8 - Doigts Longs-rhumatoides

8/9/2019 8 - Doigts Longs-rhumatoides

1/94

Kttenbte mes mcnlts gcbls mkbs

gk fkgkmne rdufktcãme

I Acbtknbe (Gngge)


2/94

Nbtrcmuitncb

• Me fcnbs eb fcnbs arîquebtes mepunsg„utngnsktncb mu fîtdctrexkte, mes jnctdîrkpnes (kbtn-]BG, kbtn NG; et NG1)

• Lïbe pcur ges prnses pcggnin-mnlntkges• Kbktcfne , pdysncpktdcgclne mesmîacrfktncbs « icurkbtes ¸ et ignbnque scbt

suppcsîes icbbues• Yeug ge trkntefebt idnrurlnikgest mnsiutî


3/94

Pcnlbet et fknb rdufktcãmesIcbiept gcic-rîlncbkg

• Zknscbber (et cpîrer) me prcxnfkg à mnstkg +++

• Ge pcnlbet est gk igea me gk acbitncb me gk fknb

? ng mcnt ïtre stkjge cu stkjngnsî kvkbt tcutekitncb sur ges selfebts mnlntkux

• Ge pcuie mcnt ïtre stkjge pcur ïtre cppcsî kuxmcnlts gcbls

• Gk idnrurlne mes FIP mcnt prîiîmer iegges mesNPP (surtcut pcur ges mîacrfktncbs eb icg meiylbe)


4/94

Eb prefner

Eb seicbm

Eb anb me pgkbbnbl eb acbitncb mes trcujges acbitncbbegs

Pcnlbet et fknb rdufktcãmesPgkbnaniktncb prî-cpîrktcnre


5/94

Fîtkikrpc-pdkgkblnebbes


6/94

Nbtrcmuitncb• Zespcbskjge me g„ube mes

mîacrfktncbs ges pgus typnqueset ges pgus vnsnjges?ge icup me vebt ugbknre

• Arîquebte• Gcbltefps jneb tcgîrîe ikr gcbltefps peu

mcugcureuse

• Fcmnaniktncb prclressnve mes prnses mnlntc- pkgfknres et pcggnin-mnlntkges• Prnse eb idkrle prîkgkjge

’ Mu pcnlbet s„ng est mîskxî ’ Mes tebmcbs agîidnsseurs sn tîbcsybcvnte


7/94

]cpclrkpdne

• Gk sybcvnte icffebieet prîmcfnbe sur gesFIP : et 9

• Gk mîacrfktncb prîmcfnbe sur gesFIP ugbknres


8/94

Pdysncpktdcgclne mes mîacrfktncbs

• Ge prnfuf fcvebs est gk mnstebsncb ikpsugc-gnlkfebtknre pkr gk prcgnaîrktncb sybcvnkge(pkbbus) et pkr ge gnqunme sybcvnkg

• M„cþ g„nfpcrtkbie me gnfnter iette mnstebsncb(sybcvncrtdäses)


9/94


• Pcsntncb mu pcnlbet eb kfcbt? ge znlzkl ’ Mîvnktncb rkmnkge mu pcnlbet

• Mîvnktncb ugbknre mes mcnlts

’ Mîvnktncb ugbknre mu pcnlbet• Mîvnktncb rkmnkg mes mcnlts


10/94


• Icbsîquebies me gk mnstebsncb ikpsugc-gnlkfebtknre ’ Mnstebsncb me gk jkbmegette sklnttkge rkmnkge

’ Guxktncb me g„kppkreng extebseur sur ge verskbtugbknre

’ Ierige vnineux


11/94


• Icbsîquebies me gk guxktncb ugbknre meg„kppkreng extebseur ’ Ge tebmcb est m„kutkbt fcnbs extebseur qu„ng se

rkpprcide mu iebtre rctktncb FIP ’ Ge tebmcb mevnebt agîidnsseur me gk FIP s„ng

pksse eb kvkbt mu iebtre me rctktncb FIP

’ Perte prclressnve me g„extebsncb kitnve FIP


12/94


• Icbsîquebies me gk guxktncbugbknre me g„kppkreng extebseur ’ Gk mcssnäre mes nbtercsseux tnre

gk jkse me P; vers g„kvkbt

’ Yujguxktncb pkgfknre me gk jkseme P; akingntîe pkr gk mnstebsncb

mes gnlkfebts icggktîrkux ’ Mîacrfktncb me gk pkrtne mcrskge

mes jkses me P;


13/94


• Icbsîquebies sur g„kppkreng agîidnsseur ’ G„nbignbknscb ugbknre mes FIP ebtrkâbe

• Ube trkbsgktncb ugbknre mes pgkques

pkgfknres• Mes icbtrknbtes sur ge verskbt ugbknre mes pcugnes K; qun se mnstebmebt? kutc-

kllrkvktncb ’ Gk sujguxktncb pkgfknre kulfebte ge jrksme gevner mes agîidnsseurs? kutc-kllrkvktncb


