I-Septic Arthritis vs Gout Flare: Kutheni iNxulumano eNye eshushu, idumbile enye enomkhuhlane yiNgxakeko yeCartilage yeeyure ezingama-24.¶

Ijoyinti elinye elitshisa kakhulu, elibomvu, elidumbileyo, nelibuhlungu kabuhlungu (acute monoarthritis), elidla ngokuchaphazela idolo, isinqe, igxalaba, isihlahla okanye iqatha, yenye yezona zinto zingxamisekileyo zokuxilonga kwezamayeza. Ngelixa icrystal-induced arthritis flares (acute gout from monosodium urate crystals or pseudogout / CPPD from calcium pyrophosphate crystals) ibangela ukudumba okumangalisayo okusabela kumayeza achasene nokudumba, i-acute bacterial septic arthritis (isifo samathambo) sisixhobo esiyinyaniso samathambo kunye ne-syndrome ye-syndrome evaliweyo ngaphakathi kwi-syndrome ye-syndrome evaliweyo kwi-cavity ye-syndrome. (**i-metalloproteinases ye-matrix kunye ne-neutrophil elastase **) ukuba ** ngokungenakuguquleka yokugaya kwaye itshabalalise i-articular articular hyaline cartilage ngaphakathi kwe-24 kwiiyure ze-48 **, ngelixa iphethe i- ** 10 ukuya kwi-15 ekhulwini lokufa kwesibhedlele ** ukusuka kwinkqubela phambili ngokukhawuleza ukuya i-sepsis kunye ne-septic shock. Okubi nangakumbi, igawuthi kunye ne-septic arthritis zinokuhlalisana ngaxeshanye kwindawo edibeneyo, kwaye ukuvutha kwekristale iyodwa ibangela umkhuhlane wenkqubo ukuya kuthi ga kwi-38.9 degrees celcius (102 degrees Fahrenheit). Ngenxa yokuba akukho vavanyo lwegazi, i-X-reyi, okanye inkqubo yovavanyo lomzimba inokulawula ngokuthembekileyo ukosuleleka ngokwalo, ilungu ngalinye elingachazwanga elitshisayo, elidumbileyo kufuneka lidibane nenaliti eyinyumba engxamisekileyo (arthrocentesis) phambi kokuba ithamo elinye lamayeza okubulala iintsholongwane okanye i-intra-articular steroids isetyenziswe. Ukuba umntu uba nobushushu obuphezulu ngokuqaqanjelwa, ukudideka, ukuphefumla ngokukhawuleza, isiyezi, ulusu olunamabala, okanye ukungakwazi ukuvuka, tsalela umnxeba kwinombolo yakho yexesha likaxakeka ngoko nangoko (911 eUnited States naseKhanada, 112 kwiEuropean Union, 999 eUnited Kingdom) amanani kaxakeka. Ukufumana imeko engxamisekileyo yosulelo kunye ne-musculoskeletal, funda izikhokelo zethu ukuqatshelwa komothuko we-septic, i-cellulitis, i-erysipelas, i-lymphongitis ebomvu, kunye nokunyuka kwethumba, kwaye igxalaba elichithiweyo, i-kneecap, kunye ne-joint immobilization.

