Categories of JOINT DISEASE Flashcards

1
Q

Categories of Joint Disease–WEEK 2

Classifications of degenerative joint disease X 10

1 – ________ osteoarthritis
• Facet arthrosis, uncinate arthrosis, costotransverse arthrosis, etc.

2 – ________ osteoarthritis
• Secondary to underlying disorder

3 –EROSIVE osteoarthritis

4 – ___________ disease
• Spondylosis deformans
• Intervertebral osteochondrosis

A

Primary

Secondary

Degenerative spine (disc)

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2
Q

Categories of Joint Disease–WEEK 2

Classifications of degenerative joint disease X 9

5 – Diffuse IDIOPATHIC Skeletal Hyperostosis = (____)
6 – Synoviochondrometaplasia
7 – _________ of the posterior longitudinal ligament (PLL)
8 – Neurotrophic arthropathy
9 – Osteitis condensans iLLii

A

DISH

Ossification

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3
Q

Categories of Joint Disease–WEEK 2

Classifications of DEGENERATIVE joint disease X 9

1 OF 9 —-PRIMARY OA

• Causes
X 2 = ___________ & _______________

A

– Idiopathic

– Age

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4
Q

Categories of Joint Disease–WEEK 2

Classifications of DEGENERATIVE joint disease X 9

2 OF 9—-SECONDARY OA

Osteoarthritis \_\_\_\_\_\_\_\_\_\_;
– Trauma
– Underlying \_\_\_\_\_\_\_\_  process
– INCREASED  stresses on joints
• INCREASED  weight
• Long term abnormal \_\_\_\_\_\_\_\_\_
A

following

disease

biomechanics

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5
Q

Categories of Joint Disease–WEEK 2

Classifications of DEGENERATIVE joint disease X 9

3 OF 9—–EROSIVE OA

• Variant of DJD (1961)
• EOA a.k.a. INFLAMMATORY  OA
– Degenerative Joint Disease (DJD) with “\_\_\_ \_\_\_” EROSIONS  at PIPs & DIPs
– Involvement at the;
• Scaphotrapesium joint!!!
• Carpal metacarpal joints
• 1st MCP joints
• NO other joints!!!!!!

**ONLY HANDS AND WRISTS

A

gull wing

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6
Q

Categories of Joint Disease–WEEK 2

Classifications of DEGENERATIVE joint disease X 9

4 OF 9—DIFFUSE IDIOPATHIC SKELETAL HYPEROSTOSIS —————————(DISH)

  • Flowing calcification and ossification of at least— 4—-contiguous VERTEBRA
  • Preservation of _____ ______
  • Absence of apophyseal ankylosis and SI changes
  • ________ if cervical spine is involved
A

disc height

Dysphagia

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7
Q

Categories of Joint Disease–WEEK 2

Classifications of DEGENERATIVE joint disease X 9

5 OF 9—–SYNOVIOCHONDROMETAPLASIA

  • AKA synovial chondromatosis, synovial osteochondromatosis
  • Metaplasia and HYPERplasia of the cartilage in a JOINT
  • _________ and is nourished by the synovial fluid
  • Can calcify or ossify
  • _______ _______ in and around the JOINT can then cause damage or dysfunction
A

Detaches

Loose bodies

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8
Q

Categories of Joint Disease–WEEK 2

Classifications of DEGENERATIVE joint disease X 9

6 OF 9----OSSIFICATION OF THE POSTERIOR
LONGITUDINAL LIGAMENT = PLL
• Occurs with \_\_\_\_\_  in many cases
• Can cause \_\_\_\_\_\_\_\_\_\_  signs
• Idiopathic
A

DISH

neurological

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9
Q

Categories of Joint Disease–WEEK 2

Classifications of DEGENERATIVE joint disease X 9

7 OF 9—-NEUROTROPHIC ARTHROPATHY–6 D’S

• Anything that affects the ______ _______to the components of a joint can cause DAMAGE to THAT joint
EX– Diabetes
EX– Syphilis
EX– Syringomyelia

Hypertrophic Pattern (6 D’s) = 
1– \_\_\_\_\_\_\_\_\_\_\_\_\_
2– Debris
3– \_\_\_\_\_\_\_\_\_\_\_\_\_
4– Density increased
5– \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
6– Destruction
A

nervous input

Distention

Dislocation–VERY COMMON

Disorganization

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10
Q

Categories of Joint Disease–WEEK 2
Classifications of DEGENERATIVE joint disease X 9

7 OF 9 CONT…..NEUROTROPHIC ARTHROPATHY

• ATROPHIC pattern
– Can occur following _________ (usually) but other
conditions can cause it as well
– Will demonstrate atrophic bone and joint loss
– _______________ is one type of description

