Joints Flashcards
What are the differences between noninflammatory and inflammatory joint diseases?
Noninflammatory Disease:
- No synovial membrane inflammation
- No systemic signs & symptoms
- Synovial fluid – Cartilage debris/%WBC/PMN
- < 25%, high viscosity
Inflammatory Disease:
- Synovial membrane inflammation caused by immune complexes (rheumatoid factor + antigen in membrane or blood) in the blood & synovial tissue. RF = autoantibodies in RA.
- Systemic signs & symptoms (fever, etc.)
- Synovial fluid contains rheumatoid factor/%PMNs 50%-80%, low viscosity
Neither the cause nor are the risk factors known, & thus is also referred to as idiopathic osteoarthritis
Primary osteoarthitis
Caused by chronic, excessive, or abnormal forces that damage the joint surfaces, underlying bone, & leads to joint instability. Also joint instability may cause the abnormal forces
Secondary osteoarthritis
Bone spurs
Osteophytes
Pathological traits include: Initial changes = joint Narrowing, thinning/softening cartilage; Erosion of the articular cartilage; Abnormal pressure produces sclerosis (thickening & hardening) of bone underneath the cartilage a.k.a. eburnation; Bone cysts filled with fluids, communicates with the joint; Formation of bone spurs or osteophytes; Soft tissue around joint swelling & inflammation
Primary and secondary osteoarthritis
Causes include joint trauma (strains, dislocations, fractures), long-term mechanical stress, joint inflammation, joint instability, neurologic disorders (decreased pain proprioceptive reflexes), and chronic joint bleeding due to excessive PTH (hemophilia and hyperparathyroidism)
Secondary osteoarthritis
What are some clinical features of patients with OA?
- Pain relieved by rest
- Joint stiffness lasting 15-20 minutes after immobility (RA lasts hours)
- Reduced ROM, crepitus, and deformities due to intra-articular changes and periarticular inflammation
- Muscle spasms, contractors and atrophy adjacent to joints
What are some symptoms of OA?
- Hip involvement: pain in butt upper/medial thigh
- Knee Joint involvement: pain, crepitus,, effusion during WB. Varus or valgus deformities
- Lumbar & Cervical Spine involvement: affects the facet joints. Radicular pain from compression of spinal nerves by osteophytes which form at the facet joint margins.
What are symptoms in hands and feet in OA?
Hands: Most often Heberden’s Nodes at the DIPs in OA
Feet: Hallux valgus and bunion deformities of the first metatarsophalangeal joint
Chronic systemic inflammatory disease of unknown etiology with features of:
- Chronic inflammation of synovial joints
- Significant but not diagnostic serologic data suggesting an immune disorder
- Variable extra-articular signs and symptoms
Rheumatoid Arthritis
What is the pathophysiology or RA?
- Inflammation begins as a synovitis in which, the inflamed synovial membrane releases PMNs, lymphocytes, and plasma cells into the joint cavity/synovial fluid.
- Inflammation leads to tissue repair or the proliferation phase of new synovial cells and new blood vessels, changing the synovial tissue into a sheet like granulation tissue called joint pannus
contains inflammatory cells (PMN [neutrophils & macrophages) that secrete lytic enzymes and chemical mediators of inflammation which, destroys synovial tissue, hyaline cartilage, and erodes underlying bone
Joint pannus
As a joint becomes progressively immobile, and the joint space becomes completely obliterated with JP that transformed to a collagen scar causing
Ankylosis
-process can be slowed with AROM during inflammatory flares
What occurs during an RA “flare”
- increased pain
- swelling
- decreased ROM
- decreased function
What are signs of RA?
- Bouchard’s Nodes at the proximal interphalangeal joint (PIPs)
- Deformity and dislocation at the metacarpophalangeal joints.
- Ulnar deviation of the fingers with anterior slippage of PIPs
- Elbow: subcutaneous nodules, painless & small (< 2 cm in diameter)
