Extra Needs 5th

L5 p2 ortho "knee injuries" دكتور وهدان https://youtu.be/XXy9xeEXaRw https://youtu.be/CeD8TzAeeB8

مدينا المسابقة ل ١٠ بالليل، اجتهدوا فيه ناس كتير اوي بعتت اللهم بارك ❤️ كل اللي بعتوا، بعتنا اسماءكم 🫡❤️

⚠️⚠️⚠️⚠️⚠️⚠️⚠️ ركزوووااااا السلام عليكم اذيكم يا جماعة 🚫 انتبهوا كويس للكلمتين دول عشان فيهم خير كبير اللهم بارك من دلوقت لغروب يوم الجمعة (١٤ رمضان) فيه مسابقة، الجوايز هتكون التبرع للمشروع الخيري بتاع الدفعة- صدقة لك ولوالديك طب ايه هي المسابقة زي ما موجود فالصورة… قراءة قرآن+ صلاة على النبي، والمستويات اللي فالصورة محدده كله ده مجرد قرايه من اي مكان فالمصحف براحتك 🚫 بأمر الله اللي يتمم المسابقة يبعت اسمه على بوت اكسترا والمستوى اللي خلصه عشان يتم التبرع عنّه وهنبعتلكم برايڤت صورة فيها إنه بفضل الله تم تأكيد التبرع عنكم فرصة حلوة على جميع الاصعدة.. طاعة ورزق ❤️ شدوا حيلكم عشان كله فالأول وفالآخر هيروح للمشروع الخيري بتاع الدفعة، والمبلغ هيتحدد على حسب كم واحد أتم المسابقة 🚫 اخيراً الموضوع قايم على أمانة كل حد فيكم البوت اهو: @extradiscussion_bot

انا لله وانا إليه راجعون والد زميلنا عز الدين يوسف في ذمة الله الرجاء الدعاء له بالرحمه والمغفره

انا لله وانا إليه راجعون والد زميلنا عز الدين يوسف في ذمة الله الرجاء الدعاء له بالرحمه والمغفره

🛑Rheumatology ⭕️Lec 1 intro & RA & JIA ⛔️ريكورد السنة اللى فاتت ▪️https://t.me/extraneeds_2021/9863 ▪️https://t.me/extraneeds_2021/9874 او ▪️https://t.me/extraneeds_2021/9873 ⛔️فيديوهات د اميرة ▪️https://t.me/extraneeds_2021/9864 ⛔️تفريغ ▪️https://t.me/extraneeds_2021/9866 ▪️https://t.me/extraneeds_2021/9877 ▪️https://t.me/extraneeds_2021/9872 ⛔️الكتاب ▪️https://t.me/extraneeds_2021/9875 ⛔️نوتس ▪️https://t.me/extraneeds_2021/9868 ▪️https://t.me/extraneeds_2021/9869 ▪️https://t.me/extraneeds_2021/9870 ⛔️الريتين ▪️https://t.me/c/1712531098/9909 MCQ⛔️ ▪️https://t.me/c/1712531098/9915

Rheumatoid arthritis ✨

JIA ✨

Rheumatoid arthritis ✨

JIA ✨Unknown etiology +begin before 16 y ✨persist for at least 6 weeks ✨one of the Mc physically disabling of child hood ✨7 categories ✨symptoms : →Pain. →Limping. →Ealy morning stiffness. ✨EAM :- →Skin rash →Uveitis MC →Lymphadenopathy 1) systemic arthritis :- ✨early childhood ✨CP →high quotidian fever . →rash. →irritabity. ✨ Investigation:- →↑WBC →Sever anemia →Thrombocytosis →↑ESR ,CPS →↑ferritin ✨Acute phase reactant ✨pattern of arthritis :- →variable. →Swollen joint →widespread polyarthritis. ✨ prognosis →worest prognosis →Early erosion →Loss of motion →Affect growth 2) persistent oligoarthritis ✨The mc type ✨ the m affected →knee > ankle > wrist. →hip :- rare. ✨MS symptom →the highest risk of chronic asymptomatic anterior uveitis> ✨MC complications :- visual loss + blindness , localized growth disturbance. ✨+Ve ANA. ✨ Investigation →slit lamp examination /3 months. ✨Poly with RF negative 3) extended oligoarthritis →Progressive , →< 4 joint. →Widespread polyarthritis. ✨MC complications→ant uveitis. 4) polyarthritis "RF -ve" ✨ Preschool girls ✨ Predominant symmetrical arthritis in UL + LL. ✨MC complications →chronic ant uveitis , → growth disturbance. ✨ Investigation →mild anemia →+ve ANA →↑ESR ,CRP. 5)Polyarthritis "+ve RF" . ✨ Similar as Adults RA. ✨Mc in adolescent girls. ✨ Rabidly progressive, destructive. ✨Not common. ✨MC EAM →rheumatoid nodules. ✨RF +ve. 6) psoriatic arthritis ✨Asymmetrical ✨Mc in large and small joints. ✨+Ve family history. ✨MC complications →asymptomatic uveitis . 7) enthesitis related arthritis ✨Mc in male. ✨LL arthritis ✨CP →sacriiliitis , spinal arthritis . ✨Mc complications →symptomatic uveitis. ✨+Ve family history. ✨HLAB27 antigen ✨-ve ANA. U ✨ TTT →NSAIDs →intra articular preparation - Most frequent → systemic steroids "avoid" Except -in systemic arthritis -macrophage activation $