A

infection

Licked candy stick

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11
Q

Categories of Joint Disease–WEEK 2

Classifications of DEGENERATIVE joint disease X 9

8 OF 9—OSTEITIS CONDENSANS ILII

  • Triangular shaped ________ of the iliac side of the SI joint
  • More common in WOMEN
  • May have a correlation to changes in the pelvis during PREGNANCY
A

sclerosis

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12
Q

Categories of Joint Disease–WEEK 2

Classifications of DEGENERATIVE joint disease X 9

9 OF 9—Degenerative spine (disc) disease
• Spondylosis deformans
• Intervertebral osteochondrosis

A

SEE SLIDES 8 AND 9

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13
Q

Categories of Joint Disease–WEEK 2

INFLAMMATORY JOINT DISEASE X 12

1---\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ =
• Involves the hands, wrist, foot, knee hip and spine
• Periarticular SOFT TISSUE SWELLING
• Juxta articular osteoporosis
• UNIFORM LOSS of joint space
• MARGINAL EROSIONS  (rat bite)
• LARGE PSEUDOCYSTS
• DEFORMITY– SWAN NECK, boutonniere, ULNAR DEVIATION, arthritis mutilans
---ADI INCREASE
---STEELE'S LAW OF THIRDS

• Spinal involvement
– PANNUS formation can affect the transverse ligament
creating instability at the atlantodental region
– Erosions / pannus‐ whittling of the dens and spinous
process
– Anterolisthesis C2‐ C4, STEPLADDER from loss of disc
height, apophyseal joint disease, ligament laxity
– Late stages can get ankylosing

A

RHEUMATOID ARTHRITIS

Pannus = is an abnormal layer of fibrovascular tissue or granulation tissue. Common sites for pannus formation include over the cornea, over a joint surface (as seen in rheumatoid arthritis), or on a prosthetic heart valve.

Anterolisthesis = is a spine condition in which the upper vertebral body, the drum-shaped area in front of each vertebrae, slips forward onto the vertebra below. The amount of slippage is graded on a scale from 1 to 4.

Ankylosing spondylitis = is a long-term type of arthritis. It affects the bones and joints at the base of the spine where it connects with the pelvis. These joints become swollen and inflamed. Over time, the affected spinal bones join together.

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14
Q

Categories of Joint Disease–WEEK 2

INFLAMMATORY JOINT DISEASE X 12

2–JUVENILE IDIOPATHIC ARTHRITIS
• Onset is less than 16 yrs.
• Used to be called Juvenile rheumatoid arthritis
• Unknown etiology
• Most common type is ______ ______ (subtype of JIA)

A

Still’s disease

**FUSED CERVICAL

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15
Q

Categories of Joint Disease–WEEK 2

INFLAMMATORY JOINT DISEASE X 12

3—ANKYLOSING SPONDYLITIS
**Ankylosing spondylitis = is a long-term type of arthritis. It affects the bones and joints at the base of the spine where it connects with the pelvis. These joints become swollen and inflamed. Over time, the affected spinal bones join together.

1 • ________– Enthesopathy occurring at discovertebral junction associated with erosion, sclerosis, &
syndesophytosis

2 • _________– Increased radiodensity of the corners of the vertebral body related to osteitis

3 • ______– Straightened or convex anterior margin of the vertebral body related to erosion

4 • __________ _____________= Ossification within the anulus fibrosis leading to thin, vertical radiodense areas

A

Osteitis

Shiny corner

Squaring

Marginal syndesmophyte

***Syndesmophytes are calcification or heterotopic ossification inside a spinal LIGAMENT or of the annulus fibrosus. Pathologically similar to osteophytes, their apperance on plain film comprises vertical and symmetrical calcification of the lateral margins of the intervertebral disc space.

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16
Q

Categories of Joint Disease–WEEK 2

INFLAMMATORY JOINT DISEASE X 12

3—ANKYLOSING SPONDYLITIS–PART 2 OF 2

5 • _________– Undulating vertebral contour owing to extensive syndesmophytes

6 • _________– Single central radiodense line on frontal radiographs related to ossification of supraspinous & interspinous ligaments

7 • __________– Three vertical radiodense lines on FRONTAL radiographs related to ossification of SUPRAspinous & INTERspinous ligaments & apophyseal joint CAPSULES

A

Bamboo spine

Dagger sign

Trolley track

17
Q

Categories of Joint Disease–WEEK 2

INFLAMMATORY JOINT DISEASE X 12

4–REACTIVE ARTHRITIS (REITER’S)

• Complications
– \_\_\_\_\_\_\_\_\_  tract obstruction
– Iritis
– Retrobulbar neuritis
– \_\_\_\_\_\_\_\_\_  ulcerations
– Aortitis
– Etiology
• Can be venereal or enteric in origin – most are VENEREAL
– Implicated organisms
• Mycoplasma? Chlamydia? Viruses?
– Progress to osseous ankylosis less frequently than AS
A

URINARY +CORNEAL

“CAN’T PEE, CANT’ SEE, CAN’T DANCE WITH ME.

