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System Pathology I -- Roecker > Exam 1 --Pt3 Joints --System Pathology > Flashcards

Exam 1 --Pt3 Joints --System Pathology Flashcards

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1
Q

What is arthritis? What sex is it more common in?

A

not a single disease or pathology, but a term to describe joint pain or joint pathology

  • major source of morbidity in US
  • MC in females
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2
Q

What are different forms for arthritis, in general?

A
  1. degenerative arthritis
  2. immune-mediated
  3. metabolic disorders affect joint
  4. infectious
  5. tumors involving joint
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3
Q

What is degenerative changes to articular cartilage of synovial joints that does not necessarily involve inflammation?

A

Osteoarthritis (OA, or degenerative joint disease, or DJD)

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4
Q

T/F. Osteoarthritis involves inflammation.

A

False. Does NOT necessarily involve inflammation, but MAY trigger it in advanced stages

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5
Q

What is the most common disease affecting the joints? What increases your risk of getting it?

A

osteoarthritis

- increase in age

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6
Q

What joint is characteristically involved with osteoarthritis?

A

DIP joints in hand

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7
Q

What is secondary osteoarthritis and what is usually the cause for developing it?

A 
develop after injury/trauma, inf., or skeletal deformity
Causes:
- ACL, meniscus tears
- obese
- dislocate joint
- joint inf. 
- congenital skeletal deform.
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8
Q

What age group does osteoarthritis affect?

A

Dx ~ age 50

Dx in ~1/2 of inds over 70

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9
Q

How does osteoarthritis develop? fast/slow?

A

it and the pain will develop insidiously (gradually)

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10
Q

T/F. Osteoarthritis usually manifests eventually with bony ankylosis.

A

FALSE! no ankylosis occurs

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11
Q

What type of arthritis does one wake with pain, but then after about 30mins of morning activities it decrease intensity?

A

osteoarthritis

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12
Q

What type of arthritis commonly involves multiple joints, such as knee, hip, shoulder, DIP joints of hand, and L or C spine?

A

osteoarthritis

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13
Q

Describe the development of osteoarthritis, from what it begins like and so on.

A

Begins with subtle softening of articular cartilage

  1. Bony Eburnation (art. bone erodes and subchondral bone becomes sclerotic
  2. Subchondral Cyst in bone due to synovial fluid entry
  3. Joint mice (free fragments of Fx subchondral bone)
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14
Q

What type of arthritis will manifest with osteophytes (bone spurs)? What are they called if on DIP joints?

A

osteoarthritis

Heberden nodes

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15
Q

What are Heberden nodes characteristic of? What are they?

A

osteoarthritis

- osteophytes on bone margins of DIP joints

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16
Q

What is a multisystem autoimmune disorder that causes chronic inflammation, primarily w/in small joints of hands, feet, wrists, ankles, and upper C spine?

A

Rheumatoid arthritis

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17
Q

Besides the small joints that Rheumatoid arthritis effects, what extraarticular areas does it effect?

A

CT of:

  • skin
  • heart
  • blood vessels
  • lungs
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18
Q

How many people are affected by rheumatoid arthritis? What sex? When is it Dx?

A

1% all US adults
3x MC in females
adulthood

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19
Q

What is the primary inflammatory cell found in tissues affected by RA?

A

CD4+ T cells

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20
Q

What about RA do chiropractors need to be aware of?

A

30% have atlanto-axial instability

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21
Q

What is present in about 80% of all patients with RA?

A

rheumatoid factor (RF)—IgM antibodies against ind’s own tissues

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22
Q

What type of arthritis that has chronic inflammation is likely to cause fibrous ankylosis and then lead to bony ankylosis?

A

Rheumatoid arthritis

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23
Q

What is condition “pannus” characteristic of? What is it?

A

Rheumatoid arthritis
- it is identical to granulation tissue found beneath skin wounds, except this forms in joints (foundation for fibrotic changes ass. with RA)

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24
Q

What type of arthritis comes on insidiously, is worse in the mornings and may not relieve with activity?

