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Harrison's Principles of Internal Medicine, 18e
| Part 15. Disorders of the Joints and Adjacent Tissues > Section 3. Disorders of the Joints and Adjacent Tissues > |
Chapter 336. Arthritis Associated with Systemic Disease, and Other Arthritides
Sections: Arthritis Associated with Systemic Disease, Other Arthritides, Myofascial Pain Syndrome, Acknowledgment, Further Readings.
Topics Discussed: arthritis; systemic disease.
Excerpt:"Acromegaly is the result of excessive production of growth hormone by an adenoma in the anterior pituitary gland (Chap. 339). The excessive secretion of growth hormone along with insulin-like growth factor I stimulates proliferation of cartilage, periarticular connective tissue, and bone, resulting in several musculoskeletal problems, including osteoarthritis, back pain, muscle weakness, and carpal tunnel syndrome.Sickle cell disease (Chap. 104) is associated with several musculoskeletal abnormalities (Table 336-1). Children under the age of five may develop diffuse swelling, tenderness, and warmth of the hands and feet lasting from one to three weeks. The condition, referred to as sickle cell dactylitis or hand-foot syndrome, has also been observed in sickle cell thalassemia. Dactylitis is believed to result from infarction of the bone marrow and cortical bone leading to periostitis and soft tissue swelling. Radiographs show periosteal elevation, subperiosteal new bone formation, and areas of radiolucency and increased density involving the metacarpals, metatarsals, and proximal phalanges. These bone changes disappear after several months. The syndrome leaves little or no residual damage. Because hematopoiesis ceases in the small bones of hands..."
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