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MOD 2 Quiz 1 > Joint pathology > Flashcards

Joint pathology Flashcards

(49 cards)

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1
Q

Primary/ idipathic osteoarthritis?

A

aging phenomenon
appears insidiously without cause
oligoartiuclar (few joints affected)

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2
Q

Secondary osteoarthritis?

A

younger individuals
history of predisposing conditions
-previous injury, congenital deformity, systemic disease
usually affect the predisposed joint

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3
Q

Clinical course osteoarthritis?

A 
insidious
deep, achy pain
morning stiff
crepitus
limit ROM
impingment on spinal foramina causing radiular pina, muscle spasm, muscle atrophy, and neuro deficits
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4
Q

Commonly seen with/ joints of osteoarthritis?

A

hips, knees, cervical and lumbar vertebrae, PIP, DIP
herberden nodes common in women
no preventive treatment, cannot halt progression

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5
Q

Genetic factors osteoarthritis?

A

genes involved with prostaglandin metabolism and WNT signaling

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6
Q

Environmental factors osteoarthritis?

A 
Aging, 80-90% have evidence of OA by 65 yo
Biochemical stress (joint stability, muscle strength)
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7
Q

Path mechanism of OA?

A

chondrocyte injury cause proliferation and form clusters
water content increases and concentration of proteoglycans decreases
Cracking of the matrix occurs as the supporing catilage and type II collage are degraded

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8
Q

Gross morphology of OA?

A

exposed subchonral surface
subchondral cyst
residual cartilage (destruction of)

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9
Q

Eburnation?

A

dectructive process of cartialge that exposes the bone

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10
Q

Rheumatoid arthritis?

A

chronic, systemic, inflammatory disorder
affects many tissues and organs
women more than men
nonsuppurative, profilerative and inflammatory synovitis

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11
Q

clinical course Rheumatoid arthritis?

A

slow and insidious
maliase, fatigue, generalized MSK pain
joint involvement ensuses after several weeks to months, small before large/symmetrical

(joints swollen, warm, painful, stiff from inactivity)

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12
Q

Lab indicators of Rheumatoid arthritis?

A

Rheumatoid factor- may appear in other conditions

Anti-CCP antibody (both tests together are sensitive)

synovial fluid shows:
neutrophils, high protein content, low mucin content

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13
Q

Diagnose Rheumatoid arthritis? (four of following)

A 
morning stiffness
arthritis in 3 or more joints
arthritis of hang joints
symmetric arthritis
rheumatoid nodules
serum rheumatoid factor
typical radiographic changes
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14
Q

Pathogenesis Rheumatoid arthritis?

A

genetic susceptibilty associated with HLA-DRB1
Environment arthritogen microbial agents: EBV, retrovirus, mycobaterium citrullinated proteins
autoimmunity

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15
Q

What causes bone/cartilage destruction?

A 
antigen is picked up by MHC class II, present to CD4+ T cell, release cytokines
activate macrophages, B cells, and recruit leukocytes

leads to pannus formation, destroy bone, catilage
fibrosis, ankylosis

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16
Q

Histology of Rheumatoid arthritis?

A

formaiton of villi
proliferative synovium
dense lymphoid aggregate

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17
Q

Rheumatoid nodule?

A

most common cutaneous lesion
usually in areas subjected to pressure (elbows, forearm)
less common in lungs, spleen, heart

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18
Q

What is a Rheumatoid nodule?

A

central zone of fibrinoid necrosis surrounded by palisading granuloma and numerous lymphocytes and plasma cells

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19
Q

Herberden’s nodes?

A

at the DIP

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20
Q

Bouchard’s node?

21
Q

Boutonniere deformity?

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A

hyperflexion of the PIP, hyperexternsion of DIP

22
Q

Swan neck deformity?

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A

hyperflexion of DIP, hyperextension of PIP

23
Q

Juvenile idiopathic arthritis?

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A

before 16 yo, persist for min 6 wks

no nodules

24
Q

JIA from RA?