14/94

Pdysncpktdcgclnemes mîacrfktncbs

• Icbsîquebies me gksujguxktncb pkgfknre mes

FIP ’ Ge agessuf b„est pgus

rîmuitnjge

’ I„est ub tcurbkbt îvcgutnamkbs gk fkgkmne +++


15/94

Idcbmrcgyse

• Iytctcxnintî mes ebzyfes sybcvnkges• Ktrcpdne gcrs me gk perte me icbtkit

krtniugknre

• Icexnstebie me gîsncbs me sîvîrntî mnaaîrebte


16/94

Zetebtnssefebt me g„kttenbte mes FIP

• Mcugeurs scuvebt kjsebtes cu fcmîrîes• Zetebtnssefebt prclressna sur ges prnses ’ Ges pktnebts s„dkjntuebt prclressnvefebt à ies

mîacrfktncbs prclressnves

’ Gk lïbe vkrne kvei ges kutres kttenbtes me gkidkâbe mnlntkge


17/94

]rkntefebt idnrurlnikg

• Yybcveitcfne krtniugknre

• Zîîqungnjrkle me g„kppkreng extebseur

• Zefpgkiefebt krtniugknre ’ Espkieurs eb sngnicbe

’ Prctdäses tctkges


18/94

Qcnes m„kjcrm

• Qcne ubnque ’ ]rkbsverskge

’ Jrnsîe• Ube vcne gcblntumnbkge

pkr rkycb

• Ube vcne gcblntumnbkge pcur meux rkycbs


19/94

Yybcveitcfne FIP


20/94

Zîîqungnjrkle mes pkrtnes fcgges?Prnbinpes me jkse

• Kaaknjgnr ge verskbtugbknre

• Zetebmre geverskbt rkmnkg

• Zeiebtrer

g„kppkrengextebseur ku mcsme gk FIP


21/94

Kaaknjgnr ge verskbt ugbknre

• Yeitncb mu gnl. icggktîrkgugbknre s„ng est rîtrkitî

• Yeitncb cu trkbsaert mes

nbtrnbsäques ugbknres (4, >)• Yeitncb me g„expkbsncbmcrskge mes dypctdîbkrnebs(


22/94

Zetebmre ge verskbt rkmnkg• Zefnse eb tebsncb mu gnl.

icggktîrkg rkmnkg (;, :)• ]rkbsaert mes nbtrnbsäques

ugbknres sur ges

nbtrnbsäques rkmnkux mumcnlt vcnsnb (>)

• ]rkbsaert me g„extebseur prcpre me g„nbmex sur ge ;er

nbtercsseux mcrskg


23/94

Zeiebtrer g„kppkreng extebseur kumcs me gk FIP

• Yeitncb me gk jkbmegettesklnttkge ugbknre et

pgnikture me gk jkbmegettesklnttkge rkmnkge


24/94

Krtdrcpgkstne à lgnssefebt

• Fknbtebkbt pcssnjge lrêie ku trkntefebtfîmnikg ? krtniugktncbs FIP eb fcnbs lrkbmbcfjre ( ube cu meux pkr fknb), fcnbs

kgtîrîes, cþ prîmcfnbe gk idcbmrcgyse, skbsgîsncb fkoeure mes gnlkfebts icggktîrkux

• Ubnquefebt eb iks m'kttenbte sîväre mes

surakies krtniugknres skbs sujguxktncb pkgfknre


25/94


• Nfpgkbts infebtîs eb idrcfe icjkgt sur geverskbt fîtkikrpneb et eb pcgyîtdygäbe surge verskbt pdkgkblneb

’ Znsques me mesieggefebt me g'ub et/cu me g'kutreicfpcskbt, et ge rnsque m'usure me g'nfpgkbt eb pcgyîtdygäbe

• Nfpgkbts eb pyrcikrjcbe, eb tdîcrne bcb

infebtîs (fcmuge m'îgkstnintî prcide me g'cs) ’ Cstîc-nbtîlrktncb nfpcssnjge


26/94


• Gk fnse eb pgkie me ies nfpgkbts àlgnssefebt bîiessnte ? ’ Gk prîservktncb mes gnlkfebts icggktîrkux, à gk

acns sur geur nbsertncb prcxnfkge sur gk tïtefîtkikrpnebbe et sur geur nbsertncb mnstkge sur gk jkse me gk pdkgkble prcxnfkge

’ G'utngnsktncb me rêpes me tkngge icbicrmkbte pcur

gk tnle fîtkikrpnebbe et gk tnle pdkgkblnebbe


27/94



28/94

^ k-t-ng ube pgkie pcurg„dîfnkrtdrcpgkstne

à lgnssefebt 3


29/94

Espkieurs eb Yngkstni®

• Prîserver ges gnlkfebts icggktîrkux ’ Yur gk tïte fîtkikrpnebbe

’ Yur gk jkse me P;

