhelm Braumüller. K.K. Hof- und Unversitätsbuchhändler.
^ ^a ^b ^c Arnaudov, G.D. (1964). Terminologia medica polyglotta. Latinum-Bulgarski-Russkij-English-Français-Deutsch. Sofia: Editio medicina et physcultura.
^ ^a ^b ^c Sliosberg, A. (1975). Elsevier’s medical dictionary in five languages. English/American / French / Italian / Spanish and German. (2nd edition). Amsterdam/Oxford/New York: Elsevier’s Scientific Publishing Company.
^ ^a ^b ^c Gladstone, W.J. & Roche, P. (1990). ‘’Dictionnaire anglais-français des sciences médicales et paramédicales/English-French dictionary of medical and paramedical sciences.’’ (3rd edition). Québec: Edisem/Paris: Maloine.
^ Körting, G. (1901). ‘’Lateinisch-Romanisches Wörterbuch.’’ (2nd edition). Paderborn: Verlag Ferdinand Schöningh.
^ ^a ^b ^c Dauzat, A., Dubois, J., & Mitterand, H. (1964). Nouveau dictionnaire étymologique et historique.’’ Paris: Librairie Larousse.
^ His, W. (1895). Die anatomische Nomenclatur. Nomina Anatomica. Der von der Anatomischen Gesellschaft auf ihrer IX. Versammlung in Basel angenommenen Namen. Leipzig: Verlag Veit & Comp.
^ ^a ^b ^c ^d Kopsch, F. (1941). Die Nomina anatomica des Jahres 1895 (B.N.A.) nach der Buchstabenreihe geordnet und gegenübergestellt den Nomina anatomica des Jahres 1935 (I.N.A.) (3. Auflage). Leipzig: Georg Thieme Verlag.
^ ^a ^b ^c ^d ^e Stieve, H. (1949). Nomina Anatomica. Zusammengestellt von der im Jahre 1923 gewählten Nomenklatur-Kommission, unter Berücksichtigung der Vorschläge der Mitglieder der Anatomischen Gesellschaft, der Anatomical Society of Great Britain and Ireland, sowie der American Association of Anatomists, überprüft und durch Beschluß der Anatomischen Gesellschaft auf der Tagung in Jena 1935 endgúltig angenommen. (4th edition). Jena: Verlag Gustav Fischer.
^ Barker, L.W. (1907). Anatomical terminology with special reference to the [BNA]. With vocabularies in Latin and English and illustrations. Philadelphia: P. Blakiston’s Son & Co.
^ ^a ^b ^c ^d Donáth, T. & Crawford, G.C.N. (1969). Anatomical dictionary with nomenclature and explanatory notes. Oxford/London/Edinburgh/New York/Toronto/Syney/Paris/Braunschweig: Pergamon Press.
^ ^a ^b ^c International Anatomical Nomenclature Committee (1966). Nomina Anatomica. Amsterdam: Excerpta Medica Foundation.
^ ^a ^b Federative International Committee on Anatomical Terminology (FICAT) (2005). Terminologia Histologica. International terms for human cytology and histology. Philadelphia/Baltimore/New York/London/Buenos Aires/Hong Kong/Sydney/Tokyo: Wolter Kluwers-Lippincott Williams & Wilkins.
^ ^a ^b ^c ^d ^e ^f ^g Foster, F.D. (1891-1893). An illustrated medical dictionary. Being a dictionary of the technical terms used by writers on medicine and the collateral sciences, in the Latin, English, French, and German languages. New York: D. Appleton and Company.
^ Schleifer, S.K. (Ed.) (2011). Corpus humanum, The human body, Le corps humain, Der menschliche Körper, Il corpo umano, El cuerpo humano, Ciało człowieka, Människokroppen, Menneskekroppen, Τό ανθρώπινο σῶμα, ЧЕЛОВЕК. FKG.
^ International Anatomical Nomenclature Committee (1977). Nomina Anatomica, together with Nomina Histologica and Nomina Embryologica. Amsterdam-Oxford: Excerpta Medica.
^ International Anatomical Nomenclature Committee (1983). Nomina Anatomica, together with Nomina Histologica and Nomina Embryologica. Baltimore/London: Williams & Wilkins
^ International Anatomical Nomenclature Committee (1989). Nomina Anatomica, together with Nomina Histologica and Nomina Embryologica. Edinburgh: Churchill Livingstone.
^ Federative Committee on Anatomical Terminology (FCAT) (1998). Terminologia Anatomica. Stuttgart: Thieme

External links

Wikimedia Commons has media related to joints.

