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Flashcards in Joint Disease Deck (47)
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___ is characterized by the joint cartilage breakdown causing painful and stiff joints.



T or F Osteoarthritis often only strikes one joint, usually a joint that bear a lot of stress such as the hip, back, knee, or hand joints. .



Symptoms of osteoarthritis

painful use of the joint, painful periods after the joint has been used, joint discomfort during significant changes in the weather, swelling in a joint, stiffness of the joint, bony lumps in the hand and finger joints, a decreased amount of joint flexibility.


How does the body attempt to repair the joint in osteoarthritis

bony growth


Risk factors for osteoarthritis

more females than males, age, as osteoarthritis is typically found in people over 45 years of age, joint injuries especially those related to sports, obesity, diseases that cause malformations or disfigurement of the bone structure, weakened quadriceps, and other forms of arthritis.


Is there a lot of inflammation with osteoarthritis?



What joints is chronic, degenerative osteoarthritis most likely to effect?

larger weight bearing joints like hip


How many joints are involved in chronic degenerative arthritis?

single or multiple, but no symmetrical


Osteoarthritis is not strictly an aging disease. What other things can contribute to the development of degenerative joint disease?

. Congenital joint deformities, joint trauma, or underlying problems such as hemochromatosis, diabetes mellitus, or obesity


______ does not come from wear and tear on the joints but is known as an inflammatory condition that stems from the immune system.

Rhuematoid arthritis


Who is RA most common in?

women 20-50


RA symptoms

swelling of the joints, in particular the small joints of the hands and feet, loss of range of motion in affected joints, loss of muscular strength in the muscles attached to the affected joints, low grade fever, fatigue which can become severe during times of flare ups, a feeling of stiffness or aching most noticeably after a period of rest or sedentary activities, malaise, a general sense of feeling ill and slow, and with enough time, deformity of the joints.


What is the cause of RA?

CD4 cells aggregate and secrete cytokines to attract B cells and macrophages to form the inflammatory response. Many patients form IgM antibodies to Fc receptors of their own IgG, and these immune complexes are the cause for extra-articular manifestations, and they can be measured as "rheumatoid factor" (RF) in blood.


Joints in RA are most affected form what?

inflammatory synovitis with destructive plannus formation


In RA, erosion of cartilaginous joint surfaces leads to ________.

ulnar deviation of fingers with swan-neck abnormality.


What joints are affected first with RA?

small joints of hands and feet, then wrists, elbows, ankles, knees


How common are rheumatoid nodules?Where do they occur?

may occur in 20% of patients with rheumatoid arthritis (and many patients with rheumatic fever).
most often about extensor surfaces, sometimes the pericardium, aortic valve (thankfully rare), lung parenchyma.


Describe the histological appearance of RA nodules.

acellular center of eosinophilic material ("fibrinoid", as before a mix of plasma proteins) surrounded by palisaded histiocytes and other cells, maybe with a rim of granulation tissue.


Acute and chronic inflammatory synovitis leads to proliferation of ______.

vascular connective tissue, later fills with polys, T cells, and plasma cells.


What is "pannus"

membrane granulation tissue


What happens to venules with acute and chronic inflammation in RA?

they assume the form and function of high endothelial, very permeable to lymphocytes venules seen in lymphoid tissue.


Is pus seen with RA?



What happens to the pannus after years of inflammation?

the pannus proliferates and can contribute to joint destruction. Pannus spreads over and erodes the articular cartilage and even bone leading to fibrosis of the joint.


What is the region of the synovial lining that erodes into the bone?

the pannus


What cells makes up the pannus?

macs, fibroblasts, and osteoclasts


Why is it important that the sublining region of the rheumatoid joint is filled with blood vessels?

important for delivering inflammatory cells to the joint, such as monocytes and lymphocytes.


How does gout present at onset?

whether acute or chronic, may begin with stiffness in the joints, followed by joint pain. The joint may swell and become warm to the touch and red in appearance. The patient may develop a fever and a skin lump that is white and chalky in appearance and may even drain a chalky material. Joint pain often begins suddenly and typically affects the great toe, knee, and ankle joints.


Is one or multiple joints affected by gout?



Diseases such as __________ may develop gout as a side effect of their condition.

diabetes, obesity, sickle cell anemia, or kidney disease


Who has higher risk for gout?

men, postmenopausal women, people who drink alcohol, anyone with high levels of uric acid


Why does gout usually strink toes and fingers first?

Because precipitates sooner at lower temperatures


What do typical monosodium urate crystals look like?

right—typical needle shaped crystals which are yellow under polarized light when the polarizer is parallel with the long axis of the crystals (remember, yellow=urate=parallel)


What are pseudogout crystals and what do they look like?

Calcium phosphate crystals (“pseudogout”) may be needle shaped or oblong, but polarize yellow when the polarizer is PERPENDICULAR to the long axis of the crystals.


Where does pseudogout usually deposit crystals?



is pseudogout common?

yes, esp in older folk


What conditions give greater risk for pseudogout?

hypercalcemia, hypophosphatemia, hypomagnesmia


What are the most common agents of infectious arthritis?

gonococcus, gram positive cocci (Staph , Strep), and gram negative rods (E. coli, H. 'flu, Pseudomonas; Salmonella in sickle cell disease).


How to organisms reach joints in infectious arthritis?

hematogenous spread


Is suppurative arthritis common in children?

No. Suppurative arthritis is uncommon in children, as opposed to osteomyelitis, which is more common in children (think of H. flu or spread from contiguous osteomyelitis).


Does bacterial arthritis usually involve one joint or many?

one large joint


What specific pathogen often involves a series of joints?

gonococcal arthritis


What happens to cartilage in infectious arthritis

The cartilage is quickly ruined by hydrolytic enzymes from polys. In bad cases, the joint may be ankylosed


____ are mobile masses usually located on the hands or feet.

ganglion/synovial cysts


Describe the histology of ganglion cysts

they are spaces lined by myxoid material—best thought of as a degenerative phenomenon in tendons or other connective tissue.


Describe giant cell tumor of tendon sheath

Often located near joints, rarely aggressive, lipid laden macrophages make it yellow, mutlinucleated giant cells and a background of histiocytes and cells that resemble synoviocytes


What is pigmented villonodular synovitis?

a localized, destructive lesion within a single joint (usually the knee), with proliferation of synovium, hemosiderin pigmentation, and destruction of the joint. Whether it is a true clonal tumor is unknown, even after gene expression profiling. Excision is usually curative though PVN may recur.


What is done to treat pigmented villinodular synovitis

excision is curative