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puffy fingers, due to, due to, caused by, associated with, which is, such…

- - - - Wrist
        
        Flexion and Extnesion
        
        Radila and Ulnar Deviation
      - Fingers
        
        Flexion and Extnesion
        
        Abduction and Adduction
      - Thumb
        
        Flexion and Extnesion
        
        Abduction and Adduction
        
        Opposition
  - - - Numbness or paresthesia in the areas of median nerve distribution suggests Carpal Tunnel Syndrome
    - - Pain during this movement indicates De Quervain’s tenosynovitis
    - - Numbness or paresthesia in the areas of median nerve distribution suggests Carpal Tunnel Syndrome
- - - - between 65-80
    - - greater in females (3:1)
  - - - 1- neoepitopes
        
        Post-translational protein modifications take place
        
        Peptidyl Arginine Deaminase (PAD)
      - 2- loss of tolerance to neoepitopes
      - 3- Activation of Citrulline reactive T cell and B cell clones
        
        Anti-citrullinated protein antibodies (ACPA) production and inflammation
    - - 1- Unknown trigger.
        
        Recruits auto-reactive lymphocytes & Macrophages to joint
      - 2- Autoreactive CD4 T cells
        
        RANK Ligand
        
        Macrophages
      - 3- Activated Macrophages Release pro-inflammatory cytokines
        
        Activation of tissue Fibroblasts & recruitment of other pro-inflammatory cells
      - 4- Activated Fibroblasts
        
        pro-inflammatory cytokines & Matrix metalloproteinases (MMPs) & RANK ligand 
        
        tissue destruction
        
        Bone destruction
  - - - ESR
      - CRP
      - Rheumatoid Factor
    - - X-ray
      - MRI
  - - - Non-selective COX inhibitors
        
        Salicylic acid (aspirin)
      - selective COX-2 inhibitors
        
        celecoxib
      - Inhibiting the cyclooxygenase enzymes
        
        prostaglandin synthesis
      - Side effects
        
        Renal effects
        
        Cardiac effects
        
        Increased risk of bleeding
        
        GIT: bleeding - ulcers
    - - Traditional Drugs
        
        Leflunomide
        
        Inhibiting pyrimidine synthesis
        
        Hydroxychloroquine - Sulfasalazine
        
        Methotrexate
        
        Inhibiting purine synthesis
      - Biologic Agents
        
        TNF-α Blocking agents
        
        Adalimumab – Golimumab – Certolizumab – Infliximab – Etanercept
        
        Increased risk of infections - Infusion-related reactions
      - Targeted synthetic DMARDs
        
        Abatacept
        
        competing with CD28 for binding on CD80/CD86
        
        Rituximab
        
        Tocilizumab and sarilumab
        
        Binding to IL-6 receptors
- - - - Trapezium
      - Trapezoid
      - Capitate
      - Hamate
    - - Scaphoid
        
        Most common fractures
      - Lunate
      - Triquetrum
      - Pisiform
  - - - Proximal
      - Middle
      - Distal
    - - Proximal
      - Distal
  - - - Abductor pollicis brevis
      - Flexor pollicis brevis
      - Opponens pollicis
    - - Abductor digiti minimi
      - Flexor digiti minimi
      - Opponens digiti minimi
    - - 4 Lumbricals
    - - Adductor pollicis
    - - Palmar interossei
        
        1-3
      - Dorsal interossei
        
        1-4
- - - - edema
  - - - sex: female
      - age: 20-50
      - previous injury
        
        tendonitis
      - arthritis