Synovial joints Illustrations and Classification

UpToDate Contents

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★リンクテーブル★

リンク元	「100Cases 27」「100Cases 16」「associate」「union」「関節」
拡張検索	「joint instability」
関連記事	「join」

「100Cases 27」

Joint
	Diagram of a typical synovial (diarthrosis) joint
	Depiction of an intervertebral disk, a cartilaginous joint
Details
Latin	Articulus; Junctura; Articulatio
System	Musculoskeletal system; Articular system
Identifiers
	Anatomical terminology

　　[★]

☆case27　関節痛

■症例

37歳　女性

主訴：関節痛

現病歴：数ヶ月、膝の痛みがだんだん強くなっていると感じていた。痛みは手や足の小関節に多く、朝歩くときに最もこわばる。痛みはジクロフェナクを飲むと和らぐ。そのほかの症状として疲労感を感じ、最近、体重が３ヶ月で４ｋｇ減っている。

喫煙歴：なし。

飲酒歴：機会飲酒

既往歴：なし

家族歴：既婚、子供は２人

服薬歴：ジクロフェナク

職業歴：legal sevretary

身体所見 examination

　顔貌　青白、臨床的な貧血を認める。近位指節間関節・中手指節関節　腫脹・effusionを伴う疼痛。中足趾節関節　圧痛。それ以外は正常。

検査　 investigation

　血液検査

　　Hb低下

　　ESR 上昇

　　尿素軽度上昇

　　クレアチニン軽度上昇

　　正常：白血球、MCV、血小板、ナトリウム、カリウム、グルコース、アルブミン

　尿検査

　　蛋白(-)、尿糖(-)、潜血(-)、

■問題

　本症例では診断とその根拠を考えるのは簡単なので、鑑別疾患をあげてその疾患に特徴的な症候を列挙しましょう。

■関節痛 DIF.283

　V Vascular

　　血友病 hemophilia　血友病性関節症(急性：疼痛、腫脹、熱感(SOR.241)

慢性：可動域の低下、変形、関節周囲筋萎縮(SOR.241))。家族歴

　　壊血病 scurvy　。生活環境。食事歴

　　無菌性骨壊死 aseptic bone necrosis (Osgood-Schlatter diseaseとか)

　I Inflammatory

　　感染性関節炎(細菌性関節炎(化膿性関節炎・淋菌性関節炎・結核性関節炎・嫌気性菌関節炎 )、真菌性関節炎、スピロヘータ関節炎(梅毒性関節炎・ライム関節炎)、マイコプラズマ関節炎、ウイルス性関節炎)

　N Neoplastic disorders

　　骨原性肉腫 osteogenic sarcoma

　　巨細胞腫 giant cell tumors

　D Degenerative disorders

　　degenerative joint disease

　　変形性関節症 osteoarthritis

　I Intoxication

　　痛風 gout (uric acid)

　　偽痛風 pseudogout (calcium pyrophosphate)

　　ループス症候群 lupus syndrome of hydralazine (Apresoline) and procainamide

　　gout syndrome of diuretics

　C Congenital and acquired malformations bring to mind the joint deformities of tabes dorsalis and syringomyelia and congenital dislocation of the hip. Alkaptonuria is also considered here.

　A Autoimmune indicates

　　関節リウマチ RA

　　血清病 serum sickness

　　全身性エリテマトーデス lupus erythematosus

　　リウマチ熱 rheumatic fever

　　ライター症候群 Reiter syndrome

　　潰瘍性大腸炎 ulcerative colitis

　　クローン病=限局性回腸炎 regional ileitis

　　乾癬性関節炎 psoriatic arthritis

　　リウマチ性多発筋痛症 polymyalgia rheumatica

　T Trauma

　E Endcrine

　　先端肥大症 acromegaly

　　閉経 menopause

　　糖尿病 diabetes mellitus

■関節炎の分類

・炎症部位の数

　単関節炎：痛風、偽痛風、離断性骨軟骨炎、血行性の化膿性関節炎のほとんど

　多関節炎：リウマチ性疾患、ウイルス性疾患、白血病での関節症状、易感染性宿主における血行性の化膿性関節炎

■関節リウマチ

　診断基準

　関節症状

　　朝のこわばり、疼痛、腫脹、関節の動揺、関節可動域制限、変形(手指、足趾、膝関節)。(SOR.211)

　　手指の近位指節間関節(PIP 関節)、中手指節関節(MP 関節)。遠位指節間関節(DIP 関節)に初発することは稀。(SOR.211)

　　左右対称性に生じることが多い。手関節、足趾、膝関節に初発する。(SOR.211)

　関節外症状

　　全身症状：発熱

　　皮膚症状：リウマトイド結節(肘の伸側、後頭部、手指)

　　眼症状：上胸膜炎(10日の経過で治癒)、強膜炎(予後不良)。稀に角膜穿孔

　　血液障害：(高頻度)貧血、白血球減少(Felty病。DMARDs投与中の場合は薬剤性の骨髄抑制を考慮)