Yenza oku ngoku¶

1. Yiya kwisebe likaxakeka esibhedlele ngokukhawuleza ukuba ilungu elinye lidumba ngequbuliso, libe shushu, kwaye litshixeke kuyo nayiphi na intshukumo: Sukulinda ubusuku bonke ukuze ubone ukuba idolo, inyonga, iqatha, isihlahla okanye igxalaba liyaphucuka ngokwalo na, ngakumbi ukuba umntu unomkhuhlane, ingqele, isifo seswekile, isifo samathambo, ukugonywa komzimba, inaliti okanye ijointtificial idibeneyo **). Kwi-bacterial septic arthritis, ** ukutshatyalaliswa kwe-cartilage esisigxina kuqala kwiiyure ze-24 ** yeempawu zokuqala.
2. Vavanya isahluli esibalulekileyo esisecaleni kwebhedi: jonga ngobunono ukuba umdibaniso unokunyamezela i-5 degrees of passive range of motion (micromotion): Ngelixa isigulane sikhulula izihlunu zabo ngokupheleleyo, ngobuchule zama ukugoba okanye ukujikelezisa umdibaniso ochaphazelekayo nge-5 nje ukuya kwi-10 degrees. Kusulelo lwesikhumba olungaphezulu (prepatellar bursitis okanye cellulitis phezu kwejoyinti), intshukumo ethambileyo ye-arc encinci ye-arc yelungu ngokwalo ayinabuhlungu de ulusu lunwenwe ngokuqinileyo. Kwi-** yenyani ye-intra-articular septic arthritis ** (kunye ne-crystal flares enzima), yonke i-capsule edibeneyo ichithwa phantsi koxinzelelo olunzima lwe-hydraulic: isigulane sibambe i-joint rigidly kwindawo yayo ** indawo yomthamo omkhulu we-capsular ** (idolo, i-15 ukuya kwi-30 degrees yokuguquguquka okuncinci; ngenxa ye-hip, i-flexible, i-blocked kunye ne-blocked yangaphandle) nge 5 degrees**.
3. Ungaze uthathe amayeza okubulala iintsholongwane asele phambi kokuba isibhedlele sidibanise inaliti yenaliti edibeneyo (arthrocentesis): Ngaphandle kokuba isigulana sithetha ngokungafihlisiyo sibeka ubomi esichengeni. umothuko we-septic iiyure kude nesibhedlele, ungaze uginye amayeza okubulala iintsholongwane asekhaya phambi kokuba ugqirha afune ulwelo olusuka kwilungu elidumbileyo. Idosi yomlomo enye ye-amoxicillin, i-cephalexin, i-doxycycline, okanye i-ciprofloxacin ayinakukwazi ukungena kwindawo edibeneyo ezaliswe bubofu kwindawo ephezulu ngokwaneleyo ukusindisa intlala, kodwa ivala inzalo yesiko le-synovial fluid, ivala ibhaktheriya ye-causative kwaye ishiya oogqirha bengaboni ukuba ngaba isigulana sifuna iiveki ezi-4 ze-washout ye-intravenous okanye i-washout.
4. Ungaze uvumele ikliniki ukuba itofe i-cortisone (i-corticosteroids) kwindawo eshushu kakhulu, edumbileyo phambi kokuba i-synovial fluid ibale kwaye i-Gram stain ikhuphe usulelo: Ukuba isigulana esinembali ye-osteoarthritis okanye i-gout sicela ikliniki engxamisekileyo ukuba ikhuphe "i-cortisone shot" kwilungu elitsha elishushu, likhuphe idolo elidumbileyo, liqale lidumbe. I-Staphylococcus aureus ibhaktheriya, i-intra-articular steroids ikhubaza iiseli zegazi ezimhlophe zengingqi kwaye ibangele **ukutshatyalaliswa ngokudibeneyo, i-osteomyelitis, kunye ne-bacteremia ebulalayo ** phakathi kweentsuku.
5. ** Ukunyanzeliswa kwe-NPO engqongqo (akukho nto ngomlomo, kubandakanywa ukutya, amanzi, okanye iipilisi zentlungu) ngelixa uhamba kwisebe likaxakeka: ** Ukuba i-arthrocentesis iqinisekisa ubovu bebhaktheriya ngaphakathi kwendawo enkulu (ingakumbi i-hip, ihlombe, okanye idolo / i-hip), oogqirha bamathambo baya kuthatha isigulane ngqo kwigumbi lokusebenza kwi-arthroscopic okanye i-arthroscopic art i-debridement (i-joint washout)** phantsi kwe-anesthesia jikelele okanye yomgogodla. Kuphephe ukunika ngomlomo ii-NSAIDs zomlomo (ibuprofen, naproxen) okanye i-acetaminophen (paracetamol) kwangaphambili, zombini ukugcina isisu singenanto kwi-anesthesia kunye nokuphepha ukufihla umkhuhlane xa ulinganisa.
6. Hlukanisa kwaye ungashukumi umdibaniso kwindawo yawo yokuphumla yendalo kwaye ukhulule bonke ubunzima: Musa ukunyanzela idolo elidumbileyo, eligobileyo okanye i-hip ngqo. Xhasa idolo elibuhlungu okanye iqatha kumqamelo ngeentonga okanye isitulo esinamavili ngoko ubunzima bomzimba bucinezela i-articular cartilage layers kunye, kwaye uxhase igxalaba elibuhlungu okanye isihlahla kwisilingi esikhululekileyo.

