İnflamatuar Romatolojik Hastalıklarda Diz Tutulumu
Özet
İnflamatuar romatizmal hastalıklarda diz eklemi tutulumu, ciddi fonksiyonel kayıplara yol açabilen ve klinik pratikte sık karşılaşılan bir durumdur. Romatoid artrit (RA), eklem kıkırdağı ve kemik hasarı ile karakterize olup, diz tutulumunun en sık görüldüğü inflamatuar hastalıktır; kronik sinovit, hareket kısıtlılığı ve Baker kisti gibi tablolara neden olur. Güncel biyolojik tedaviler, RA hastalarında total diz artroplastisi ihtiyacını azaltmaktadır. Spondilartrit (SpA) grubu hastalıklardan Ankilozan Spondilit, Reaktif Artrit ve Psöriatik Artrit (PsA) vakalarında da diz tutulumu asimetrik oligoartrit ve entezit şeklinde sıkça gözlenir; tanı ve takip süreçlerinde tüm vücut MRG ve ultrasonografi kritik roller üstlenir. PsA'da bazen septik artriti taklit eden akut psödoseptik tablolar gelişebilir. Ayrıca Ailevi Akdeniz Ateşi (FMF) dizde ataklarla seyreden artrite yol açarken, Behçet Hastalığında akut monoartrit, kıkırdak kalınlığında azalma ve avasküler nekroz bildirilmiştir. Sistemik Lupus Eritematozus (SLE) hastalarında ise muayene bulguları negatif olsa dahi ultrasonografi ile %40'a yakın inflamatuar değişiklik saptanabilir. Kalıcı hasarı önlemek için erken tanı ve sıkı takip şarttır.
Knee joint involvement in inflammatory rheumatic diseases is a critical clinical condition that can lead to severe functional impairment. Rheumatoid arthritis (RA), characterized by progressive cartilage and bone destruction, is the most prevalent inflammatory condition affecting the knee, frequently resulting in chronic synovitis, restricted range of motion, and Baker's cysts. Modern biologic therapies have demonstrated a significant capacity to lower total knee arthroplasty rates among RA patients. Within the spondyloarthritis (SpA) spectrum—encompassing Ankylosing Spondylitis, Reactive Arthritis, and Psoriatic Arthritis (PsA)—knee involvement commonly manifests as enthesitis and asymmetric oligoarthritis, where whole-body MRI and ultrasonography serve as pivotal diagnostic and monitoring tools. Notably, PsA can present with acute pseudoseptic arthritis, clinically mimicking true joint infections. Furthermore, Familial Mediterranean Fever (FMF) causes episodic knee swelling, whereas Behçet's Disease is linked to acute monoarthritis, femoral cartilage thinning, and avascular necrosis. In Systemic Lupus Erythematosus (SLE), subclinical joint inflammation is detectable via ultrasound in nearly 40% of patients. Early therapeutic intervention is mandatory to prevent permanent structural damage.
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