• Utngnser ges rêpesme tknggeicbicrmkbte pcur

gk tnlefîtkikrpnebbe etgk tnle pdkgkblnebbe


30/94



31/94



32/94


• Mes lrcffetseb tntkbe scbtiebsîs îvnter gearcttefebt me gk

sngnicbe sur gestrkbides meseitncb csseuse

• Geurstkjngnsktncb mkbsg„cs est pkracns(scuvebt)

prcjgîfktnque


33/94

Kttegge pcst-cpîrktcnre

• Ytktnque eb extebsncb mes FIP, gknsskbtgnjres ges NP

• Mybkfnque kvei rkppeg îgkstnque mcrskg et

rkmnkg


34/94

Zîsugtkt acbitncbbeg mes YZY

• Mnspkrntncb mes mcugeurs

• Fcjngntî fcyebbe

’ Agexncb


35/94

Zîsugtktacbitncbbeg mes

YZY

g a n g m n g


36/94

Zîsugtkt acbitncbbeg mes nfpgkbtseb Yngkstni®

• Mnspkrntncb mes mcugeurs• Fcjngntî fcyebbe

’ Agexncb 50° à


37/94

Zîsugtkt mes nfpgkbts ebYngkstni®

• Gk rupture m„ubnfpgkbt b„est pks

rkre (5 à :5%) etb„est pks tcuocurssyfptcfktnque

(stkjngnsktncb pkrg„ebikpsugktncb)

• Peu me sngnicbnte


38/94

Nbmniktncbs tdîrkpeutnques

• Yybcvnte skbs mîskxktncb ’ Yybcvncrtdäse + kttegge me repcs

• Mîskxktncb skbs idcbmrcgyse nfpcrtkbte bn

sujguxktncb pkgfknre ’ Yybcveitcfne-rîkxktncb-stkjngnsktncb• Mîskxktncb kvei idcbmrcgyse nfpcrtkbte bn

sujguxktncb pkgfknre ’ Yybcveitcfne-rîkxktncb et prctdäses à lgnssefebt

• Mîskxktncb kvei idcbmrcgyse nfpcrtkbte et/cusujguxktncb pkgfknre

’ Yybcveitcfne-rîkxktncb et espkieur eb sngnicbe


39/94

Nbterpdkgkblnebbes


40/94

Nbtrcmuitncb• Mîacrfktncbs mnlntkges

’ Nscgîes• Ubn cu jngktîrkges• Ubn cu pgurnmnlntkges• Dcfcläbes cu dîtîrcläbes

’ Ksscinîes à kttenbte pcnlbet et FIP ++

• Mîacrfktncbs me gk PZ pcuvkbt +/-kssciner ’ Jcutcbbnäre ’ Mcnlt eb fkngget

’ Icg me iylbe• Zetebtnssefebt ignbnque et mnaaniugtî tdîrkpeutnque

vkrnkjges segcb gk gîsncb? ’ Mefkbme estdîtnque 2 acbitncbbegge ? jcutcbbnäre

’ Mefkbme acbitncbbegge 2 estdîtnque ? icg me iylbe


41/94

Gîsncb mes tebmcbs agîidnsseurs?tîbcsybcvnte et rupture


42/94

Gîsncb mes agîidnsseurs

• Peuvebt exnster nbmîpebmkffebt mes gîsncbskrtniugknres

• ]îbcsybcvntes jgcikles tebmnbeux• Zuptures mîakut me fcjngntî NPP et cu

NPM ’ Kttrntncb csseuse ku pcnlbet ’ ]îbcsybcvnte ku pcnlbet et/cu à gk fknb

• ]rkntefebt? ’ Yuture mnreite rkrefebt pcssnjge ’ Lreaae icurte sn rupture eb zcbes 9, = cu 5 ’ Lreaae gcblue eb ub cu meux tefps (GP) pcur ges

mcnlts gcbls ’ Kutres pcssnjngntîs ?

- Kmcssefebt mkbs gk pkufe- Krtdrcmäse me g„krtniugktncb fcjngnsîe - Cpîrktncbs icfjnbîes ? lreaae sur P: +

krtdrcmäse NPM


43/94

Krtdrnte NPP skbs mîacrfktncb eb jcutcbbnäre cu icg me iylbe

Yt m î m t tn


44/94

Ytkme prîicie skbs mestruitncbkrtniugknre

• Yybcvnte persnstkbte fkglrî trkntefebt fîmnikg (1 fcns) ’ Znsque mcrskg mnstebsncb extebseur et jcutcbbnäre

’ Znsque pkgfknre icg me iylbe

• Yybcveitcfne NPP• Crtdäse NPP m„extebsncb sn mnstebsncb jkbmegette fîmnkbe

et fcjngnsktncb eb agexncb NPM


45/94

Ytkme tkrmna kvei mestruitncb krtniugknre

• Mcugeurs et/cu sybcvnte persnstkbte fkglrîtrkntefebt fîmnikg (1 fcns)

• Yur mcnlt rknme


46/94

Ytkme tkrmna kvei mestruitncb krtniugknre

Krtdrcmäse• Kttenbte me g„nbmex

• Kttenbte ubnmnlntkge, kitnvntîme acrie

• Ignbcmkitygne snlbnaniktnve

• Agessuf nfpcrtkbt (2 50°)

• Kbtîiîmebt nbaeitneux

• Ytcih csseux nbsuaanskbt• mîanint tebmnbeux

• Îtkt iutkbî prîiknre

Krtdrcpgkstne• Mcnlts ugbknres (9,=,5)

