Joint Diseases (Charlie Handie) Flashcards Preview

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Flashcards in Joint Diseases (Charlie Handie) Deck (50)
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1
Q

How does osteoarthritis affect the joints?

A

affects one joint, usually a joint that bear a lot of stress (hip, back, knee, or hand)

2
Q

Symptoms of osteoarthritis?

A
  • -Pain during/after use of joint
  • -Discomfort during significant weather changes
  • -Swelling or stiffness
  • -Bony lumps in the hand and finger joints
  • -Decreased joint flexibility
3
Q

What causes bony growth in osteoarthritis patients?

A

the body’s attempt to repair the joint; when it is unable to repair, makes it more difficult with the addition of bony growths.

4
Q

Risk factors for osteoarthritis

A
  1. gender (F>M)
  2. age (>45 y/o)
  3. joint injuries (esp due to sports)
  4. obesity
  5. diseases that cause abn bone structure
  6. weakened quadriceps
  7. other forms of arthritis
5
Q

What causes the abn joint function associated with osteoarthritis?

A

bony overgrowth

6
Q

Common epidemiology of RA?

A

F>M (3:1), ages 20 to 50

but can be at any age

7
Q

What are the treatment goals for RA?

A

alleviate symptoms and decrease or even stop the progression of the disease; no cure

8
Q

Symptoms of RA

A
  1. swelling of the joints (*small joints of hands/feet)
  2. loss of ROM in affected joints
  3. loss of strength in muscles attached to affected joints
  4. low grade fever
  5. fatigue (can become severe during flare ups)
  6. stiffness or aching (most noticeably after rest or sedentary activities)
  7. deformity of the joints (takes time)
9
Q

What cells initiate RA symptoms?

A

CD4 cells, which signal B cells and macrophages

10
Q

What causes extra-articular manifestations in RA?

A

IgM antibodies formed in response to Fc receptors of patients’ own IgG

11
Q

What is measured in the blood of RA patients?

A

rheumatoid factor (RF), which are the IgM/IgG immune complexes

12
Q

Joints in patients with RA are most affected by…

A

inflammatory synovitis with destructive pannus formation

13
Q

What causes the characteristic ulnar deviation of fingers in RA?

A

Erosion of cartilagenous joint surfaces (“swan neck”)

14
Q

In RA, ______ are usually affected first, followed by:

A
  1. small joints of hands and feet

2. wrists, elbows, ankles, and knees

15
Q

In RA, what may be seen microscopically?

A
rheumatoid nodules (20%), which consist of an acellular center of eosinophilic material ("fibrinoid")
surrounded by palisaded histiocytes and other cells

maybe with a rim of granulation tissue

16
Q

Where do rheumatoid nodules most commonly appear?

A

extensor surfaces
sometimes the pericardium
aortic valve (rare)
lung parenchyma

17
Q

Pannus =

A

“a membrane of granulation tissue”

18
Q

Acute and chronic inflammatory synovitis leads to:

A

proliferation of vascular CT in the synovium

this later fills with polys, T-cells, and plasma cells

19
Q

How does the pannus affect joints after years of chronic inflammation?

A

proliferates, spreads over and erodes the articular cartilage and even bone, leading to fibrosis

20
Q

Pannus contains which cells, which contribute to destruction?

A

macrophages, fibroblasts and osteoclasts

21
Q

OA or RA?

Caused by wear and tear on the body

A

osteoarthritis

22
Q

OA or RA?

Symptoms can be felt systemically

A

RA

23
Q

Who is at an increased risk of developing gout?

A
  • -Men
  • -postmenopausal women
  • -people who drink alcohol
24
Q

Patients with what conditions may develop gout as a side effect?

A
  • -diabetes
  • -obesity
  • -sickle cell anemia
  • -kidney disease
25
Q

Hyperuricemia may result from:

A
  1. overproduction

2. kidneys not able to eliminate enough uric acid

26
Q

What are the symptoms of gout?

A
  1. stiffness (first)
  2. joint pain (appears suddenly)
  3. swelling/warm to touch
  4. fever
  5. white and chalky skin lump (may even drain chalky material)
27
Q

What joints are affected by gout?

A

great toe, knee, and ankle joints
(rare for only one to be affected)

note: whenever I’ve seen this in preceptor and ER, it was always big toe, then ankle, then knee; also, even a bedsheet brushing against the toe would make a grown man cry)

28
Q

In gout, phagocytosis of crystals by neutrophils results in the release of:

A

LTB4, prostaglandins, free radicals

29
Q

If nml body temperature, at what blood uric acid levels do monosodium urate crystals form?

How does low body temp affect crystal formation?

A
nml = 7 mg/dL
lower = crystals form at lower blood uric acid levels
30
Q

Why does gout typically affect fingers/toes first?

A

because blood temperature falls the further blood gets from the heart

31
Q

What is tophus?

A

precipitated monosodium urate crystals

32
Q

What three buzzwords describe uric acid crystals under micrograph?

A

“yellow=urate=parallel”

*uric acid crystals are yellow under polarized light when the polarizer is parallel with the long axis of the needle-shaped crystals

33
Q

What is pseudogout, and how is it different under micrograph?

A

*yellow=CaP=perpendicular

crystals polarize yellow when the polarizer is PERPENDICULAR to the long axis of the crystals

34
Q

What type of crystals cause pseudogout?

A

Calcium phosphate crystals

35
Q

What joints does pseudogout usually affect?

A

knees

36
Q

Who is most commonly affected by pseudogout?

A

older patients

37
Q

What puts patients at a greater risk of developing pseudogout?

A

hypercalcemia, hypophosphatemia or hypomagnesemia

38
Q

Most common agents in infectious arthritis?

A
  1. gonococcus
  2. gram positive cocci (Staph , Strep)
  3. gram negative rods (E. coli, H. ‘flu, Pseudomonas)
39
Q

Most common agents causing infectious arthritis in sickle cell disease?

A

Salmonella

40
Q

How do organisms that cause inf arthritis arrive at the joint?

A

hematogenous spread

41
Q

What causes cartilage damage in infectious arthritis?

A

hydrolytic enzymes from polys

42
Q

What cause of infectious arthritis is uncommon in children?

A

Suppurative arthritis

43
Q

What cause of infectious arthritis is common in children?

A

osteomyelitis

due to H. flu or spread from contiguous osteomyelitis

44
Q

What type of infectious arthritis usually involves a series of joints?

A

Gonococcal arthritis

45
Q

What type of infectious arthritis usually involves only one large joint?

A

Bacterial arthritis

46
Q

Causes of infectious infectious arthritis:

A
  1. direct trauma
  2. hematogenous spread
  3. aspiration, injection or surgery
  4. osteomyelitis
  5. inflames extra-articular structures
47
Q

What are Ganglion (synovial) cysts?

A

mobile masses usually located on the hands or feet; spaces lined by myxoid material

48
Q

Where are giant cell tumors of tendon sheath usually located?

A

near joints

49
Q

What do giant cell tumors of tendon sheath look like microscopically?

A

multinucleated giant cells, with a background of histiocytes and cells that resemble synoviocytes

50
Q

What is Pigmented Villonodular Synovitis? How is it characterized?

A

localized, destructive lesion within a single joint; proliferation of synovium, hemosiderin pigmentation, and destruction of the joint