Umthi wesigqibo: kushushu kakhulu, ukudumba kwelungu elinye (i-monoarthritis).¶

flowchart TD
    Start["Ubushushu obubukhali, bubomvu, budumbile, okanye bubuhlungu kwilungu elinye (idolo, ihip, igxalaba, iqakala, iWrist, okanye inzwane)"] --> CheckSepsis{"1. Naziphi na iiFlegi eziBomvu ze-Sepsis: Ukudideka, ii-Rigors, i-BP Drop, i-Heart Rate> 110, okanye ukuphefumula ngokukhawuleza?"}

    CheckSepsis -->|"EWE: Systemic Sepsis okanye Septic Shock"| Call911["I-IMMEDIATE 911 / 112 / 999 PROTOCOL YE-SEPSIS: 1. Fowunela i-Ambulensi ngokukhawuleza uThutho lweSibhedlele esiKhawulezayo 2. Zoba iiNkcubeko zeGazi + Yenza i-Emergency Bedside Joint Aspiration 3. Qalisa i-Broad-Spectrum IV Antibiotics ngaphakathi kweyure ye-Triage"]

    CheckSepsis -->|"NO: Hemodynamically uzinzile"| CheckChildHip{"2. Ngaba isigulane nguMntwana owala ngokukhawuleza ukuthwala ubunzima ngomlenze omnye okanye ukuhambisa i-hip yabo?"}

    CheckChildHip -->|"EWE: I-Peediatric Hip ecaphukisayo"| KocherCheck["PEDIATRIC KOCHER ICRITERIA EXAXmisekileyo: 1. Hamba ngokuthe ngqo kwiSebe likaNgxamiseko lwaBantwana (Gcina uMntwana iNPO) 2. Khangela i-4 Kocher Predictors: Non-Weight-Bearing, Fever >38.5 C (101.3 F), ESR >40 mm/hr, WBC >12.ounds Necrosis kwiiyure nje"]

    CheckChildHip -->|"HAYI: Intetho yabantu abadala"| CheckBursaVsJoint{"3. Ngaba ukuvuvukala ngokungqongqo ngaphandle kwe-Kneecap / Elbow Tip nge-Pain-Free 10-Degree Micromotion, OKANYE Ngaphakathi kwe-Deep Joint Capsule?"}

    CheckBursaVsJoint -->|"Ngokungqongqo phezu kweKneecap / Olecranon; I-Micromotion engenabuhlungu"| SepticBursitis["I-SEPTIC BURSITIS ESITYELELWAYO OKANYE I-CELLULITIS ENGAPHEZULU: 1. Ungaze udlule inaliti kwiSikhumba esiBomvu esosulelekileyo kwiNxulumano eliNxibeleleyo 2. UVavanyo oluNgxamisekileyo loNyango lweBursal Aspiration okanye iAntibiotics"]

    CheckBursaVsJoint -->|"I-Deep Joint itshixiwe ngokuchasene ne-5-Degree Passive Motion"| UrgentTap["ISEBE LENKXASEKO EyisiGunyaziso I-ARTHROCENTESIS: 1. Gcina iNPO ineSigulana; UNGATHATHI i-Antibiotics yomlomo okanye i-Cortisone Shots Phambi kwe-Tap 2. I-Aspirate Synovial Fluid ye-WBC Count, i-% PMNs, i-Gram Stain, iNkcubeko, kunye ne-Polarized Light Crystal Exam 3. Khumbula: Ubukho beGout/CPPD Crystals AKULAWULI I-Septic Arthritis ekhoyo."]