• Ignbcmkitygne kjsebte cufnbeure

• Agessuf 7 50°

• Ytcih csseux suaanskbt

• Nbtîlrntî tebmnbeuse

• Îtkt iutkbî icrreit• À prcpcser kvei

prumebie sur mcnlt

fcjnge


47/94

Krtdrcpgkstnes NPP

• Pyrcikrjcbe ( tkux îgîvî meicfpgniktncbs)

• Prctdäse tctkge fîtkg vs. PE

• Nfpgkbts type Ywkbscb cu Beuagex,fcnbs fkuvknse scgutncb ’ Ycugklefebt ? 0% iks

’ Fcjngntî ? =0° (:5°-15°) ’ ]kux me arkiture ? 0%-90%

’ Pks : nfpgkbts me Ywkbscb sur gk fïfe

idkâbe mnlntkge

d m


48/94

Krtdrcmäse NPP

• À mnsiuter sn ges FIPscbt mkbs ub seiteurutnge me fcjngntî

• Kppcrte nbmcgebie et

stkjngntî mkbs ube pcsntncb me acbitncb

• Mcbber pgus me agexncbà g„krtdrcmäse pcur gesmcnlts ugbknres, surtcutsn g„dyperextebsncb meg„NPM est

regktnvefebt nfpcrtkbte

• Bkgejuaa

(estdîtnque ++) ’ Nbmex? :5°

’ +5° pkr mcnlt

’ Kurniugknre? =0°• Dkrrnsscb,

Fnggebmer(acbitncbbegge

++) ’ Nbmex? =0°

’ +;0° pkr mcnlt

’ Kurniugknre?


49/94

Zeprnse m„krtdrcpgkstne ? krtdrcmäse


50/94

Jcutcbbnäre

Pd n d g n m g j nä


51/94

Pdysncpktdcgclne me gk jcutcbbnäre

Ikuse exigusnve 6 Yybcvnte NPP (++) Mnstebsncb me gk ikpsuge mcrskge, puns rupture me gk jkbmegette fîmnkbe meg„kppkreng extebseur et mes anjres qun gesubnssebt kux jkbmegettes gktîrkges

Extrusncb me g„NPP ebtre ges meux jkbmegettesgktîrkges, icffe ube jcutcbbnäre acriîe pkrub jcutcb

**



52/94

• Evcgutncb vers ub agessuf me g„NPP ’ Pkr perte m„eaanikintî me gk jkbmegette fîmnkbe mnstebmue

(sybcvnte) ’ Pkr gk guxktncb mes jkbmegettes gktîrkges eb kvkbt mu iebtre me

rctktncb me g„NPP

• Pkrkggägefebt ube dyperextebsncb NPM mue ’ À g„utngnsktncb mu mcnlt pkr ge pktnebt ’ Ku repcrt sur g„NPM me gk tctkgntî me gk

trkitncb me g„kppkreng extebseur

’ À gk tebsncb exeriîe pkr ges jkbmegettesgktîrkges guxîes

• Kllrkvktncb prclressnve mes mîacrfktncbs, fïfe kpräs

mnspkrntncb me gk sybcvnte




53/94

• Anxktncb seicbmknre mu agessuf NPP qun mevnebtnrrîmuitnjge ’ Pkr rîtrkitncb mes gnlkfebts rîtnbkiugknres

trkbsverses, me gk pgkque pkgfknre et mesgnlkfebts icggktîrkux kiiesscnres

’ Pkr rîtrkitncb me gk lknbe mes agîidnsseurs ’ Pkr rîtrkitncb iutkbîe

• Anxktncb seicbmknre me g„dyperextebsncb NPM

qun mevnebt nrrîmuitnjge ’ Pkr rîtrkitncb mes GZC ’ Pkr rîtrkitncb me gk ikpsuge mcrskge me g„NPM ’ Pkr rîtrkitncb iutkbîe mcrskge


Jng gn n


54/94

Jngkb ignbnque

• Mnaaîrebiner jcutcbbnäres scupges et ebrknmnes

• Agessuf NPP et me dyperextebsncb NPM idnaarîs

• Icbsîquebies sur acbitncb lgcjkge me gk fknb,bctkffebt eb iks m„kttenbte pgurnmnlntkge

• Îtkt surakies krtniugknres ? Zkmnc

Zîtrkitncb GZC ?]est me Dknbes

Ig nan tn gn n


55/94

Ytkme N Ytkme NN Ytkme NNN

NPP - ;0 à ;5° m„extebsncb,rîmuitnjge

- 90 à =0° m„extebsncb, pkrtneggefebt rîmuitnjge

Ebrknmnssefebt ebagexncb

NPMGîläre dyperextebsncbAgexncb gnfntîe sn NPP à0°

Dyperextebsncb fcmîrîeagexncb gnfntîe

Ebrknmnssefebt ebdyperextebsncb

FIP Gîläre dyperextebsncb meicfpebsktncb

Dyperextebsncbfcmîrîe

Igkssnaniktncb me BKGEJUAA et FNGGEBMEZ (;>


56/94

Prnbinpes tdîrkpeutnques;- [u„est-ie qun lïbe ge pktnebt 3

’ Dyperextebsncb NPM 3 + lïbkbte que ge agessuf NPP pcur ges mcnlts ugbknres

’ Agessuf NPP 3

: - [ueg est g„îtkt me gk FIP 3 ’ ]cgîrkbie fenggeure mu agessuf NPP sn gk FIP k

lkrmî ube extebsncb icfpgäte, vcnre mes ikpkintîsm„dyperextebsncb

9 - Icfjneb y k-t-ng me mcnlts tcuidîs 3 ’ ]cgîrkbie fenggeure mes mîacrfktncbs pgurnmnlntkges