A

Rheumatoid arthritis

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25
What joint is most likely to be involved in RA? What characteristic feature does it result in?
MCP joints ulnar deviation of phalanges, symmetrically
26
What is "swam-neck deformity" and "boutonniere deformity" characteristic of?
Rheumatoid arthritis | - describing the ulnar deviation of the phalanges
27
What may develop within the subcutaneous tissues of inds. with RA? What area of skin are they MC formed?
Rheumatoid nodules - forearm, elbows, occiput, and lumbosacral region - rare in lungs
28
What condition involves having RA, neutropenia, and spenomegally?
Felty Syndrome | - recurrent infs, too few neutrophils
29
What age group and sex does Felty Syndrome MC affect?
elderly (50-70) | females
30
What condition involves a combination of RA and pneumoconiosis? (What is pneumoconiosis?)
Caplan syndrome | an occupational lung disease ass. with inhalation of particulate matter
31
What is Juvenile Rheumatoid Arthritis?
(JRA, or juvenile idiopathic arthritis-JIA) - heterogenous group of disorders of unknown cause - has diagnostic criteria
32
What is the diagnostic criteria for Juvenile Rheumatoid Arthritis?
(JRA or JIA) - joint pain lasts at least 6 weeks and onsets prior to age 16 - no rheumatoid nodules - negative for rheumatoid factor
33
When someone with juvenile rheumatoid arthritis joint pain, also has spiking fevers, skin rashes, pericarditis, what is the condition called?
Still's Disease
34
During what age group does juvenile rheumatoid arthritis MC develop?
young children b/w 1-3 or may develop a bit later b/w ages 6-12
35
How common is juvenile rheumatoid arthritis and what sex is MC affected?
1 in 10,000 children 3x MC in females
36
What causes deformation of the thoracolumbar spine and is defined by presence of endplate abnormalities that have caused at least 3 VBs ot have 5 degrees of wedging?
Scheuermann's disease
37
Due to the defects in the vertebral endplates of Scheuermann's disease, what develops?
Schmorl's nodes - IVD herniation through endplate and into VB - usually asymptomatic
38
What is another name for Scheuermann's disease?
Juvenile Kyphosis | - b/c due to wedging of VB, freq. ass. with hyperkyphosis of T spine
39
What condition is a form of osteochondrosis of the secondary ossification centers and is MC among adolescents, esp. males and athletes? How common is it?
Scheuermann's disease 8% of population
40
What are the reported symptoms of Scheuermann's disease?
- "dull" or "achy" pain located in T or L spine - pain exacerbated with physical activity - hyperkyphosis of T - hypolordosis of L - "self-limiting" (no Tx)
41
What is the term for a group of immune-mediated inflammatory joint conditions involving chronic inflammation with T cells involved?
Seronegative Spondyloarthropathies
42
What pathologies are under Seronegative Spondyloarthropathies?
"PEAR" Psoriatic Arthritis Enteropathic Arthritis Ankylosing Spondylitis Reactive Arthritis
43
What are the five common features among the Serognegative spondyloarthropathies?
1. neg. for rheumatoid factor (seroneg.) 2. Enthesis--destructive change of ligs. att. 3. SI involved 4. Pos. for HLA-B27 = RF 5. joint inflam. lead to ankylosis
44
What is a seronegative spondyloarthropathy that develops in patients with a chronic inflam. skin condition, and also has "sausage fingers"?
Psoriatic Arthritis | - affects up to 30% all with psoriasis
45
What are some symptoms of Psoriatic arthritis?
- dactylitis ("sausage fingers")-- DIP, PIP, and MCP joints | - sacroilitis (40%)
46
What is a seronegative spondyloarthropathy that develops in patients with chronic inflammatory intestinal conditions?
Enteropathic artritis develops in inds. with IBD, such as Crohn disease or ulcerative colitis
47
Enteropathic arthritis develops in about ____ of all ind's with IBD.
20% May manifest before the IBD though
48
What joints does enteropathic arthritis affect? What symptoms does one usually have?
- peripheral extremities or SI joints - abd. pain - blood in stool - joint pain
49
What type of arthritis involves the ind. experiencing prolonged pain in the morning and exacerbated with prolonged standing or sitting or physical activity and is ass. with inflam. intestinal issues?
Enteropathic Arthritis | SI joint affected!!
50
What is a common seronegative spondyloarthropathy has an insidious onset tha to worsens with time and when in an advanced cases is described as "bamboo spine" or "trolly track" sign on x-ray?
Ankylosing spondylitis (AS)
51
Who does ankylosing sponylitis tend to affect?
``` young adults (prior to age 40) 3x MC in males ```
52
