SAMENVATTING REUMATOLOGIE
MODULE ONDERZOEK & BEHANDELING IIIB
INHOUDSOPGAVE
Inleiding ........................................................................................................................................................... 5
Wat is reumatologie? .......................................................................................................................................... 5
Belang van kinesitherapie? ................................................................................................................................. 5
Prognose ............................................................................................................................................................. 6
Anamnese en klinisch onderzoek ........................................................................................................................ 6
Pijntypes .......................................................................................................................................................... 7
Andere onderzoeken ....................................................................................................................................... 9
Het gewricht ...................................................................................................................................................... 11
Gewrichtskraakbeen ..................................................................................................................................... 11
Synoviaal vocht ............................................................................................................................................. 12
Metabool - Degeneratieve aandoeningen ...................................................................................................... 13
Osteoporose ...................................................................................................................................................... 13
Definitie ......................................................................................................................................................... 13
Risicofactoren................................................................................................................................................ 14
Pathogenese.................................................................................................................................................. 15
Kinesitherapeutische aanpak ........................................................................................................................ 16
Overige behandelingen ................................................................................................................................. 17
Osteoartrose...................................................................................................................................................... 18
Definitie ......................................................................................................................................................... 18
Primair vs. secundair ..................................................................................................................................... 18
Klinisch beloop en symptomen ..................................................................................................................... 20
Diagnose ........................................................................................................................................................ 21
Radiografische kenmerken ............................................................................................................................ 22
Prognose ....................................................................................................................................................... 22
Behandeling .................................................................................................................................................. 22
Weke delen .................................................................................................................................................... 27
Fibromyalgie...................................................................................................................................................... 27
Definitie ......................................................................................................................................................... 27
Epidemiologie................................................................................................................................................ 28
Diagnose ........................................................................................................................................................ 28
Pathogenese.................................................................................................................................................. 30
Behandeling .................................................................................................................................................. 31
, Prognose ....................................................................................................................................................... 35
Spierletsels ........................................................................................................................................................ 36
Gradaties ....................................................................................................................................................... 36
Diagnose ........................................................................................................................................................ 36
Behandeling – acuut...................................................................................................................................... 36
Prognose ....................................................................................................................................................... 37
Peesletsels ......................................................................................................................................................... 38
Terminologie ................................................................................................................................................. 38
Oorzaken ....................................................................................................................................................... 38
Opbouw ......................................................................................................................................................... 39
Pathologenese............................................................................................................................................... 39
Diagnose ........................................................................................................................................................ 40
Locaties - meestvoorkomende ...................................................................................................................... 40
Behandeling – algemeen ............................................................................................................................... 41
Fricties ........................................................................................................................................................... 41
Aanpak van risicofactoren ............................................................................................................................. 41
Actieve revalidatie......................................................................................................................................... 42
Oefentherapie Achillespees .......................................................................................................................... 42
Oefentherapie patellapees ........................................................................................................................... 42
Evidentie ....................................................................................................................................................... 43
Bursitis ............................................................................................................................................................... 44
Diagnose ........................................................................................................................................................ 45
Behandeling .................................................................................................................................................. 45
Inklemmingsneuropathie .................................................................................................................................. 47
Definitie ......................................................................................................................................................... 47
Diagnose ........................................................................................................................................................ 47
Lokalisatie...................................................................................................................................................... 47
Behandeling .................................................................................................................................................. 47
Complex Regionaal Pijn Syndroom (CRPS) ........................................................................................................ 48
Epidemiologie................................................................................................................................................ 48
Terminologie ................................................................................................................................................. 48
Kliniek ............................................................................................................................................................ 48
Diagnose ........................................................................................................................................................ 49
Pathofysiologie .............................................................................................................................................. 50
Behandeling .................................................................................................................................................. 50
Prognose ....................................................................................................................................................... 52
Preventie ....................................................................................................................................................... 52
Systeemziekten of bindweefselaandoeningen ............................................................................................... 53
Lupus – Systemic Lupus Erythematosus (SLE) ................................................................................................... 53
Epidemiologie................................................................................................................................................ 53
Kliniek ............................................................................................................................................................ 53
Diagnose ........................................................................................................................................................ 55
Belangrijkste ANtilichamen ........................................................................................................................... 56
Pathogenese.................................................................................................................................................. 57
Behandeling .................................................................................................................................................. 57
Prognose ....................................................................................................................................................... 58
, Intermezzo corticosteroiden* ....................................................................................................................... 59
Intermezzo raynaud** .................................................................................................................................. 60
Sjögren syndroom ............................................................................................................................................. 61
Epidemiologie................................................................................................................................................ 61
Kliniek ............................................................................................................................................................ 61
Diagnose ........................................................................................................................................................ 62
Behandeling .................................................................................................................................................. 62
Sclerodermie – systemic sclerodermia .............................................................................................................. 64
Epidemiologie................................................................................................................................................ 64
Pathofysiologie .............................................................................................................................................. 64
Kliniek ............................................................................................................................................................ 64
Diagnose ........................................................................................................................................................ 66
(Mal)nutritie .................................................................................................................................................. 67
