Dougherty Part 5

Question 1

what is the cause of primary osteoarthritis

Answer 1

idiopathic with aging

Question 2

where does primary osteoarthritis primarily effect men and women

Answer 2

men: hips predominate
women: knees and hands

Question 3

what are the main causes of secondary osteoarthritis

Answer 3

repeated injuries to a joint
hemochromatosis
obesity

Question 4

osteoarthritis is also called what and is due to what by what

Answer 4

degenerative joint disease (DJD)

degeneration of cartilage outpaces repair

Question 5

what are the phases of osteoarthritis

Answer 5

chondrocyte injury
chondrocytes proliferate
chondrocytes drop out with loss of cartilage

Question 6

what is bone eburnation and when is it seen

Answer 6

exposed bone on surface-looks like polished ivory and underlying bone sclerosis
seen in osteoarthritis

Question 7

what is an osteophyte (bone spur) and when is it seen

Answer 7

extra bone at joint edge

seen in osteoarthritis

Question 8

what is seen grossly in osteoarthritis

Answer 8

superficial roughened and cracked cartilage
subchondral cysts of synovial fluid
bone eburnation
joint mice
osteophytes

Question 9

what is joint mice and when are they seen

Answer 9

loose bodies of cartilage

seen in osteoarthritis

Question 10

what happens to osteoarthritis with use

Answer 10

worsens

Question 11

what is a heberden node and when is it seen

Answer 11

osteophytes in DIP in women

seen in osteoarthritis

Question 12

what does a patient with osteoarthritis present with

Answer 12

deep achy pain
morning stiffness
worsens with use
crepitus of joint
limited range of motion
vertebral osteophytes impinge on nerve roots

Question 13

osteoarthritis spares what

Answer 13

wrists, elbows, shoulders

Question 14

what is rheumatoid arthritis

Answer 14

systemic autoimmune inflammatory disease

nonsuppurative proliferative inflammatory synovitis often destroying cartilage with later ankylosis of the joint

Question 15

who and when are affected by rheumatoid arthritis

Answer 15

females > males

any but most often 40-70

Question 16

what is pannus

Answer 16

exuberant inflamed synovium
chronic inflammation with T-cells (mostly CD4+), B-cells, plasma cells, macrophages
granulation tissue with hemosiderin
erodes articular cartilage
erodes bone (juxtarticular cysts, subschondral cysts, osteoporosis)

Question 17

what is the pathogenesis of rheumatoid arthritis

Answer 17

antigen exposure in a susceptible host creating an ongoing autoimmune processes

Question 18

80% of rheumatoid arthritis patients have what

Answer 18

Rheumatoid factor (non specific)

Question 19

antibodies to what are found in rheumatoid arthritis that is more specific than RH factor

Answer 19

Citrullin-modified peptides (anti-cyclic citrullinated peptide or CCP Ab)

Question 20

Rheumatoid arthritis affects what joints

Answer 20

symmetric with small joints before large:
PIP, MCP, MTP
later wrists, ankles, elbow, knees (spares hip)

Question 21

what is seen in the joints of people with rheumatoid arthritis

Answer 21

swollen, warm, painful, and stiff with inactivity

Question 22

what is seen on an x-ray of rheumatoid arthritis

Answer 22

juxta-articular osteopenia
bone erosions with narrowing of joint space from loss of articular cartilage
joint effusions

Question 23

what is seen grossly in late stage rheumatoid arthritis

Answer 23

radial deception of wrist
ulnar deception of fingers
flexion-hyperextension of fingers (swan neck, boutonniere)
synovial cysts

Question 24

what is a Bakers Cyst and whats its associated with

Answer 24

synovial cyst of the back of knee (popliteal fossa)

rheumatoid arthritis

Question 25

what is the most common cutaneous manifestation seen in rheumatoid arthritis

Answer 25

rheumatoid nodules

Question 26

where are rheumatoid nodules found

Answer 26

areas subject to pressure: ulnar aspect of forearm, elbows, occiput, lumbrosacral

Question 27

what are rheumatoid nodules

Answer 27

fibrinoid necrosis surrounded by macrophages

Question 28

what happens to blood vessels rheumatoid arthritis

Answer 28

vasculitis: does not involve kidneys can be obliterative endarteritis of vasa nervorum and digital arteries leukocytoclastic venulitis (purpura, skin ulcers, and nail bed infarction)

Question 29

what are the criteria for rheumatoid arthritis (need 4 of them to diagnose)

Answer 29

``` AM stiffness more than 2 joints arthritis typical hand joint involvement symmetric arthritis rheumatoid nodules serum rheumatoid factor typical radiologic changes ```

Question 30

juvenile idiopathic arthritis is waht

Answer 30

a heterogeneous group by definition before age 16 and present 6 weeks: oligoarticular (less than 5 joints)

Question 31

where does juvenile idiopathic arthritis normally affect

Answer 31

large joints: knees wrists

Question 32

what extra-articular manifestations are associated with juvenile idiopathic arthritis

Answer 32

``` pericarditis myocarditis pulmonary fibrosis uveitis glomerulonephritis growth retardation ```

Question 33

what are the two main differences between juvenile idiopathic arthritis and rheumatoid arthritis

Answer 33

absence of rheumatoid factor absence of rheumatoid nodules may be ANA positive

Question 34

what is found in both rheumatoid arthritis and juvenile idiopathic arthritis

Answer 34

pannus formation | morphology of involved joints

Question 35

seronegative spondyloarthropathites are usually positive for what and negative for what

Answer 35

HLA B27 positive (most) | Rheumatoid factor negative

Question 36

ankylosing spondyloarthritis aka "rheumatoid spondylitis" is found in what patients

Answer 36

young adults onset 2-3 decade with low back pain M > F

Question 37

at what sites is ankylosing spondyloarthritis found

Answer 37

axial joints: sacroiliac joints apophyseal joints of vertebrae

Question 38

in ankylosing spondyloarthritis what happens to the joints

Answer 38

inflammation of tendon/ligament insertion: ossification of inflammation fibrous and boney ankylosis

Question 39

what complications are involved with ankylosing spondyloarthritis

Answer 39

``` 1/3 hip, knee, shoulder arthritis uveitis aortitis amyloidosis spine fractures ```

Question 40

bamboo spine is due to what and seen in what

Answer 40

fusion of the vertebrae | seen in ankylosing spondyloarthritis

Question 41

reactive arthritis is commonly due to what

Answer 41

genitourinary: chlamydia GI: shigella, salmonella (diarrhea)

Question 42

reactive arthritis is also known as

Answer 42

Reiter Syndrome

Question 43

what is the triad associated with reactive arthritis (reiter syndrome)

Answer 43

arthritis urethritis or cervicitis conjunctivitis

Question 44

sausage toe or finger is due to what and seen in what

Answer 44

digital tendon sheath synovitis | seen in Reiter syndrome

Question 45

reactive arthritis (weiter syndrome) is associated with what

Answer 45

HLA-B27 | some HIV

Question 46

what joints and in what pattern does reiter syndrome affect

Answer 46

lower extremity: ankles, knees, feet in asymmetric pattern

Question 47

what extra-articular signs are seen in retire syndrome

Answer 47

balanitis conjunctivitis heart condition defects aortic regurgitation