**AFFECTS FEET THE MOST

18
Q

Categories of Joint Disease–WEEK 2

INFLAMMATORY JOINT DISEASE X 12

5–PSORIATIC ARTHRITIS

• Most common location‐ SMALL** JOINTS **OF HANDS
esp. DIPS.
• If DIP, PIP & MCP are all involved in a single digit = _____ ___________ – a reliable diagnostic sign
• 2nd most common – small joints of FEET
• 3rd most common – SI
• 4th most common –spine
• Occasionally – knee, hip or shoulder
• “________ _________”
– FLUFFY periosteal reaction at the margins of
erosion
• Overall shorting = opera glass appearance
• Resorption of TERMINAL TUFT
• “______ ______ ________” telescoping
• Can have psoriatic skin lesions, but NOT always.

A

RAY pattern

MOUSE EARS

PENCIL IN CUP

*****8”SAUSAGE FINGERS”

19
Q

Categories of Joint Disease–WEEK 2

INFLAMMATORY JOINT DISEASE X 12

6—ENTEROPATHIC ARTHRITIS
• May be associated with ulcerative colitis, Crohn’s disease, Whipple’s disease, GI _________ or intestinal bypass surgery.
• SI & vertebral changes are indistinguishable from ___

A

GI INFECTIONS

AS

20
Q

Categories of Joint Disease–WEEK 2

INFLAMMATORY JOINT DISEASE X 12

7—_________________
• Immunologically induced CONNECTIVE TISSUE DISORDER
• Multi system involvement
• Skin rash is common (BUTTERFLY rash on the face)
• SYMMETRIC, NON EROSIVE arthropathy
• Phalangeal TUFT resorption
• OsteoNECROSIS, usually hip
• TENDON weakening and rupture
• Insufficiency fractures
• Osteomyelitis and septic arthritis from CHRONIC corticosteroid usage

A

SYSTEMIC LUPUS ERYTHEMATOSUS

**DEFORMITY WITHOUT….EROSIONS!!

21
Q

Categories of Joint Disease–WEEK 2

INFLAMMATORY JOINT DISEASE X 12

8---\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
• Collagen vascular disease
• Two types = 
1– LOCALIZED
• Usually involves the skin and hands
– Tuft resorption

2– PROGRESSIVE
• Progressive systemic sclerosis
– Can affect organ systems AKA = CREST!!!!
– Calcinosis, Raynaud’s, Esophageal dysmotility, Sclerodactyly, Telangiectasia

A

SCLERODERMA

***Calcinosis = is the formation of calcium deposits in any soft tissue.

***Raynaud’s (ray-NOHZ) disease = causes some areas of your body — such as your fingers and toes — to feel numb and cold in response to cold temperatures

***Esophageal motility refers to contractions occurring in the esophagus, which propel the food bolus forward toward the stomach. When contractions in the esophagus become irregular, unsynchronized or absent, the patient is said to have esophageal dysmotility.

**Sclerodactyly is a localized thickening and tightness of the skin of the fingers or toes. Sclerodactyly often leads to ulceration of the skin of the distal digits and is commonly accompanied by atrophy of the underlying soft tissues.

***Telangiectasia = a condition characterized by dilation of the capillaries, which causes them to appear as small red or purple clusters, often spidery in appearance, on the skin or the surface of an organ.

22
Q

Categories of Joint Disease–WEEK 2

INFLAMMATORY JOINT DISEASE X 12

9—POLYMYOSITIS / DERMATOMYOSITIS
• Inflammation and degeneration of muscle and skin with associated soft tissue calcification

  • PolyMYOsitis – __________ only
  • DERMAtoMYOsitis – ______&_________
A

Muscle

Skin and muscle

**SLIDE 52 IS A GREAT EXAMPLE

23
Q

Categories of Joint Disease–WEEK 2

INFLAMMATORY JOINT DISEASE X 12

10—___________________
• This is a condition that can demonstrate an
OVERLAP of RA, dermatomyositis, scleroderma
and SLE

A

MIXED CONNECTIVE TISSUE DISEASE

24
Q

Categories of Joint Disease–WEEK 2

INFLAMMATORY JOINT DISEASE X 12

11—– Septic arthritis
• Covered later under Infection

12–– Hemophilic arthropathy
• Covered later under Blood/Vascular

A

BOTH COVERED LATER

25
Q

ENDOCRINE / METABOLIC /
DEPOSITION / VASCULAR DISORDERS

DISEASE MANIFESTATIONS  X 8
1– Acromegaly
2– Calcium pyrophosphate dehydrate deposition (CPPD)
3– Hydroxyapatite deposition disease (HADD)
4– Gout
5– Ochronosis
6– Sarcoidosis
7– Pigmented villonodular synovitis
8– Osteonecrosis
A

