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Flashcards in Joint Deck (11):
1

What is a joint? Describe the different types of joints?

Connection between two bones;
solid joints: tightly connected to provide structural strength (cranial sutures);
synovial joints: joint space to allow for motion

2

Synovial joints have a(n) _____ surface of adjoining _____ made of _____ _____ that is surrounded by a joint capsule; _____ lining the joint capsule secretes fluid rich in ______ ____ to lubricate the joint and facilitate smooth motion

articular; bones; hyaline cartilage (type II collagen);
synovium; hyaluronic acid

3

Degen joint disease (osteoarthritis) is what? What is it often due to? Major risk factors? What joints are affected? Presents? Path features?

Progressive degen of articular cartilage (most common arthritis);
usually due to wear and tear;
think age (after 60 years), obesity, trauma;
affects limited number of joints, like hips, lower lumbar spine, knees, and DIP and PIP of fingers;
joint stiffness in the morning that worsens during the day;
disruption of cartilage that lines articular surface (frags of cartilage floating in the joint space are called 'joint mice'), eburnation of the subchondral bone, oseteophyte formation (reactive bony outgrowths which occur in DIP, or Heberden nodes, and PIP, or Bouchard nodes in the fingers)

AC Green is getting older, as is COMMON of most NBA players. He is feeling the wear and tear of all his NBA games. Thankfully, he's not 60 yet and he's slim and hasn't been hit with a bat yet. However, his dad has noticed pain in his hips, lower lumbar spine, knees, DIP, and PIP. When he talks to his dad, he notices that he has joint stiffness early, and it gets worse throughout the day.

DCAS: Joint mice; ebola sucks balls; osteophytes: DIP and PIP boy

4

Rheumatoid arthritis: what is it? What is it characterized by? Clinical features? Labs? Complications

Chronic, systemic autoimmune disease (usually in women of LATE CHILDBEARING AGE) and deals with HLA-DR4; involves the joints (hallmark is synovitis leading to formation of pannus, or inflamed granulation tissue; also destruction of cartilage and ankylosis/fusion of the joint);
Arthritis with:
1. morning stiffness that improves with activity: symmetric involvement of PIP joints of fingers (swan-neck deformity), wrists (radial deviation), elbows, ankles, and knees, but DIP IS USUALLY SPARED!!
2. fever, malaise, weight loss, myalgias
3. rheumatoid nodules (central zone of necrosis surrounded by epithelioid histiocytes; arises in skin and visceral organs)
4. Vasculitis (multiple organs may be involved)
5. Baker cyst (swelling of bursa behind the knee)
6. Pleural effusions, LAD, and interstitial lung fibrosis;
Labs: IgM autoantibody against Fc portion of IgG (rheumatoid factor), a marker of tissue damage and disease activity; also NEUTROPHILS and high protein in synovial fluid;
Comp: anemia of chronic disease and secondary amyloidosis

Kevin Durant's mom had him at an old age. Had a House in LA and married to a DR(4). Before she had him, she noticed some joint pain. She thought she had SINNED and tried to hit herself with a PAN. On the move to DC she noticed something wrong with her ankle.

Since having Kevin, she's noticed that her stiffness starts early but gets better. She sees that there's issues with her PIP joints, that they look like swans, wrists (pointing outward), and her elbows, ankles, and knees. She felt like she was getting shorter (joint-space narrowing, osteopenia, losing cartilage). She can't work anymore as an RN because she's engulfed by housework, and she can feel her skin wrinkling. She argues with Vin Baker multiple times and she's having difficulty breathing and notices some swelling around her neck.

Kevin's Mom would never fuck with God, there's no Room FOR that. He continues to NEUtralize LeBron's muscles. Watch out for getting too skinny though Kevin!!

5

Seronegative spondyloarthropathies: characterized by, ankylosing spondyloarthritis, Reiter, psoriatic arthritis

Group of joint disorders with: lack of rheumatoid factor, axial skeleton involvement, HLA-B27 association;
Ankylosing spondyloarthritis:
1. involves SI joints and spine (young adults, usually male
2. presents with low back pain and potential bamboo spine with vertebral bodies fusing
3. extra-articular manifestations include uveitis and aortitis, leading to aortic regurgitation);
REITER syndrome: arthritis, urethritis, and conjunctivitis (think young adults, usually males, weeks after GI or C trachomatis infection);
PSORIATIC ARTHRITIS seen in 10% of cases of psoriasis (involves axial and peripheral joints, with sausage fingers or toes because of DIP joints of hands and feet affected)

Bobby is always talking to me his SISter and about his lower back. I tell him that he should keep moving around unless he wants his back to be as stiff as bamboo. He might also start having difficulties seeing with all that pain and he might start regurgitating each time he thinks of being a cardiologist.