Kutheni i-bacterial pus itshabalalisa i-joint phakathi kwe-24 kwiiyure ze-48¶

Ngokungafani nesikhumba, i-muscle, okanye ithambo, ** i-articular hyaline cartilage ** (i-glass-smooth, i-low-friction cushion egubungela iziphelo zamathambo ngaphakathi kwe-synovial joint) ine- ** zero imithambo yegazi, i-nerve zero, kunye ne-zero lymphatic drainage **. Emva kokuba i-cartilage yabantu abadala itshatyalalisiwe, ayikwazi ukuphinda ikhule.

1. Iibhaktheriya zingena njani kwindawo edibeneyo evaliweyo¶

I-synovial membrane efakwe ngaphakathi kwi-capsule edibeneyo ine-vascular vascular, iyenza ibe sisihluzo sokuqala sebhaktheriya ejikeleza egazini, kodwa ngokungaqhelekanga ** ayinayo inwebu engaphantsi ekhuselayo **. Iintsholongwane zihlasela indawo edibeneyo ngeendlela ezintathu: 1. Imbewu ye-Hematogenous (i-70 ukuya kwi-80 yepesenti yamatyala): Ngexesha losulelo lwegazi oludlulayo okanye olugqithileyo (**bacteremia **) olusuka kwithumba elikude lesikhumba, ukukrala, usulelo lwe-urinary tract, inyumoniya, ukusetyenziswa kweziyobisi emithanjeni, i-endocarditis, okanye inkqubo yamazinyo / i-catheter, ibhaktheriya ihamba nge-synovial-catheter kunye ne-catheter ngqo kwi-synovial-catheter i-synovium kwi-joint fluid. 2. Ukutofa ngokuthe ngqo (i-15 ukuya kwipesenti ezingama-20): Iintsholongwane zityhalwa ngokuthe ngqo kumngxuma odibeneyo ngokwenzakala okugqobhozayo (iva, isikhonkwane, ukulunywa yikati, okanye inqindi eqiniweyo "i-fight bite" ibetha izinyo phezu kweknuckle), intsholongwane intra-articular corticosteroid okanye i-injection ye-hyaluronic okanye i-hyaluronic acid. 3. ** Ukusasazeka kwe-Contiguous (i-5 ukuya kwi-10 ekhulwini): ** Ukusuleleka kwethambo elisondeleyo (**i-acute osteomyelitis **) iqhuma kwi-cortex kwindawo edibeneyo, idume kakhulu kwiintsana kunye nabantwana abancinci, apho imithwalo yegazi iwela i-plate yokukhula (**physis **) kwi-hip, ihlombe, i-elbow, kunye ne-ankle.

2. I-enzymatic cartilage meltdown cascade¶

Kanye iintsholongwane ezifana ne-Staphylococcus aureus* (kuquka i-MRSA, ejongene namatyala angaphezu kwama-50 eepesenti zabantu abadala), Streptococcus iintlobo, Neisseria gonorrhoeae (kwi-sexually active young people), okanye Gram-negative bacilli (Pseudomonas, liEruginosa abadala abadala izigulana ezibuthathaka, okanye abasebenzisi beziyobisi be-IV) bangene kwi-synovial fluid enezondlo: - Iyure 0 ukuya 12 (Neutrophil Invasion & Pressure Surge): I-synovial membrane ikhukula umngxuma odibeneyo kunye namashumi amawaka e-polymorphonuclear neutrophils (iiseli zegazi ezimhlophe) kunye nolwelo. Ngenxa yokuba i-capsule ye-fibrous joint capsule ayikwazi ukwandisa ngokulula, i-intra-articular hydrostatic pressure skyrockets, i-pinching ivale imithwalo yegazi encinci ye-epiphyseal enikezela ithambo elingaphantsi (ingakumbi ngaphakathi kwebhola-kunye ne-socket ** i-hip joint **, ebangela ** i-necrosis ye-avascular ye-femoral head ). - Iyure ye-12 ukuya kweye-24 (Ilahleko ye-Proteolytic Glycosaminoglycan): Zombini iibhaktiriya (nge- bacterial Chondroitinase kunye ne-toxins) kunye neeseli zegazi ezimhlophe zesigulana zikhupha izixa ezikhulu ze lysosomal proteases, collagenases, and matrix metalloproteinases (MMPs). Ngaphakathi iiyure ezingama-24, ezi enzymes zihlutha ukuya kuthi ga kwi-0 eklwini le-cartilage's proteoglycan (glycosaminoglycan) matrix * - Iyure 24 ukuya 48+ (Irreversible Collagen Scaffolds Collapse): Emva kokuba iproteoglycan cushion inyibilikisiwe, i-structural Type II collagen meshwork ye-cartilage fractures phantsi koxinzelelo lwe-mechanical joint. Nangona i-antibiotics kamva ibulala yonke ibhaktheriya ngoSuku lwe-4, i-cartilage sele inyibilika ngokusisigxina ukuya kwithambo elingenanto, ishiya isilana sinethambo-on-bone isifo samathambo okanye i-joint edibeneyo ( ankylosis **).