　　アミロイドーシス：ネフローゼや下痢を来した症例で疑う。アミロイド蛋白はAA

　　腎障害：稀。アミロイドーシスの続発症か薬剤性を考慮。

　　呼吸器症状：間質性肺炎の合併多い。下肺野に好発。通常無症状。メトトレキセートなどの使用により薬剤性の急性間質性肺炎を生じることがある。

　　心・血管障害：リンパ管炎による難治性の浮腫。

　　神経症状：環軸関節亜脱臼により項部痛や脊髄症上が出現しうる。

　　骨粗鬆症

　　腱鞘滑膜炎：手指、手関節、足関節

■両側性多関節炎の鑑別疾患

　OA：遠位指節間関節を冒すのが特徴的で、近位指節間関節、中手指節関節を冒しうる。

　RA：

　SLE：軽度、症状の程度が変動する非びらん性の関節炎

　gout：単関節炎からはじまる。

　血清陰性関節炎：強直性脊椎炎、感染、ライター病：中～大関節に非対称性の関節炎。仙腸関節と遠位指節間関節にも関節炎

　急性ウイルス性関節炎：風疹。

■KEY POINTS

・RAでは遠位指節間関節は冒されない傾向がある。

・RAの全身症状は関節症状に先行することがある。

・RAの活動性と貧血及びESRは相関している。

・NSAIDsは腎機能に悪影響を与えることがある。

■initial plan

　Dx 1. 単純X線写真

　　　　・亜脱臼、関節周囲の骨萎縮(傍関節性骨骨粗鬆症,juxta-articular osteoporosis)、関節裂隙の狭小化、関節辺縁のびらん(bony erosion)

　　　　　・初期のRAで第5趾に骨びらんが一般的に見られる。

　　　　・血液検査

　　　　　・RF、抗DNA 抗体

　Tx 1. 鎮痛薬

　　　　・NSAIDs：鎮痛とこわばりの軽減

　　 2. DMARDs(メトトレキセート、レフルノミド、金製剤、ペニシラミン)

　　　　・NSAIDsで症状が治まらない場合に考慮

　　 3. 抗TNF 抗体

　　　　・重症のRAで効果がある場合がある。

■参考文献

SOR　標準整形外科学第10版医学書院

DIF　Differential Diagnosis in Primary Care Fourth Edition版 Lippincott Williams & Wilkins

「100Cases 16」

　　[★]

☆case16　膝の痛み

■glossary

indigestion 消化障害、消化不良

■症例

80歳　男性

主訴：左膝の痛みと腫脹

現病歴：左膝の痛みを2日前から認めた。膝は発熱・腫脹しており、動かすと疼痛を生じる。時々胸焼けと消化不良が見られる。6ヶ月前のhealth checkで、高血圧(172/102mmHg)と血中クレアチニンが高い(正常高値)こと以外は正常といわれた。その4週間数回血圧を測定したが、高値が継続したため、2.5mg bendrofluamethizide(UK)/ベンドロフルメチアジド bendroflumethiazide(US)で治療を開始した。最近の血圧は138/84 mmHgであった。

喫煙歴：なし。

飲酒歴：一週間に平均4unit。

既往歴：股関節に中程度(mild)の変形性関節症

家族歴：特記なし

服薬歴：アセトアミノフェン(股関節の疼痛に対して)

身体所見 examination

　血圧 142/86mmHg。体温37.5℃。脈拍88/分。grade 2 hypertensive retinopathy(高血圧症性網膜症)。心血管系、呼吸器系に検査場異常なし。手にDIPにヘバーデン結節なし。

　左膝が発熱し腫脹している。関節内に液、patellar tap陽性。90℃以上膝関節を屈曲させると痛みを生じる。右の膝関節は正常に見える。

検査　 investigation

　生化学：白血球増多、ESR 上昇、尿素高値、グルコース高値

　単純X線：関節間隙やや狭小。それ以外に異常は認めない。

■problem list

　#1 左膝の痛み

　#2 胸焼け

　#3 消化不良

　#4 高血圧

　#5 クレアチニン正常高値

　#6 股関節の変形性リウマチ

　#7 高血圧性網膜症

■考え方

　・関節痛の鑑別診断を考える。

　・VINDICATEで考えてみてもよいでしょう。

　・関節痛の頻度としては　外傷＞慢性疾患(OAなど)＞膠原病＞脊椎疾患＞悪性腫瘍

■関節痛の鑑別疾患

DIF 282

V Vascular 血友病 hemophilia, 壊血病 scurvy, 無菌性骨壊死 aseptic bone necrosis (Osgood-Schlatter diseaseとか)

I Inflammatory 淋疾 gonorrhea, ライム病 lyme disease, 黄色ブドウ球菌 Staphylococcus, 連鎖球菌 Streptococcus, 結核 tuberculosis, 梅毒 syphilis, 風疹 rubella, 単純ヘルペス herpes simplex, HIV human immunodeficiency virus, サイトメガロウイルス cytomegalovirus

N Neoplastic disorders 骨原性肉腫 osteogenic sarcoma, 巨細胞腫 giant cell tumors

D Degenerative disorders degenerative joint disease or 変形性関節症 osteoarthritis

I Intoxication 痛風 gout (uric acid), 偽痛風 pseudogout (calcium pyrophosphate), ループス症候群 lupus syndrome of hydralazine (Apresoline) and procainamide, gout syndrome of diuretics

C Congenital and acquired malformations bring to mind the joint deformities of tabes dorsalis and syringomyelia and congenital dislocation of the hip. Alkaptonuria is also considered here.