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My Pathoma Unit 2 > Chapter 18 Joints/polymyositis/dermatomyositis > Flashcards

Chapter 18 Joints/polymyositis/dermatomyositis Flashcards

1
Q

What type of cartilage is in articular joints? What connective tissue is predominant?

A

Hyaline, collagen type II

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2
Q

What is secreted by the synovium in the joint capsule?

A

fluid rich in hyaluronic acid

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3
Q

What is DJD most often due to?

A

wear and tear

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4
Q

What are the risk factors for DJD?

A

Age, obeisity and trauma

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5
Q

Describe the joint distribution of DJD? Particularly in the hands

A

affects a limited number of joints; hips, lower lumbar spine, knees. In the hands the MCP joints are spared but the PIP and DIP are effected. The base joint of the thumb mimics wrist pain

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6
Q

What is the classic presentation of DJD?

A

Joint stiffness in the morning that worsens during the day

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7
Q

What are some pathological features of DJD?

A

joint mice (fragments of cartilage and bone)
eburnation of subchondral bone
Osteophyte formation

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8
Q

What is the classic demographic for rheumatoid arthritis?

A

women of late childbearing age

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9
Q

What cell surface marker is rheumatoid arthritis associated with?

A

HLA-DR4

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10
Q

describe th epathogenesis of rheumatoid arthritis

A

systemic autoimmune disease characterized by involvement of joints. Hallmark is synovitis leading to the formation of a pannus (inflamed granulation tissue). Leads to destruction of cartilage and ankylosis (fusion) of the joint or joint deviation.

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11
Q

What are the arthritic features of rheumatoid arthritis(Joint involvement)

A

Arthritis with morning stiffness that improves with activity. symmetric involvment of PIP and MCP joints (swan-neck deformity of fingers, extension of PIP flexion of DIP). radial deviation of wrists. Elbow, ankle, and knees involved. DIP is SPARED. Joint space narrowing, loss of cartilage and osteopenia are seen on xrays

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12
Q

what constitutional symptoms are seen with rheumatoid arthritis?

A

fever, malaise, weight loss, myalgias

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13
Q

What are rheumatoid nodules?

A

central zone of necrosis surrounded by epithelioid histiocytes; arise in skin and visceral organs

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14
Q

Name 8 possible symptoms of rheumatoid arthritis?

A 
1 Arthritis
2 constitutional symptoms
3 rheumatoid nodules
4 vasculitis
5 bakers cyst
6 pleural effusions
7 LAD
8 interstitial lung fibrosis
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15
Q

What are two laboratory findings of rheumatoid arthritis?

A

rheumatoid factor (Ab against Fc portion of IgG) and Anti CCP Ab, neutrophils and high protein in synovial fluid

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16
Q

What are two complications of rheumatoid arthritis?

A

anemia of chronic disease and secondary amyloidosis

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17
Q

What are 3 characteristics of seronegative spondyloarthropathies?

A

1 lack of rheumatoid factor
2 axial skeleton involvement
3 HLA-B27 association

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18
Q

Name 3 seronegative spondyloarthopathies?

A

1 Ankylosis spondyloarthritis
2 Reiter Syndrome
3 Psoriatic Arthritis

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19
Q

What joints does ankylosis spondyloarthritis involve?

A

SI and spine

20
Q

What demographic is ankylosis spondyloarthritis seen in?

A

arises in young adults, most often males

21
Q

how does ankylosis spondyloarthritis present?

A

low back pain, involvement of vertebral bodies eventually arises, leading to fusion of the vertebrae (bamboo spine)

22
Q

What are 2 extra-articular manifestations of ankylosis spondyloarthritis ?

A

uveitis and aortitis (leading to aortic regurgitation)

23
Q

What is the classic triad of reiters syndrome?

A

arthritis, urethritis, and conjunctivitis

24
Q

What is reiter syndrome a sequelae of?

A

Classically arises in young adults weeks after GI (Shigella, salmonella, yersinia, camphylobacter) or chlamydia infections

25
Q

What are two common causes of infectious arthritis?

A

N. Gonorrhoeae

S. Aureus

26
Q

What is the presentation of infectious arthritis?

A

classically involves a single joint, usually the knee. Presents as a warm joint with limited range of motion; fever, increases white count, and elevated ESR

27
Q

What joints does psoriatic arthritis affect?

A

involves axial and peripheral joints; DIP joints of thends and feet are most commonly affected, leading to “sausage” fingers or toes.

28
Q

What are 3 seronegative spindyloarthropathies?

A

Ankylosis spondyloarthritis
reiter syndrome
psoriatic arthritis

29
Q

What are three causes of secondary gout?

A

leukemia and myeloproliferative disorders- increased cell turnover leads to hyperuricemia
Lesch Nyhan syndrome- X-linked deficiency of HGPRT (salvage pathway) presents with mental retardation and self mutilation
Renal insufficiency- decreased renal excretion of uric acid

30
Q

What is the most common presentation of acute gout attack?

A

Podagra- painfull arthritis of big toe.

31
Q

What inflammatory cell is at the center of gout?

A

neutrophil

32
Q

How does alcohol and meat precipitate arthritis?

A

Alcohol- compete for excretion in the kidney

meat- high levels or RNA and DNA

33
Q

What does chronic gout lead to?

A

Tophi- white, chalky aggregates of uric acid with fibrosis and giant cell reaction in the soft tissue of joints
renal failure- urate crystals may deposit in kidney tubules (urate nephropathy)

34
Q

What laboratory findings are present in gout?

A

hyperuricemia; synovial fluid shows needle shaped crystals with negative birefringence under polarized light

35
Q

What does negative birefringence mean?

A

crystals are yellow when they lay flat. Crystals are yellow under parallel light.

36
Q

What is pseudogout?

A

resembles gout clinically, but is due to deposition of calcium pyrophosphate dihydrates (CPPD); synovial fluid shows rhomboid-shaped crystals with weakly positive birefringence under polarized light.

37
Q

Dermatomyositis is an inflammatory disorder involving what organs?

A

Skin and skeletal muscle

38
Q

What underlying condition should be considered with dermatomyositis?

A

associated with carcinoma ( especially gastric)

39
Q

Describe the clinical features involving skeletal muscle in dermatomyositis and polymyositis

A

Bilateral proximal muscle weakness; distal involvement can develop late in disease. (proximal weakness may present as I cant comb my hair or climb the stairs)

40
Q

Describe the skin involvement of dermatomyositis?

A

rash of the upper eyelids (heliotrope rash); malar rash may also be seen. Red papules on the elbows, knuckles and knees called Gottron papules

41
Q

What laboratory findings would be positive in dermatomyositis?

A

elevated creatine kinase. positive ANA and anti-jo-1 antibody, anti Mi2 Ab, anti P155/140 Ab.

42
Q

Describe the specific inflammatory process in the muscle in dermatomyositis? what type of cells

A

Perimysial inflammation (CD4+ T cells) with perifascicular atrophy on biopsy

43
Q

What is the treatment for dermatomyositis and polymyositis?

A

corticosteroids

44
Q

What organs are involved in the inflammatory process of polymyositis?

A

Skeletal muscle.

45
Q

describe the presentation and pathophysiology of polymyositis?

A

resembles dermatomyositis clinically, but skin is not involved; endomysial inflammation (CD8+ T cells) with necrotic muscle fibers.

46
Q

What composes granulation tissue?

A

Blood Vessels, fibroblasts, myofibroblasts

My Pathoma Unit 2 (6 decks)

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