nmebtnques que mes mîacrfktncbs pgurnmnlntkgesmnaaîrebtes cu ubnmnlntkges

P n n tdî tn


57/94

Prnbinpes tdîrkpeutnques

• Idnrurlne mes pkrtnes pcur jcutcbbnäre ? gesfcnbs jcbs rîsugtkts me gk idnrurlne meicrreitncb mes mîacrfktncbs mnlntkges

• Znsque ? trkbsacrfer mîacrfktncb eb agexncb ebrknmeur eb extebsncb mnlntkge ebicre pguslïbkbte

• Yybcveitcfne prîicie NPP eb iks me sybcvnte persnstkbte fkglrî ge trkntefebt fîmnikg ? îvntergk mnstebsncb me gk jkbmegette fîmnkbe pkr pkbbus sybcvnkg

] nt t m t m ; NPP


58/94

]rkntefebt mu stkme ; ? NPP

• ]rkntefebt crtdîtnque me g„NPP ’ Ytkme prîicie 6 scupge ’ Pktnebt peu lïbî et rnsque me rknmeur

pcst-cpîrktcnre eb extebsncb

’ ]rkntefebt crtdcpîmnque pkr ktteggestktnque cu mybkfnque, gknsskbtg„NPM gnjre

’ Nboeitncb nbtrk-krtniugknre(icrtnicãmes…), sybcvncrtdäses

’ Yybcveitcfne (vcne gktîrkge) sn îtktnbagkffktcnre persnstkbt ?gnjîrktncb pkgfknre mes jkbmegettesgktîrkges pkr seitncb mes GZ]

] nt t m t m ; NPM


59/94

]rkntefebt mu stkme ; ? NPM

• Fkbnpugktncb eb agexncb me g„NPMeb fknbtebkbt g„NPP eb extebsncb, pcur mcrskgnser ges jkbmegettesgktîrkges et îvnter gk rîtrkitncb mu

GZ] et mu GZC• ]est me Dknbes pcsntna ? tîbctcfnekppkreng extebseur eb kfcbt meg„nbsertncb mes GZC

McgpdnbGnttger Iurtns ]ujnkbk

] nt t m t m :


60/94

]rkntefebt mu stkme :

• ]rkntefebt idnrurlnikg ’ M„kjcrm ksscupgnr ges

mîacrfktncbs pkr gkhnbîsntdîrkpne et ges crtdäses

’ Yybcveitcfne me g„NPP ’ Gnjîrktncb pkgfknre mes

jkbmegettes gktîrkges pkr seitncbmes GZ]

’ Leste sur g„NPM? • ]îbctcfne extebseur ku mcs me P:

• Krtdrcmäse sn mestruitncb cu

kbhygcse NPM

AcwgerMcgpdnb

] nt t m t m :


61/94

]rkntefebt mu stkme :

• Zeicbstruitncb me g„kppkrengextebseur peu reicffkbmîe,ikr peu eaanikie ? ’ Zkiicurinssefebt mu ikg

tebmnbeux

’ Zînbsertncb kvkbiefebt me gk jkbmegette iebtrkge

’ Zkpprcidefebt mes jkbmegettesicggktîrkges

] nt t m t m 9


62/94

]rkntefebt mu stkme 9

• ]rkntefebt idnrurlnikg ’ Mîacrfktncbs anxîes, rknmeurs, gîsncbs

ikrtngklnbeuses NPP

’ ;) Krtdrcgyse kbtîrneure

’ :) Meux kgterbktnves

• Krtdrcpgkstne + reicbstruitncb me g„kppkrengextebseur

• Krtdrcmäse ’ 9) Ies : lestes scbt ge pgus scuvebt ksscinîs à

ube tîbctcfne me g„extebseur

Nbmniktncbs tdîrkpe tnq es


63/94

Ytkme N

rîmuitnjge

Ytkme NN

« ebicre ¸rîmuitnjge

Ytkme NNN

anxîe

NPP - ;0 à ;5° m„extebsncb,rîmuitnjge

- 90 à =0° m„extebsncb, pkrtneggefebt rîmuitnjge

Ebrknmnssefebt ebagexncb

NPM Gîläre dyperextebsncbAgexncb gnfntîe sn NPP à0°

Dyperextebsncb fcmîrîeagexncb gnfntîe

Ebrknmnssefebt ebdyperextebsncb

FIP Gîläre dyperextebsncb meicfpebsktncb

Dyperextebsncbfcmîrîe

]tt • Crtdäses m„extebsncbbciturbes+/- tîbctcfne extebseursur P:

