CLASSIFICATION OF RHEUMATIC DISEASE

Blondina Marpaung

Rheumatic Division Department of Internal Medicine FK USU - Medan

Classification of Rheumatic Disease( American Rheumatism Association 1973)

I. Diffuse Connective Disease

A. Rheumatoid Arthritis

B. Juvenile Arthitis:1. Onset systemic

2. Onset polyarticular

3. Onset Oligoarticular

C. Systemic Lupus Eritematosus

D. Progressive Systemic Sclerosis

E. Polymyositis / dermatomyositis

F. Vasculitis nekrotisasi and another vasculopathy 1. Polyartheritis nodosa related Hepatitis B and granulomatosis alergic Churg-Strauss 2. Hypersensitivity vasculitis : Henoch Schonlein purpura.

3. Wegener Granulomatosis 4. Giant cell arthritis a. Temporary Arthritis b. Takayasu Arthritis

5. Lymph node mucocutaneous syndrome (Kawasaki Disease)

6. Behcet Disease

G. Sjogren Syndrome

H. Unclassifed syndrome (including mixed connective disease ).

I. Another classified :

rheumatic polymialgia ,

paniculitis (Weber-Christian disease),

erythema nodosum,

policondritis , etc.

II. Arthitis related spondyltis

A. Ankylosing spondyltis B. Reiter syndrome C. Psoriatik arthritis D. Arthritis related chronic collitis

III. Degenerative Joint Disease (Osteoarthritis / Osteoarthrosis )

A. Primary B. Secondary

IV. Arthritis, tenosinovyitis and bursitis related with infectionA. Direct 1. Bacteriaa. Gram positive Coccus (staphylococcus and another bacteria).b. Gram negative Cocus (gonococcus and another bacteria).c. Gram negative basild. Mycobacteriume. Treponema f. Etc

2. Virus 3. Fungi 4. Parasite 5. Idiopathic ( Whipple Disease )

B. Indirect

Bacteria including : acute rheumatic fever, intestinal shunt, Post shigella dysentri, yersinia, etc

V. Rheumatic disease related systemic disease and endocrin

A. Crystal influence

1. Monosodium Crystal ( gouthy ) 2. Kalsium pirofosfat dihidrat (Pseudogout, kondrokalsinosis)

3. Hidroksiapatit

B. Biochemistry Abnormality

1. Amiloidosis 2. Vitamin C Deficiency( Scurvy ). 3. Specific enzyme deficiency :Fabry DiseaseFarber DiseaseAlkaptonuria Lesch Nyhan Syndrome 4. Dyslipidemia

5. Mukopolisakarida 6. Haemoglobinopathy Sickle Cell disease, etc 7. Pure Connective Disorder: Ehler-Danlos SyndromeMarfan SyndromeElastic pseudo xantoma,etc 8. Etc

C. Endocrin Disease

1. Diabetes Mellitus 2. Acromegali3. Hiperparatiroidism4. Thyroid Disease (hyperthyroidism, hypothyroidism).

D. Immunodeficiency Syndrome.

E. Another Heredity disease :.

1. Arthrogryposis multiplex congenital 2. Hypermobility Syndrome 3. Progressive Myositis Ossificans

VI. Neoplasma.

A. Primary ( sinovioma, sinovio sarcoma ) B. Metastatic

VII.Neuropatic Disorder

A. Charcot Joint B. Compression Neuropathy 1. Peripheral entrapment (carpal-tunnel syndrome, etc) 2. Radiculopathy 3. Spinal Stenosis C. Sympathic reflex dystrophy D. Etc

VIII. Related with bone disorder and joint manifestation

A. Osteoporosis 1. Generaly 2. Regional ( local )

B. Osteomalasia

C. Osteoartropathy hypertrofik

D. Hiperostosis skeletal idiopatik difus, including Forrestier hiperostosis disease, vertebra ankilosing

E. Osteoitis1. Generaly osteoitis deformans - Paget disease2. Local osteoitis condensans illii, osteoitis pubis F. Necrosis avaskularG. Osteocondritis ( osteo chondritis dissecans )H. Congenital Hip Dysplasia. I. Slipped capital Femoral epiphysis.J. Costocondritis ( including Tietze syndrome )K. Osteolysis and condrolysis

III.Nonarticular Rheumatism

A. Miofasial Pain Syndrome : 1. General: - Fibrosis - Fibriomyalgia 2. Regional.

B. Low Back Pain and discus intervertebra disorder.

C. Tendinitis ( tenosinovitis ) and or bursitis.

1. Bursitis subakromial / subdeltoid. 2. Tenosinovytis, tendinitis bicipital. 3. Bursitis olecranon. 4. Epicondilitis humeral medial or lateral. 5. Tenosinovyitis De Quervain. 6. Capsulitis adhesif shoulder joint (frozen - shoulder) 7. Trigger finger.

D. Ganglion CystE. Fascilitis.F. Chronic strain ligament and muscle

G. Vasomotor Disorder. 1. Erythromelalgia. 2. Raynaud Phenomen.

H. Another pain syndrome including weather sensiivity., psikogenik rheumatism

X. Another Disorder

A. Disorder related with arthritis. 1.Trauma ( direct trauma ). 2. Lyme arthritis. 3. Pancreas Disease. 4. Sarcoidosis. 5. Palindromic Rheumatism. 6. Sinovytis villonodular. 7. Hidrartrosis intermitten. 8. Hemofilia.

B. Another situation.

1. Internal dearrangement from joint including - condromalasia patella,- loose bodies 2. Familial mediterranean fever. 3. Eosinophilic fascilitis. 4. Active Chronic Hepatitis. 5. Drug related syndrome.

Thank YouDr. Blondina Marpaung, SpPD - KR

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