Behandeling .................................................................................................................................................. 67
Prognose ....................................................................................................................................................... 68
Polymyositis Dermatomyositis .......................................................................................................................... 69
Terminologie ................................................................................................................................................. 69
Epidemiologie................................................................................................................................................ 69
Kliniek ............................................................................................................................................................ 70
Diagnose ........................................................................................................................................................ 71
Technische onderzoeken............................................................................................................................... 71
Differentiaal diagnose ................................................................................................................................... 71
Behandeling .................................................................................................................................................. 72
Prognose ....................................................................................................................................................... 72
Ehlers Danlos ..................................................................................................................................................... 73
Kinesitherapie ............................................................................................................................................... 73
Inflammatoire reuma ..................................................................................................................................... 74
Reumatoide artritis ........................................................................................................................................... 74
Definitie ......................................................................................................................................................... 74
Epidemiologie................................................................................................................................................ 74
Pathofysiologie .............................................................................................................................................. 74
Kliniek ............................................................................................................................................................ 75
Pathogenese.................................................................................................................................................. 77
Diagnose ........................................................................................................................................................ 78
Behandeling .................................................................................................................................................. 80
Prognose ....................................................................................................................................................... 87
Spondyl-artropathieën ...................................................................................................................................... 88
Psoriasis artritis ............................................................................................................................................. 88
Ziekte van Bechterew - Spondylytis ANkylosans ........................................................................................... 92
Infecties en artritis ........................................................................................................................................ 99
Stofwisselingsreuma .................................................................................................................................... 100
Jicht (gout)....................................................................................................................................................... 100
Definitie ....................................................................................................................................................... 100
Epidemiologie.............................................................................................................................................. 100
Pathogenese................................................................................................................................................ 100
, Kliniek en stadia .......................................................................................................................................... 100
Diagnose ...................................................................................................................................................... 102
Behandeling ................................................................................................................................................ 103
Prognose ..................................................................................................................................................... 103
Chondrocalcinosis – pseudo-jicht .................................................................................................................... 104
Definitie / Epidemiologie ............................................................................................................................ 104
Kliniek .......................................................................................................................................................... 104
Risicofactoren.............................................................................................................................................. 104
Diagnose ...................................................................................................................................................... 105
Behandeling ................................................................................................................................................ 105
Ziekte van Paget – osteitis deformans ........................................................................................................ 106
Casussen ...................................................................................................................................................... 108
ARTROSE .......................................................................................................................................................... 109
FIBROMYALGIE ................................................................................................................................................ 109
MODULE ONDERZOEK & BEHANDELING IIIB
INHOUDSOPGAVE
Inleiding ........................................................................................................................................................... 5
Wat is reumatologie? .......................................................................................................................................... 5
Belang van kinesitherapie? ................................................................................................................................. 5
Prognose ............................................................................................................................................................. 6
Anamnese en klinisch onderzoek ........................................................................................................................ 6
Pijntypes .......................................................................................................................................................... 7
Andere onderzoeken ....................................................................................................................................... 9
Het gewricht ...................................................................................................................................................... 11
Gewrichtskraakbeen ..................................................................................................................................... 11
Synoviaal vocht ............................................................................................................................................. 12
Metabool - Degeneratieve aandoeningen ...................................................................................................... 13
Osteoporose ...................................................................................................................................................... 13
Definitie ......................................................................................................................................................... 13
Risicofactoren................................................................................................................................................ 14
Pathogenese.................................................................................................................................................. 15
Kinesitherapeutische aanpak ........................................................................................................................ 16
Overige behandelingen ................................................................................................................................. 17
Osteoartrose...................................................................................................................................................... 18
Definitie ......................................................................................................................................................... 18
Primair vs. secundair ..................................................................................................................................... 18
Klinisch beloop en symptomen ..................................................................................................................... 20
Diagnose ........................................................................................................................................................ 21
Radiografische kenmerken ............................................................................................................................ 22
Prognose ....................................................................................................................................................... 22
Behandeling .................................................................................................................................................. 22
Weke delen .................................................................................................................................................... 27
Fibromyalgie...................................................................................................................................................... 27
Definitie ......................................................................................................................................................... 27
Epidemiologie................................................................................................................................................ 28
Diagnose ........................................................................................................................................................ 28
Pathogenese.................................................................................................................................................. 30
Behandeling .................................................................................................................................................. 31
, Prognose ....................................................................................................................................................... 35
Spierletsels ........................................................................................................................................................ 36
Gradaties ....................................................................................................................................................... 36
Diagnose ........................................................................................................................................................ 36
Behandeling – acuut...................................................................................................................................... 36
Prognose ....................................................................................................................................................... 37
Peesletsels ......................................................................................................................................................... 38
Terminologie ................................................................................................................................................. 38
Oorzaken ....................................................................................................................................................... 38
Opbouw ......................................................................................................................................................... 39
Pathologenese............................................................................................................................................... 39
Diagnose ........................................................................................................................................................ 40
Locaties - meestvoorkomende ...................................................................................................................... 40