Uthelekiso olusecaleni: IArthritis yeSeptic vs Acute Gout vs Pseudogout (CPPD) vs Septic Bursitis¶

Uhlalutyo lwe-Synovial fluid: ukutolika itephu yenaliti kaxakeka (arthrocentesis)¶

Ngenxa yokuba iimvavanyo zomzimba kunye neemvavanyo zegazi (** i-serum uric acid **, ** i-white cell count **, ** i-ESR **, kunye ne ** CRP **) idibanisa kakhulu phakathi kwe-septic arthritis kunye ne-crystal arthritis, oogqirha bexakeka baxhomekeke ku- ** uhlalutyo lwe-synovial fluid ** olutsalwa nge-arthrocentesis eyinyumba njengomgangatho wegolide:

I-arthritis ye-septic yabantwana ye-hip: i-Kocher Criteria engxamisekileyo¶

Kwiintsana, abancinci, kunye nabantwana, i-acute bacterial septic arthritis ye-hip yenye yezona zinto zingxamisekileyo zotyando kubantwana. Ngenxa yokuba imithwalo yegazi egcina i-femoral head ekhulayo yomntwana iphila (**imithambo ye-retinacular ye-lateral epiphyseal artery **) ihamba ngokuthe ngqo ngaphakathi kwe-capsule edibeneyo ye-hip, i-pus iqokelela phantsi koxinzelelo ngaphakathi kwe-hip yomntwana ** ikrwitsha ukunikezelwa kwegazi ukuya phezulu kwi-femur ngaphakathi kwe-6 ukuya kwiiyure ze-12, i-lipancy engapheliyo kunye ne-disc edibeneyo ye-hip-length ukukhubazeka ubomi bonke.

1. Umntwana okanye umntwana onesinqe seseptic uwubamba njani umlenze wakhe ("I-Fabere Posture")¶

Umntwana osemncinci okanye umntwana onokuvuvukala kwe-hip ngokukhawuleza ** wenqaba ukuma, ukuhamba, okanye ukuthwala ubunzima emlenzeni omnye ** (okanye umntwana ukhala ngokungenasiphelo ngexesha lonke utshintsho lwe-diaper). Jonga indlela umntwana abamba ngayo umlenze ochaphazelekayo ngelixa elele emqolo: - Isinqe sibanjwe Iguquguquke (igobe phezulu), ithinjwa (iwiswe ngaphandle ecaleni njengomlenze wesele), kwaye ijikeleziswa ngaphandle (unyawo lujikele ngaphandle). - Ngoba? Ngenxa yokuba le ** i-FABERE posture ** yandisa umthamo wangaphakathi we-capsule edibeneyo ye-hip kunye nokunciphisa uxinzelelo olubuhlungu lwe-intra-articular. Naluphi na umzamo wokulungisa umlenze womntwana okanye ukuqengqeleka ithanga ngaphakathi kubangela ukukhala ngoko nangoko.