• NPP? sybcveitcfne +reicbstruitncb me gk jkbmegette fîmnkbe (Gnttger,…) +/-

• NPM? tîbctcfne extebseursur P:

• NPP? krtdrcmäse,krtdrcpgkstne

• NPM? tîbctcfne

Nbmniktncbs tdîrkpeutnques


64/94

Mcnlt eb fkngget

Pdysncpktdcgclne mu fkngget


65/94

Pdysncpktdcgclne mu fkngget

• Yybcvnte mcrskge NPM

• Mnstebsncb mu tebmcb extebseur

Agexncb prclressnve me g„NPM

Icg me iylbe seicbmknre eb iks me mnstebsncb me gk pgkque

pkgfknre

]rkntefebt mu fkngget


66/94

]rkntefebt mu fkngget• ]rkntefebt crtdcpîmnque

’ Kux stkmes nbntnkux, peu mîacrfîs kvei sybcvnte fcmîrîe ’ Kttegge eb extebsncb

• Krtdrcmäse NPM ’ Nbmniktncbs?

• Yn mîacrfktncbs nfpcrtkbtes bcb rîmuitnjges• Yn nbstkjngntî gktîrkge• Yn mestruitncb krtniugknre

’ Pcsntncb• Zeitntume sur NN et NNN

• Gîläre agexncb pcur NQ et Q ’ Ytkjngnsktncb• : jrcides eb ircnx• ; vns kxnkge• Fktîrnku ebmcfîmuggknre



67/94


• Eb iks me icg me iylbe? ’ Krtdrcmäse NPM + tîbcmäse

kbtîrneure ku AIY

’ Icrrnle ges meux mîacrfktncbs


68/94

Icgs me iylbe

Kspeits ignbnques mu icg me iylbe


69/94

Kspeits ignbnques mu icg me iylbe

• Ub cu pgusneurs mcnlts

• Mîacrfktncbs nmebtnques cu vkrnîes, +/- sîväres

• Zîmuitnjges cu anxîes

Pdysncpktdcgclne mu icg me iylbe


70/94

Pdysncpktdcgclne mu icg me iylbe

• Îtncpktdclîbne fugtnakitcrnegge +++ ? ’ Krtniugknres et/cu tebmnbeuses ’ Jcbbe icfprîdebsncb me gk jkgkbie fusiugc-

tebmnbeuse +++ ’ Fugtn-sntes ? FIP, NPP , NPM ’ Ikuses prcxnfkges sercbt trkntîes eb prefner

(pcnlbet, FIP)• Ikuses FIP ’ Yujguxktncb pkgfknre me P; ’ Zîtrkitncb nbtrnbsäques

• Ikuses NPP

’ Yybcvnte NPP (eb lg jcutcbbnäre) ’ Mnstebsncb me gk pgkque pkgfknre NPP ’ ]îbcsybcvnte mu agîidnsseur superanineg ’ Zupture mu agîidnsseur superanineg

• Ikuses NPM

’ Îvcgutncb m„ub mcnlt eb fkngget

Pdysncpktdcgclne ? ikuse ku pcnlbet


71/94

Pdysncpktdcgclne ? ikuse ku pcnlbet

• Perte me dkuteur mu ikrpe pkr mestruitncb csseuse(icggkpsus ikrpneb) cu sujguxktncb kbtîrneure rkmnc-ikrpnebbe

• Zegêidefebt mes fusiges extrnbsäques ? Fnse eb oeu

kiirue mes fusiges nbtrnbsäques• Be suaant pks me akìcb nscgîe, kttenbte FIP kgcrs ge

pgus scuvebt ksscinîe (mîacrfktncb eb znl-zkl pcnlbet-FIP)

Pdysncpktdcgclne ? ikuses FIP


72/94

Pdysncpktdcgclne ? ikuses FIP

• Gk pgus arîquebte

• Yujguxktncb cu guxktncb pkgfknre P; (mnstebsncb me gk pgkque pkgfknre pkr gk sybcvnte, sujguxktncb mu tebmcbextebseur mkbs gk vkggîe)

• Fnse eb tebsncb mes nbtrnbsäques m„kjcrm iýtî ugbknrekulfebtkbt gk acrie me g„kppkreng extebseur sur g„NPPirîkbt ube dyperextebsncb NPP

• Agexncb NPM pkr mîtebte me g„kppkrengextebseur eb kvkg me g„NPP et fnse ebtebsncb mu agîidnsseur prcacbm pkrdyperextebsncb NPP

Pdysncpktdcgclne ? ikuses NPP


73/94

Pdysncpktdcgclne ? ikuses NPP

• Mnstebsncb +/- mestruitncb pkr ge pkbbus sybcvnkg ? ’ Pgkque pkgfknre ’ Ieih-renbs ’ +/- nbsertncb mnstkge AMY

• Dyperextebsncb NPP ebtrkâbe ?