RA ✨chronic systemic disease (inflammatory) , autoimmune disease ✨common during the most productive years of adulthood (20:40y) ✨more common in females, developed countries ✨the primary and main lesion is synovitis ✨synovitis >> pannus formation >>cartilage break down >> bone erosion >> deformity. ✨ACPA /Anti CCP >> most specific . ✨RF→not specific , found in other Conditions like old age , HCV, Graves disease,...etc , not found in all RA patients ✨HLA DRB 1 is the most imp genetic factor ✨Th1, Th 17 and B cells play a role in autoimmunity.. ✨cytokines like TNF alpha , IL 1 ,IL6 ✨the most imp cytokine is TNF alpha ✨smoking is a PDF ✨pattern >> symmetrical affection of small joints ✨the typical joint involvement → swelling of PIP ,MCP, MTP. ✨RA never affect distal interphalangeal. ✨feet first then hand ✨RA →Peripheral affection not axial ✨But very very late atlantoaxial joint may be affected lead to cord affection, quadriplagia and may lead to death ✨ Squeeze tst :- →2 fingers : sever synovitis. →4 fingers : if early synovitis ✨Deformities of the hand :- →Boutonniere deformity. →Swan neck deformity. →Ulnar deviation of MCP joints. ✨ the MC Extra articular manifestation →Rheumatoid nodules (sc ) in the dorsum of the hand , extensor surfaces of elbow ✨presence of Symptoms of Inflammatory arthritis ✨The typical CP of inflamed joints →soft tissue swelling &tenderness, ✨SYNOVITIS is essential for dx ✨investigation → most imp ( RF , Anti CPP ,ACPA ) →ACPA : severity. →serology (CRP >ESR) →leukocytosis,thrombocytosis. →reduced hb , low serum iron →↑ferritin →liver functions,creatine and urine ex →HCV ab →TSH ✨imaging is not a routine ✨US/Doppler → in subclinical synovitis ✨X ray → for dx of joint damage and Deformities ✨ Conventional radiography → GS to diagnose join damage. ✨Domains :- ACR diagnostic criteria →joint involvement, →serology (RF,Anti CPP), →acute phase reactants (CRP,ESR), →Duration ✨IF the score > 6 indicates RA ✨MAX score →10 ✨ TTT:- →steroid .... Bridging therapy , DEMARDs , biologics →early aggressive ✨start with low to moderate doses of Steroid and NSAID as a bridging therapy ✔️واول لما يدخل في remission اسحب الدوا وابدا ف ال DMARDs ✔️اتأكد الاول انه مش مريض ضغط او قلب او سكر ✨DMARDs as MTX, SSZ, HCQ, lefunomide ✨MTX is hepatotoxic and ci in pregnancy ✔️ادي folic acid مع ال MTX ✔️هبدا ب monotherapy منفعش اخليه Double و tritherapy ✨Biologics →after failure of DMARDS , if the case is severe ,... →like TNF alpha inhibitors, IL 6 inhibitors, T & B cells inhibitors ✔️همشي ال biologics مع ال DEMARDs لغايه لما يدخل ف remission هوقف ال biologics واكمل بال DEMARDs