2. Iikhrayitheriya ezi-4 ze-Kocher: ukwahlula i-Septic Hip kwi-benign "Transient Synovitis"¶

Ngenxa yokuba i-benign, i-self-solving i-virus ye-hip ebizwa ngokuthi ** i-synovitis ye-transient ("i-synovitis enetyhefu") ** ihlala ibangela ukuba abantwana abaneminyaka eyi-3 ukuya kwe-8 baqhwaleze kwiintsuku ezimbalwa emva kokubanda okuqhelekileyo, oogqirha babantwana kunye noogqirha bamathambo basebenzisa i-** i-Kocher Criteria ** (kunye ne-C-reactive protein) ukumisela ukuba nokwenzeka kwebhaktheriya

Ukwahluka okukhethekileyo okusemngciphekweni omkhulu: Usulelo lweGonococcal olusasazwayo, iLyme Arthritis, kunye neSternoclavicular Sepsis¶

Ayizizo zonke ijoyinti ezosulelekileyo ezibonisa i-classic Staphylococcus aureus sepsis yamadolo. Lumka kwii-syndromes ezintathu ezahlukeneyo zeklinikhi ezifuna uvavanyo olukhethekileyo:

1. Ukosuleleka kweGonococcal (DGI / Gonococcal Arthritis-Dermatitis Syndrome):
2. **Ibethelwa bani
3. I-Classic Triad: Ngaphambi kokuba ihlale kwindawo enye okanye ezimbini (ngokuqhelekileyo idolo, isihlahla, okanye iqatha), i-DGI inikezela nge-*(1) i-polyarthralgias efudukayo ** (iintlungu zokuxhuma ukusuka edolweni ukuya esihlahleni ukuya esihlahleni ukuya eqakaleni), (2) i-tenosynovitis (ebuhlungu, ukudumba okubomvu ecaleni kwe-tendon, i-tendon kwi-sheath, i-tendon okanye i-shath (3) izilonda zolusu ezingenazintlungu okanye ezophayo (amasuntswana ama-5 ukuya kwangama-20 amasuntswana angwevu kwisiseko esibomvu phezu kweminwe, iintende, izihlahla, okanye amaqatha).
4. I-Diagnostic Catch: Iinkcubeko eziqhelekileyo ze-synovial fluid ziyakhula Neisseria gonorrhoeae ngaphantsi kwe-50 yepesenti yexesha, kwaye i-synovial count ye-WBC ingaba ngama-20,000 ukuya kuma-40,000 kuphela iiseli/uL. Oogqirha kufuneka baqokelele iimvavanyo ze-nucleic acid amplification (i-NAAT / PCR swabs) ukusuka kumchamo / umlomo wesibeleko, i-rectum, kunye nomqala (pharynx) ecaleni kwegazi kunye neenkcubeko ezidibeneyo, kwaye unyange nge-intravenous ceftriaxone.
5. Isifo seLyme Monoarthritis (Borrelia burgdorferi):
6. Inkcazo: Iiveki ukuya kwiinyanga emva kokulunywa kwekhalane lexhama elingaziwayo kwimimandla egqubayo (kuMntla-mpuma, eMid-Atlantic, nakuMbindi-ntshona we-United States; uMbindi noMntla Yurophu), isigulana siba ne idolo elidumbile kakhulu ("ibhaluni yebhaluni yedolo effusion") oko kukhwankqisa ngaphezu kweentlungu* *ezibuhlungu ngakumbi Ngokungafaniyo ne-Staph septic arthritis, isigulana esine-Lyme knee arthritis sihlala singenayo i-fever ** kwaye ** sisenako ukuhamba siye ekliniki sithwele ubunzima ** nangona idolo liphuma ngamandla. Ifunyanwe nge-serum enamanqanaba amabini iLyme ELISA/i-Western blot kunye ne-synovial fluid iLyme PCR; unyango lweentsuku ezingama-28 lwe-doxycycline yomlomo okanye i-amoxicillin ngaphandle kokufuna utyando lokuhlanjwa.
7. Sternoclavicular kunye neSacroiliac Joint Septic Arthritis:
8. Ukuba ngokukhawuleza, ukuvuvukala okukhulu, ubomvu, kunye nokuthamba kwethambo kubonakala kwi-**sternoclavicular joint ** (apho i-collarbone yangaphakathi idibana nomphezulu wesifuba kwisiseko sentamo), ikrokrela i-hematogenous septic arthritis (ehlala ibangelwa * Staphylococcus aureus * okanye * Pseudomonas *, ngakumbi kwizigulane ezine-central diabetes, i-substage IV , i-substage IV). Ngenxa yokuba i-sternoclavicular joint ehlala ngokuthe ngqo phambi kwe- **subclavian vein, i-brachiocephalic artery, kunye ne-mediastinum ephezulu **, i-abscess ye-sternoclavicular engaphendulwanga iqhuma ngasemva kwisifuba (**ihla i-necrotizing mediastinitis **) kwaye ifuna i-CT / MRI imaging kunye ne-cardiothopedic sumo engxamisekileyo.