’ Mcrskgnsktncb mes jkbmegettes icggktîrkges et GZC mîtebmus ?kitncbs sur NPM mnfnbuîes ’ Fnse eb tebsncb mu AMY pkr dyperextebsncb NPP

• Mîacrfktncb eb agexncb NPM

Pdysncpktdcgclne ? ikuses NPM


74/94

Pdysncpktdcgclne ? ikuses NPM

• Evcgutncb fkgget anbler (mnstebsncb cu rupture jkbmegette terfnbkge me g„extebseur pkr pkbbussybcvnkg NPM)

• Fnlrktncb prcxnfkge extebseur ciiksncbbe ’ Mîtebte jkbmegettes terfnbkges

’ Icbiebtrktncb me gk acrie me g„kppkreng extebseur sur g„NPP

• Mnstebsncb struitures pkgfknres NPP

• Dyperextebsncb NPP et icg me iylbe

Jngkb ignbnque et rkmncgclnque


75/94

Jngkb ignbnque et rkmncgclnque

• Icg me iylbe scupge cu ebrknmn ? fcjngntî pkssnve vs. kitnve

• Melrî me rîtrkitncb nbtrnbsäque ? test meAnbcidnettc

• Acbitncb et îvebtuegge tîbcsybcvnte mestebmcbs agîidnsseurs

• Exkfeb lgcjkg, scudknts, mcugeurs, acbitncb,• Etkt krtniugknre ? Zkmnc

]est me Anbcidnettc


76/94

]est me Anbcidnettc• Kpprîine gk fcjngntî NPP

segcb gk pcsntncb FIP• Ge pgkiefebt me gk FIP

eb extebsncb ciiksncbbe

ube fnse eb tebsncb mesnbtrnbsäques (tebmcbs sntuîseb kvkg me g„kxe me agexncbFIP)

• ]est bîlktna ? ge pktnebt peut agîidnr g„NPP, FIP ebextebsncb

]est me Anbcidnettc


77/94

]est me Anbcidnettc• ]est pcsntna 6 rîtrkitncb mes

nbtrnbsäques ? agexncb NPP gnfntîecu nfpcssnjge qukbm FIP ebextebsncb

• ]ester nbtrnbsäques ugbknre etrkmnkux ? ’ Zîtrkitncb ge pgus scuvebt iýtî

ugbknre mkbs gk mîacrfktncb igkssnque

eb icup me vebt ugbknre ’ G„nbtrnbsäque mu iýtî ugbknre est testîspîinanquefebt FP eb extebsncb etnbignbknscb rkmnkge

Igkssnaniktncb mes icgs me iylbe (Bkgejuaa)


78/94


• ]ype N ? Agexncb kitnve NPP icfpgäte mkbstcutes ges pcsntncbs ’ Zesskut me gk jkbmegette icggktîrkge

’ ]est me Anbcidnettc bîlktna ’ Gîsncbs? • Yybcvnte mes agîidnsseurs• Îgcblktncb PP

• Zupture cu îgcblktncbextebseur ku mcs NPM…



79/94


• ]ype NN ? Agexncb NPP est gnfntîe mkbs iertknbes pcsntncbs ’ ]est me Anbcidnettc pcsntna ? agexncb NPP gnfntîe

gcrsque FIP pgkiîe eb extebsncb et eb nbignbknscbrkmnkge, agexncb NPP pcssnjge sn FIP agîidne

’ Gîsncbs? ]ype N +rîtrkitncb mes nbtrnbsäques



80/94


• ]ype NNN? Agexncb NPP gnfntîe queggeque scnt gk pcsntncb me gk FIP

Gîsncbs? ]ype NN + rîtrkitncb me gkikpsuge et me g„kppkreng extebseur ku

mcs me g„NPP, rîtrkitncb iutkbîe,kmdîrebie mes jkbmegettes gktîrkges àgk jkbmegette fîmnkbe

• ]ype NQ? Zknmeur NPP icfpgäte kveikgtîrktncb mes surakies krtniugknres

Gîsncbs? ]ype NNN + mestruitncb

cstîc-krtniugknre

]rkntefebt mu icg me iylbe


81/94

]rkntefebt mu icg me iylbe

• Pgus nbestdîtnque et pgus acbitncbbeggefebt lïbkbt quegk jcutcbbnäre, surtcut kux stkmes NNN et NQ

• Bcfjreuses ikuses à mîfefjrer pcur trknter gk cu gesikuses et ses icbsîquebies (++) ’ Icrreitncb mu fkngget

’ Icrreitncb me g„dyperextebsncb NPP

’ Kfîgncrktncb me gk agexncb kitnve NPP ’ Kfîgncrktncb me gk agexncb pkssnve NPP

’ Gnjîrktncb mes nbtrnbsäques

’ ]rkntefebt me g„krtdrcpktdne

Icrreitncb me gk rîtrkitncb mes


82/94

nbtrnbsäques

• Zîseitncb me g„expkbsncbmcrskge mes nbtrnbsäques ebicbservkbt geur nbsertncbcsseuse