The thing with being a PA is you think you're in the center, when you're on the outside looking in. In reality, anytime they're raising their hands and kicking their feet, I just think, "what a sausagefest"

6

Infectious arthritis: cause; involves, presentation

Arthritis due to infectious agent, usually bacterial;
causes include: N gonorrhoeae (young adults, most common cause), S aureus (older children and adults, 2nd most common cause);
Involves single joint, usually the KNEE!!
Presents: warm joint with limited range of motion; fever, increased white count, and elevated ESR often present

AGAtha Christie writes book for all ages; she's noticed a problem with JUST her knee and it's gotten warmer and she can't really move it, so she just keeps writing. Feels hot, she's very white, and ESR up

7

Gout: what is it due to; what about the forms? How can gout present? Labs?

Deposition of monosodium urate crystals in tissues, ESPECIALLY JOINTS;
due to hyperuricemia (overproduction or decreased excretion of uric acid, which is derived from purine metabolism and excreted by kidney);
primary gout the most common form;
secondary gout:
1. leukemia and myeloproliferative disorders (increased cell turnover leads to hyperuricemia)
2. Lesch-Nyhan syndrome (X-linked deficiency of HGPRT presenting with mental retardation and self-mutilation
3. Renal insufficiency;
Acute gout: exquisitely painful arthritis of the great toe (podagra): MSU crystals deposit in joint, triggering an acute inflamm reaction; alcohol or meat consumption might precipitate arthritis;
Chronic gout: 1. development of tophi (white chalky aggregates of uric acid crystals with fibrosis and giant cell reaction in soft tissue and joints
2. Renal failure: urate crystals may deposit in kidney tubules (urate nephropathy)
Lab findings: hyperuricemia; synovial fluid with NEEDLE-SHAPED crystals with negative birefringence under polarized light;
Pseudogout: resembles gout clinically, but due to DEPOSITION OF CALCIUM PYROPHOSPHATE DIHYDRATE (CPPD) and synovial fluid shows rhomboid-shaped crystals with weakly positive birefringence under polarized light

I go to MSU now, and my joints are just aching in excitement. I think I'm hyper for sure. Primarily, I just want to avoid pain in my toe. Secondly, I want to avoid what Jon Lester had, I don't want to start flaying myself and going dumb, and I want to be able to piss after ball games. Like I said, I want to keep my big toe from being painful, and my mom tells me not to drink alcohol or eat red meat. I'm worried about stuff building up in my urine and I don't want those giant alien eyes staring at me, that would just be negative thinking!!

Also, fuck that fake ass Chris Paul: Pussy can't Dunk, I'm positive of that

8

What are the three phases of changes in osteoarthritis?

1. Chondrocyte injury
2. early OA, where chondrocytes proliferate and secrete inflamm mediators, collagens, proteoglycans, and proteases (act to remodel the cartilaginous matrix)
3. Late OA: repetitive injury and chronic inflamm leading to chondrocyte drop out, marked loss of cartilage (MMP degradation)

9

What a re a couple things that can lead to pannus formation in RA?

1. Synovial cell hyperplasia
2. Dense inflammatory infiltrates

10

Dermatomyositis: What is it, etiology, clinical, labs, treatment?

After Keenan's run, my muscles are on fire and my skin is burned. I hope it's not something in his stomach. He says his shoulders are weak, and something might be building up in his hands He has something on his upper eyelids, looks red. Is that a butterfly on his face? There's some stuff on his elbows, knuckles and knees. We looked in the lab, and sure enough, high CK, positive ANA, anti-Jo-1 Ab, and all around his muscles there seems to be fire and atrophy. Best that he get some corticosteroids.

11

Polymyositis:

Eric feels like his muscles are burning, but his skin is still pale. He describes that inside of him, his muscles feel like death.