Behandeling – algemeen ............................................................................................................................... 41
Fricties ........................................................................................................................................................... 41
Aanpak van risicofactoren ............................................................................................................................. 41
Actieve revalidatie......................................................................................................................................... 42
Oefentherapie Achillespees .......................................................................................................................... 42
Oefentherapie patellapees ........................................................................................................................... 42
Evidentie ....................................................................................................................................................... 43
Bursitis ............................................................................................................................................................... 44
Diagnose ........................................................................................................................................................ 45
Behandeling .................................................................................................................................................. 45
Inklemmingsneuropathie .................................................................................................................................. 47
Definitie ......................................................................................................................................................... 47
Diagnose ........................................................................................................................................................ 47
Lokalisatie...................................................................................................................................................... 47
Behandeling .................................................................................................................................................. 47
Complex Regionaal Pijn Syndroom (CRPS) ........................................................................................................ 48
Epidemiologie................................................................................................................................................ 48
Terminologie ................................................................................................................................................. 48
Kliniek ............................................................................................................................................................ 48
Diagnose ........................................................................................................................................................ 49
Pathofysiologie .............................................................................................................................................. 50
Behandeling .................................................................................................................................................. 50
Prognose ....................................................................................................................................................... 52
Preventie ....................................................................................................................................................... 52
Systeemziekten of bindweefselaandoeningen ............................................................................................... 53
Lupus – Systemic Lupus Erythematosus (SLE) ................................................................................................... 53
Epidemiologie................................................................................................................................................ 53
Kliniek ............................................................................................................................................................ 53
Diagnose ........................................................................................................................................................ 55
Belangrijkste ANtilichamen ........................................................................................................................... 56
Pathogenese.................................................................................................................................................. 57
Behandeling .................................................................................................................................................. 57
Prognose ....................................................................................................................................................... 58
, Intermezzo corticosteroiden* ....................................................................................................................... 59
Intermezzo raynaud** .................................................................................................................................. 60
Sjögren syndroom ............................................................................................................................................. 61
Epidemiologie................................................................................................................................................ 61
Kliniek ............................................................................................................................................................ 61
Diagnose ........................................................................................................................................................ 62
Behandeling .................................................................................................................................................. 62
Sclerodermie – systemic sclerodermia .............................................................................................................. 64
Epidemiologie................................................................................................................................................ 64
Pathofysiologie .............................................................................................................................................. 64
Kliniek ............................................................................................................................................................ 64
Diagnose ........................................................................................................................................................ 66
(Mal)nutritie .................................................................................................................................................. 67
Behandeling .................................................................................................................................................. 67
Prognose ....................................................................................................................................................... 68
Polymyositis Dermatomyositis .......................................................................................................................... 69
Terminologie ................................................................................................................................................. 69
Epidemiologie................................................................................................................................................ 69
Kliniek ............................................................................................................................................................ 70
Diagnose ........................................................................................................................................................ 71
Technische onderzoeken............................................................................................................................... 71
Differentiaal diagnose ................................................................................................................................... 71
Behandeling .................................................................................................................................................. 72
Prognose ....................................................................................................................................................... 72
Ehlers Danlos ..................................................................................................................................................... 73
Kinesitherapie ............................................................................................................................................... 73
Inflammatoire reuma ..................................................................................................................................... 74
Reumatoide artritis ........................................................................................................................................... 74
Definitie ......................................................................................................................................................... 74
Epidemiologie................................................................................................................................................ 74
Pathofysiologie .............................................................................................................................................. 74
Kliniek ............................................................................................................................................................ 75
Pathogenese.................................................................................................................................................. 77
Diagnose ........................................................................................................................................................ 78
Behandeling .................................................................................................................................................. 80
Prognose ....................................................................................................................................................... 87
Spondyl-artropathieën ...................................................................................................................................... 88
Psoriasis artritis ............................................................................................................................................. 88
Ziekte van Bechterew - Spondylytis ANkylosans ........................................................................................... 92
Infecties en artritis ........................................................................................................................................ 99
Stofwisselingsreuma .................................................................................................................................... 100
Jicht (gout)....................................................................................................................................................... 100
Definitie ....................................................................................................................................................... 100
Epidemiologie.............................................................................................................................................. 100
Pathogenese................................................................................................................................................ 100
, Kliniek en stadia .......................................................................................................................................... 100
Diagnose ...................................................................................................................................................... 102
Behandeling ................................................................................................................................................ 103
Prognose ..................................................................................................................................................... 103
Chondrocalcinosis – pseudo-jicht .................................................................................................................... 104
Definitie / Epidemiologie ............................................................................................................................ 104
Kliniek .......................................................................................................................................................... 104
Risicofactoren.............................................................................................................................................. 104
Diagnose ...................................................................................................................................................... 105
Behandeling ................................................................................................................................................ 105
Ziekte van Paget – osteitis deformans ........................................................................................................ 106
Casussen ...................................................................................................................................................... 108
ARTROSE .......................................................................................................................................................... 109
FIBROMYALGIE ................................................................................................................................................ 109