HERE WE GO

26
Q

ENDOCRINE / METABOLIC /
DEPOSITION / VASCULAR DISORDERS

DISEASE MANIFESTATIONS X 8

1—ACROMEGALY

• Growth hormone HPERsecretion due to
________ _________
• Acromegaly in adults, gigantism in children
• In gigantism – enlargement of everything
• In acromegaly – widening and enlargement of
costochondral junction, mandible, tufts, heel
pad, sella turcica, articular and disc spaces
• Widened joint spaces leads to _________

A

pituitary adenoma

degeneration

27
Q

ENDOCRINE / METABOLIC /
DEPOSITION / VASCULAR DISORDERS

DISEASE MANIFESTATIONS X 8

2—CALCIUM PYROPHOSPHATE DEPOSITION DISEASE (CPPD)

  • Clinical findings similar to _____(________)
  • ______ _______ in the hyaline or fibrocartilage
  • Can cause erosions
A

gout (pseudo gout)

Linear calcification

28
Q

ENDOCRINE / METABOLIC /
DEPOSITION / VASCULAR DISORDERS

DISEASE MANIFESTATIONS X 8

3—HYDROXYAPATITE DEPOSITION DISEASE (HADD)

  • DEPOSIT of calcium in the _____OR_______
  • ____________ is common site
  • Can cause damage to affected tissue
A

tendon or capsule

Shoulder

29
Q

ENDOCRINE / METABOLIC /
DEPOSITION / VASCULAR DISORDERS

DISEASE MANIFESTATIONS X 8

4—GOUT

  • Purine metabolism disorder
  • _____________ build up around SMALL joints of the hands and feet
  • Affects joints late
  • _____ ________ sign
  • TOPHUS formation
A

Uric acid crystals

Overhanging edge

30
Q

ENDOCRINE / METABOLIC /
DEPOSITION / VASCULAR DISORDERS

DISEASE MANIFESTATIONS X 8

5—OCHRONOSIS (ALKAPTONURIA)

  • Lack of homogentisic acid oxidase
  • Deposition of pigment in connective tissue
  • _________ of DISC and other connective tissue
  • Bamboo spine
  • Looks like AS, but with calcification of the disc
A

Calcification

***The term –ochronosis —-usually refers to the bluish black discoloration of certain tissues, such as the ear cartilage and the ocular tissue, seen with alkaptonuria. Some authorities however refer to musculoskeletal manifestations of alkaptonuria as ochronosis.

31
Q

ENDOCRINE / METABOLIC /
DEPOSITION / VASCULAR DISORDERS

DISEASE MANIFESTATIONS X 8

6—SARCOIDOSIS

• Multisystem disease of unknown etiology
• Noncaseating granulomas, subcutaneous nodules
• _______ is the most common site of involvement
• ___________, lace or lattice ‐like trabecular pattern of destruction
• Acro‐osteolysis
• Cystic defects
–a chronic disease of unknown cause characterized by the enlargement of ____ ______ in many parts of the body and the widespread appearance of granulomas derived from the reticuloendothelial system.

A

Thorax

Honeycomb,

lymph nodes

32
Q

ENDOCRINE / METABOLIC /
DEPOSITION / VASCULAR DISORDERS

DISEASE MANIFESTATIONS X 8

7—PIGMENTED VILLONODULAR SYNOVITIS (PVNS)

• \_\_\_\_\_\_\_\_\_  proliferation
• \_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_  around the joint
• Joint space is preserved until late
• Osteopenia late
**Osteopenia refers to bone density that is lower than normal peak density but not low enough to be classified as osteoporosis.
A

Synovial

Cystic erosions

33
Q

ENDOCRINE / METABOLIC /
DEPOSITION / VASCULAR DISORDERS

DISEASE MANIFESTATIONS X 8

8 OF 8—OSTEONECROSIS AVASCULAR NECROSIS

A • Osteonecrosis
1 – This is a condition where the _____ _______ to an osseous structure is diminished or ELIMINATED

2 – Causes can be numerous
• Trauma
• Inborn blood disorder (sickle cell anemia)
• Vascular disease
• Kidney disease
• Alcoholism
• Corticosteroid usage
• Lupus
• Infection
• O2 decrease (smoking, decompression events)
• Coagulation problems
• Radiation
• Idiopathic
A

vascular supply

OSTEONECROSIS
AVASCULAR NECROSIS
• Commonly affected bone/ joints
– Femoral head/ hip
– Distal humerus/ elbow
– Lunate/ wrist
– Distal femur/ knee
– Talus/ ankle
– Humeral head/ shoulder