About ___ percent of individuals with ankylosing spondylitis test positive in ______.
90% test positive for HLA-B27
53
What is ankylosing spondylitis usually triggered by?
various inflammatory stimuli - smoking - infection - trauma
54
In virtually all cases of ankylosing spondylitis, what joint is involved? What other joints maybe affected too?
SI joint-- first sacroilitis--- leading to ankylosis of SI joint L spine, hips, knees, shoulders, or costovertebral joints
55
What type of pain is very common in inds. with ankylosing spondylitis?
Sacroiliac pain - common when lying down due to limited pelvic mobility - refers pain to gluteal region - nocturnal LBP
56
When the costovertebral joint is involved in cases of ankylosing spondylitis, what can occur?
inability to move thorax upon inhalation--> reduced chest expansion
57
Inflammation of anklyosing spondylitis causes what to form within the spinal ligaments?
syndesmophytes
58
What are some radiographical findings associated with advanced aklyosing spondylitis?
- prominent syndesmophytes - ankylosis of SI joint - "bamboo spine" - "trolly track" sign - ankylosis of lumbar spine - "dagger sign" - hypolordosis of L spine - "squaring" of VBs
59
What condition is a seronegative spondyloarthropathy that develops in response to a GI or genitourinary (GU) infection?
Reactive Arthritis (previously Reiter syndrome/disease)
60
Who is MC affected by reactive arthritis?
- young adults 20-40 - males - Caucasians - 80% positive for HLA-B27
61
What commonly causes inflammation and oligoarthritis in large joints of the body, at attachment of Achilles tendon, conjunctiva of eye, urethra, or cervix?
Reactive Arthritis (Reiter syndrome)
62
What conditions manifests with pain in multiple joints within a month of experiencing GI or GU infection, with ass. urethritis, cervicitis, or diarrhea?
Reactive arthritis
63
What is a good mnemonic to remember few common areas of pain for Reactive arthritis?
"can't see, can't pee, can't climb a tree"
64
What idiopathic chronic inflammatory condition affects joints and musculature of elderly individuals with prolonged morning stiffness MC in the shoulder, and girdles of the body?
Polymyalgia Rheumatica
65
What are the risk factors for developing polymyalgia rheumatica?
- female sex - over age 50 - northern European ancestry - family history - personal history of giant cell arteritis
66
About 15% of people with ____ _____ go on to develop a specific type of vasculitis called Giant Cell Arteritis (GCA or Temporal arteritis). What % of ppl with GCA go on to develop this condition?
Polymyalgia Rheumatica half (50%)
67
What is the recommended treatment of polymyalgia rheumatica?
low-dose corticosteroids; and should be a rapid response to the medication
68
What condition is characterized by acute episodes of arthritis that results from accumulation of urate crystals (monosodium urate) in or around joints?
Gout
69
What is tophus and what is is associated with?
tophus = paste-like, chalk-like collection of urate crystals Gout
70
What is the difference between Primary Gout and Secondary Gout? Which is MC?
Primary-- (MC-90%); originates from enzyme defect causing abnorm. purine metabolism/poor excretion Secondary-- develops after exposure to med or another pathology
71
What are some pathologies that may lead to development of Secondary Gout?
renal failure, leukemia, multiple myeloma(CA of plasma cells)
72
What is arthritis from gout known as? What does it cause?
acute gouty arthritis - causes episodes of joint and soft tissue pain - red, warm, swollen, and painful
73
What is the location of nearly 1/2 of all cases of gout? What is it called? What are other locations for gout to affect?
MTP joint of hallux; known as podagra helix of ear, prepatella bursa, knee, olecranon process
74
What will Acute gouty arthritis develop? How long does it take to resolve?
after several years of hyperuricemia resolves in days to weeks
75
What is the initial stage of gout and when is it MC for inds?
it involves asymptomatic hyperuricemia MC in males around puberty OR menopausal females
76
What is the final stage of gout called? What does it involve?
Chronic topheaceous gout - chronic joint pain - erosion/destruction of joint surface - gouty nephropathy (kidney damage)
77
Individuals in chronic topheaceous gout (final stage of gout) can suffer from what lethal complication?
about 20% suffer from gouty nephropathy
78
What are the risk factors for gout?
- male sex - older than age 30 - excessive alcohol intake - obesity - family history - renal failure

System Pathology I -- Roecker (14 decks)

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