Flashcards in Joint Diseases (Charlie Handie) Deck (50):
How does osteoarthritis affect the joints?
affects one joint, usually a joint that bear a lot of stress (hip, back, knee, or hand)
Symptoms of osteoarthritis?
--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
What causes bony growth in osteoarthritis patients?
the body’s attempt to repair the joint; when it is unable to repair, makes it more difficult with the addition of bony growths.
Risk factors for osteoarthritis
1. gender (F>M)
2. age (>45 y/o)
3. joint injuries (esp due to sports)
5. diseases that cause abn bone structure
6. weakened quadriceps
7. other forms of arthritis
What causes the abn joint function associated with osteoarthritis?
Common epidemiology of RA?
F>M (3:1), ages 20 to 50
(but can be at any age)
What are the treatment goals for RA?
alleviate symptoms and decrease or even stop the progression of the disease; no cure
Symptoms of RA
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)
What cells initiate RA symptoms?
CD4 cells, which signal B cells and macrophages
What causes extra-articular manifestations in RA?
IgM antibodies formed in response to Fc receptors of patients' own IgG
What is measured in the blood of RA patients?
rheumatoid factor (RF), which are the IgM/IgG immune complexes
Joints in patients with RA are most affected by...
inflammatory synovitis with destructive pannus formation
What causes the characteristic ulnar deviation of fingers in RA?
Erosion of cartilagenous joint surfaces ("swan neck")
In RA, ______ are usually affected first, followed by:
1. small joints of hands and feet
2. wrists, elbows, ankles, and knees
In RA, what may be seen microscopically?
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
Where do rheumatoid nodules most commonly appear?
sometimes the pericardium
aortic valve (rare)
“a membrane of granulation tissue"
Acute and chronic inflammatory synovitis leads to:
proliferation of vascular CT in the synovium
(this later fills with polys, T-cells, and plasma cells)
How does the pannus affect joints after years of chronic inflammation?
proliferates, spreads over and erodes the articular cartilage and even bone, leading to fibrosis
Pannus contains which cells, which contribute to destruction?
macrophages, fibroblasts and osteoclasts
OA or RA?
Caused by wear and tear on the body
OA or RA?
Symptoms can be felt systemically
Who is at an increased risk of developing gout?
--people who drink alcohol
Patients with what conditions may develop gout as a side effect?
--sickle cell anemia
Hyperuricemia may result from:
2. kidneys not able to eliminate enough uric acid
What are the symptoms of gout?
1. stiffness (first)
2. joint pain (appears suddenly)
3. swelling/warm to touch
5. white and chalky skin lump (may even drain chalky material)
What joints are affected by gout?
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)
In gout, phagocytosis of crystals by neutrophils results in the release of:
LTB4, prostaglandins, free radicals
If nml body temperature, at what blood uric acid levels do monosodium urate crystals form?
How does low body temp affect crystal formation?
nml = 7 mg/dL
lower = crystals form at lower blood uric acid levels
Why does gout typically affect fingers/toes first?
because blood temperature falls the further blood gets from the heart
What is tophus?
precipitated monosodium urate crystals
What three buzzwords describe uric acid crystals under micrograph?
*uric acid crystals are yellow under polarized light when the polarizer is parallel with the long axis of the needle-shaped crystals
What is pseudogout, and how is it different under micrograph?
crystals polarize yellow when the polarizer is PERPENDICULAR to the long axis of the crystals
What type of crystals cause pseudogout?
Calcium phosphate crystals
What joints does pseudogout usually affect?
Who is most commonly affected by pseudogout?
What puts patients at a greater risk of developing pseudogout?
hypercalcemia, hypophosphatemia or hypomagnesemia
Most common agents in infectious arthritis?
2. gram positive cocci (Staph , Strep)
3. gram negative rods (E. coli, H. 'flu, Pseudomonas)
Most common agents causing infectious arthritis in sickle cell disease?
How do organisms that cause inf arthritis arrive at the joint?
What causes cartilage damage in infectious arthritis?
hydrolytic enzymes from polys
What cause of infectious arthritis is uncommon in children?
What cause of infectious arthritis is common in children?
(due to H. flu or spread from contiguous osteomyelitis)
What type of infectious arthritis usually involves a series of joints?
What type of infectious arthritis usually involves only one large joint?
Causes of infectious infectious arthritis:
1. direct trauma
2. hematogenous spread
3. aspiration, injection or surgery
5. inflames extra-articular structures
What are Ganglion (synovial) cysts?
mobile masses usually located on the hands or feet; spaces lined by myxoid material
Where are giant cell tumors of tendon sheath usually located?
What do giant cell tumors of tendon sheath look like microscopically?
multinucleated giant cells, with a background of histiocytes and cells that resemble synoviocytes