Iinombolo zengingqi zikaxakeka kunye neeprothokholi ze-arhente¶

• I-United States neKhanada: Fowunela 911 ukuba ijoyinti eshushu, edumbileyo ikhatshwa ngumkhuhlane ophezulu, ukuqina, ukudideka, isiyezi, okanye ukungakwazi ukuma. Kungenjalo, qhubekela ngqo kwiSebe likaNgxamiseko leSibhedlele (hayi ikliniki yekhemesti yokuthengisa okanye uhambe-ungena kukhathalelo olungxamisekileyo olungenazo izinto ze-arthrocentesis eziyinyumba, i-polarized microscopy, kunye notyando lokufowunela amathambo).
• EUnited Kingdom: Fowunela 999 xa ukrokrela ukuba sepsis okanye uye ngqo kwisibhedlele esikufutshane isebe le-A&E. Ngaphantsi ** I-British Society ye-Rheumatology (BSR) kunye neBritish Orthopedic Association (BOA) Izikhokelo ze-Hot Swollen Joint **, yonke i-monoarthritis enzima kufuneka iqhube i-joint aspiration for microscopy, i-synovial cell count, kunye nenkcubeko ngaphambi kokulawulwa kwe-antibiotics, kunye nokuhlaziywa kwe-orthopedic engxamisekileyo yokuhlamba ngokudibeneyo.
• I-European Union: Fowunela 112 yothutho lwe-ambulensi olungxamisekileyo okanye uye kwisebe likaxakeka esibhedlele kulandela i-European Alliance of Associations for Rheumatology (EULAR) iindlela ezibukhali ze-monoarthritis.
• Ostreliya neNew Zealand: Fowunela 000 e-Australia okanye 111 eNew Zealand, okanye unikezele ngoko nangoko kwisibhedlele sikarhulumente okanye iSebe leeNgxamiseko leSibhedlele sikarhulumente ukuze ufumane i-arthrocentesis engxamisekileyo kunye nothethwano lwamathambo.
• ** I-Indiya kunye ne-Asia-Pacific: ** Shayela ** 112 ** okanye ** 108 ** e-India, ** 995 ** eSingapore, ** 119 ** eJapan naseMzantsi Korea, okanye ** 999 ** eHong Kong naseMalaysia.

Imibuzo edla ngokubuzwa¶

Kutheni idolo elitshisa kakhulu, elidumbileyo okanye isinqe sithathwa njengengxakeko yonyango yeeyure ezingama-24?¶

Ngokungafaniyo nolusu okanye izihlunu, intlala egudileyo ebizwa ngokuba yihyaline cartilage egquma iziphelo zamathambo ngaphakathi kwelungu alinagazi yaye alinako ukuphinda likhule xa lonakele. Xa iintsholongwane zosulela indawo edibeneyo (septic arthritis), ityhefu yebhaktiriya kunye ne-proteolytic enzymes ezikhutshwa ziiseli ezimhlophe zegazi ziqalisa ukunyibilikisa i-cartilage's shock-absorbing proteoglycan matrix kwiiyure ezingama-24 ukuya kwezingama-48. Ngaphandle kokukhupha inaliti engxamisekileyo, ukuhlanjwa kwamalungu otyando, kunye ne-antibiotics emithanjeni, ukutshatyalaliswa ngokusisigxina kwethambo-kwithambo okanye i-sepsis esongela ubomi ingenzeka phakathi kweentsuku ezimbini.