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Example text
Des periartikulären Gewebe und einem diffusen Ödem der abartikulären Weichteile (z. B. spondylogen ausgelöst, bei Kollagenosen) zu differenzieren; dies betrifft besonders den Handbereich um die Fingergrundgelenke. ~ ~ ~ ~ Subkutis: Lipomatosis, Lipatrophie; u. a. Roll- und Kneifschmerz. Muskulatur: Tonus, Verhärtungen, Verspannungen (Myogelosen) , Druckpunkte, Triggerpoints (vom Druckpunkt ausstrahlender Schmerz). Sehneninsertionen um die großen Gelenke und im Stammbereich: Ausschluß von Enthesopathien.
B. Yersinia-Arthritis), Gelenkbeteiligung bei Enteropathien (M. Crohn, Colitis ulcerosa, M. Whipple). ~ Hautbeteiligung: Kollagenosen, Psoriasis-Arthritis, reaktive Arthritis, Purpura rheumatica. ~ Augensymptome: Sjögren-Syndrom, reaktive Arthritis (Konjunktivitis), Spondylarthropathien, M. Behc":et, jcA, selten RA. ~ Beteiligung der Mundschleimhaut: Sjögren-Syndrom, M. Behc":et, reaktive Arthritis, Medikamentenallergien. ~ Haarausfall: Kollagenosen, besonders systemischer Lupus erythematodes (SLE), Arthropathie bei Hyperthyreose.
Diagnostik von Kristallarthropathien Der Nachweis von Kristallen in Gelenkflüssigkeiten und im Gewebe wird vor allem mit polarisationsoptischen Methoden (unter Zuhilfenahme eines Rotkompensators) geführt. Jeder Gelenkerguß unklarer Ätiologie sollte auf Kristalle untersucht werden. Sorgfältige Durchführung (Vermeidung von Verunreinigungen) und Erfahrung in der Identifizierung von Kristallen sind Voraussetzung. Weiterführende labormedizinische Untersuchungen zur Erkennung zugrunde liegender Stoffwechselstörungen sind oft notwendig.