’ tctkge cu pkrtnegge ’ sur ge verskbt ugbknre

(rîtrkitncb prîmcfnbkbte) cusur ges meux verskbts

• Gnjîrktncb scuvebt aknte gcrsm„ub leste sur gk FIP

Icrreitncb mu fkngget


83/94

Icrreitncb mu fkngget

• Krtdrcmäse NPM eb

reitntume

Icrreitncb me


84/94

Icrreitncb meg„dyperextebsncb NPP

• Cjtebnr ub gîler agessuf NPP pcur îvnter ube rîinmnve me gk

mîacrfktncb +++• ]eidbnques

’ ]îbcmäse (AIY, JG) +/- lesteNPM

’ Ikpsugcmäse pkgfknre

• Kttegge NPP-stcp pebmkbt 5-1sefknbes

Kfîgncrktncb me gk agexncb kitnve NPP


85/94

Kfîgncrktncb me gk agexncb kitnve NPP

• Mîakut agexncb kitnve ? gk ikuse 6 estkux tebmcbs agîidnsseurs

]îbcsybcveitcfne et tîbcgyse mestebmcbs agîidnsseurs

• Zîîmuiktncb kitnve prîicie me gkagexncb NPP scus prcteitncb kttegge

NPP-stcp

Kfîgncrktncb me gk agexncb pkssnve NPP


86/94

Kfîgncrktncb me gk agexncb pkssnve NPP

• Fkbnpugktncb exterbe mcuie

• Yn rîtrkitncb iutkbîe mcrskge nbinsncbsiutkbîes cjgnques me mîidkrle, mnstkges à

g„NPP, gknssîes à gk iniktrnsktncb mnrnlîe

• Nffcjngnsktncb eb agexncb quegques ocurs? ’ Kttegge NPP-stcp

’ Cu jrcide cjgnque

• Krtdrcgyse mkbs ges iks mnaaninges, terfnbîe

pkr ube fkbnpugktncb eb agexncb

]rkntefebt me g„krtdrcpktdne


87/94

]rkntefebt me g krtdrcpktdne

• Krtdrcpgkstne ’ Nfpgkbts? Ywkbscb, Beuagex

’ Prctdäses tctkges

• Krtdrcmäse ’ Nbmex cu fîmnus

’ Yn rupture mes agîidnsseurs ’ Eb iks me prctdäse FIP

Nbmniktncbs


88/94

Nbmniktncbs• Yegcb scupgesse et îtkt NPP

• II scupge, rîmuitnjge? ’ Fkbnp, ZA et crtdäses ’ Yybcvnte +/- rupture AIY

sybcveitcfne, tîbcmäse kbtîrneure NPP ’ Ikuse NPM krtdrcmäse NPM + tîbcmäseNPP

• II anxîe? ’ Krtdrcmäse cu prctdäse NPP segcb ge mcnlt

et g„kttenbte FIP? ’ Prctdäse FIP krtdrcmäse ’ FIP sknbe prctdäse

]rkntefebt mes types N me ikuse NPP


89/94

]rkntefebt mes types N me ikuse NPP

• Mnstebsncb me gk pgkque pkgfknre ?tîbcmäse kusuperanineg

• Zupture AMY ?tîbcmäse me gk jkbmegette gktîrkge me

g„extebseurnpsngktîrkge (_kbicggn)

]rkntefebt mes types N me ikuse NPM


90/94

]rkntefebt mes types N me ikuse NPM

• Kgtîrktncbs arîquebtes NPM ? krtdrcmäse NPM

]rkntefebt mes types NN


91/94

]rkntefebt mes types NN

• Icrreitncb dyperextebsncb NPP

nbsuaanskbte• Gnjîrktncb nbtrnbsäque ksscinîe

mu iýtî me gk rîtrkitî

• Zîseitncb anjres nbtrnbsäques àg„crnlnbe me gk mcssnäre ebrespeitkbt g„nbsertncb csseuse

• G„nbtrnbsäque ugbknre peut ïtreicfpgätefebt rîsîquî, y icfprnsscb nbsertncb csseuse eb iks merîtrkitncb nfpcrtkbte.

]rkntefebt mes types NNN


92/94

]rkntefebt mes types NNN

• Dyperextebsncb anxîe ’ (Fkbnpugktncb snfpge)

’ Gnjîrktncb mcrskge, pgkstne iutkbîe, vîrnaniktncb

percpîrktcnre me g„kitncb mes agîidnsseurs

]rkntefebt mes types NQ


93/94

yp Q

• Dyperextebsncb anxîe, kgtîrktncbs NPP,rîtrkitncb iutkbîe ’ Krtdrcmäse

’ (Krtdrcpgkstne)

Icbigusncbs


94/94

Icbigusncbs• Ges mîacrfktncbs mnlntkges mkbs gk PZ

peuvebt ïtre nscgîes cu s„kssciner (ge pgusscuvebt) kux mîacrfktncbs mu pcnlbet et mesFIP

• Gk icrreitncb me tcute mîacrfktncb bîiessnte ?

’ Ge jngkb mu pcnlbet ’ Gk reideride me gk cu mes ikuses ( nbinmebietdîrkpeutnque)

’ Ub exkfeb icfpget mes idkâbes mnlntkges• Ub mcnlt eb fkngget cu eb jcutcbbnäre, fïfe

anxî, est bettefebt fneux tcgîrî qu„ub icg meiylbe anxî… ’ Ge prefner b„efpïide pks g„ebrcugefebt mu mcnlt

G m nä ï d t t n g j g

Documents

8 - Doigts Longs-rhumatoides