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A

oilgoarthritis is more common
systemic disease more frequent
large joints affected more often than small joints
rhuematoid nodules and RF are usually absent
ANA seropositivity is common

25
Crystal induced arthritis?
gout, pseudogout
26
Gout?
monosodium urate crystals accumulate in the joint, due to overproduction or underexcretion of uric acid hyperuricemia
27
clin course gout?
``` asymptomatic hyperuricemia acute gouty arthritis (hyperemic, warm, painful joint) (rule out septic arthritis) intercritical gout chronic tophasceous gout ```
28
Classify gout?
primary or idiopathic (usually) secondary (increased nucleic acid turnover) (leukemia, cancer) Metabolic disease (Lesch-Nyhan deficient HGPRT) renal disease
29
Uric acid crystals?
need shaped, negatively birefirngent, water soluble crystals
30
Path of Gout?
crystals phagocytized by macrophage, release IL-1beta other cytokines to cause release of proteases, to cause tissue injury and inflammation crystals also activate complement, neutrophil chemotaxis, phagocytosize crystals by neutrophils,lysis of neutrophils, release of lysosomal enzymes, tissue injury and inflammation
31
Gross morph gout?
synovium is endematous and congested
32
Histo of gout?
dense neutrophilic infiltrate with uric acid crystals in synovium scattedered lymphocytes, plasma cell and macrophages
33
Thophus?
pathognomonic lesion of gout gross- urates from visible depositis in the synovium, Hyperplastic and fibrotic synovieum Histo- large aggregates of urate crystals intense inflammatory reaction
34
Pseudogout (chondrocalcinosis)?
calcium pyrophosphate crystals accumulate and deposit in the joint, can be seen on xray over 50, common knee weakly bifringent, rhomboid/geometric shaped crystals
35
Pseudogout assoc with?
diabetes, hypothyroidism, hyperparathyroidism, hemochromatosis
36
Infectious arthritis?
potential serious, can cause deformatities routes of infection -hematogenous dissemination (via blood) -direct inocculation -contiguous spread from soft tissue abcess or focuse of osteomyeltitis
37
Etiologic agents for infectious arthritis?
Bacteria Mycobacterium TB sprichete: Borrelia burgdorferi virus
38
bacterial arthritis?
suppurative arthritis, cloudy synovial fluid acute onset on painful and swollen infected joint systemic symptoms, fever, leukocytosis, increased ESR etiologic agents by group
39
etiologic agents of bacterial arthritis?
<2 yo--- H. influenza older children and adults--- S.aureus Sex active women-- Gonococcus all ages with sickle cell disease--- salmonella
40
Lyme disease?
``` Tick borne (Ixodes dammini) disease Borrelia burgdroferi skin rash migratory arthritis involving the knees, shoulder and elbows CNS and cardiac involvement ```
41
Erythema Chronicum Migrans?
target lesion from lyme disease | not allergy but actual infection
42
Seronegative Spondyloarthropathies?
develop in genetically predisposed individuals | HLA-B27 (prevalent in caucasians)
43
immuno Seronegative Spondyloarthropathies?
immune mediated manifestations triggered by a T cell response towards an antigen that cross=reacts with native molecules of MSK system peripheral or azial inflammatory oligoarthritis
44
Seronegative Spondyloarthropathies? (ex)
Anklyosing spondyloarthritis Reiter syndrome Enteritis-Associated Arthritis (GI infection) Psoriatic arthritis (chronic inflammatory arthropathy develeops in more than 10% of this pop)
45
Anklyosing spondyloarthritis?
rehuamtoid spondylitis destruction of articular cartilage and resultant bony ankylosis esp sacroiliac joint (LBP) men are affected more than women HLA-B27 (complications) fracture spine, uveitis, aortitis, and amyloidosis
46
Reiter Syndrome?
Form of reactive arthritis waxes/wanes over period wks-months caused by autoimmune rxn by previous infection HLA-B27 pos
47
Reiter Syndrome previous intiated by?
``` GI infection (Shigella, Salmonella, Campylobacter) GU (Chlamydia) ```
48
Reiter Syndrome triad of?
nongonoccocal urethritis or cervititis | conjunctivitis
49
Extra-articular symptoms of Reiter Syndrome?
inflammatory balanitis, cardiac conduction abnormalities and aortic reguritation

MOD 2 Quiz 1 (9 decks)

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