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Flashcards in Joints Deck (74):
1

What is a joint?

Connection between two bones

2

How do joints provide structural strength?

Solid joints are tightly connected (eg cranial sutures)

3

What are synovial joints?

They have a joint space to allow for motion

4

What is the articular surface of adjoining bones in a synovial joint made of?

hyaline cartilage (type II collagen) that is surrounded by a joint capsule

5

What facilitates smooth motion of the synovial joint?

Synovium lining the joint capsule secretes fluid rich in hyaluronic acid to lubricate the joint and facilitate smooth motion.

6

What is osteoarthritis?

Progressive degeneration of articular cartilage; most common type of arthritis

7

What is the most common type of arthritis?

osteoarthritis

8

What is osteoarthritis most often due to?

wear and tear

9

What is the major risk factor for osteoarthritis?

Age

10

In whom is osteoarthritis common?

after 60 years

11

In addition to age, what are some additional risk factors for osteoarthritis?

obesity and trauma.

12

What joints are affected by osteoarthritis?

a limited number of joints (oligoarticular); hips, lower lumbar spine, knees, and the distal interphalangeal joints (DIP) and proximal interphalangeal joints (PIP) of fingers are common sites

13

What is the classic presentation for osteoarthritis?

joint stiffness in the morning that worsens during the day

14

What are the pathologic features for osteoarthritis?

1) Disruption of the cartilage that lines the articular surface; fragments of cartilage floating in the joint space are called joint mice 2) Eburnation of the subchondral bone 3) Osteophyte formation (reactive bony outgrowths); classically arises in the DIP (Heberden nodes) and PIP (Bouchard nodes) joints of the lingers

15

What are Heherden nodes?

Osteophyte formation in distal interphalangeal joints

16

What are Bouchard nodes?

Osteophyte formation in proximal interphalangeal joints

17

What is rheumatoid arthritis?

Chronic, systemic autoimmune disease

18

In whom does rheumatoid arthritis classically arise?

in women of late childbearing age

19

What is rheumatoid arthritis associated with?

HLA-DR4

20

What is rheumatoid arthritis characterized by?

involvement of joints

21

What is the hallmark for rheumatoid arthritis?

synovitis leading to formation of a pannus (inflamed granulation tissue).

22

What does rheumatoid arthritis lead to?

destruction of cartilage and ankylosis (fusion) of the joint

23

What are the clinical features for rheumatoid arthritis?

1) Arthritis with morning stiffness that improves with activity 2) Fever, malaise, weight loss, and myalgias 3) Rheumatoid nodules 4) Vasculitis 5) Baker cyst 6) Pleural effusions, lymphadenopathy, and interstitial lung fibrosis

24

For rheumatoid arthritis, describe the arthritis that is seen clinically?

Symmetric involvement of PIP (proximal interphalangeal joints) joints of the fingers (swan-neck deformity), wrists (ulnar deviation), elbows, ankles, and knees is characteristic; DIP (distal interphalangeal joints) is usually spared (unlike osteoarthritis)

25

What is a difference between the arthritis seen in rheumatoid arthritis and osteoarthritis?

In rheumatoid arthritis the DIP is usually spared unlike osteoarthritis

26

For rheumatoid arthritis, what is seen on x-ray?

Joint-space narrowing, loss of cartilage, and osteopenia

27

What are rheumatoid nodules?

They are a central zone of necrosis surrounded by epithelioid histiocytes; arise in skin and visceral organs

28

What is vasculitis?

Multiple organs may be involved.

29

What is Baker cyst?

swelling of bursa behind the knee

30

What are the laboratory findings for rheumatoid arthritis?

1) IgM autoantibody against Fc portion of IgG (rheumatoid factor); marker of tissue damage and disease activity 2) Neutrophils and high protein in synovial fluid

31

What are the complications for rheumatoid arthritis?

anemia of chronic disease and secondary amyloidosis

32

What are the seronegative spondyloarthropathies?

1) Ankylosing spondylarthritis 2) Reiter syndrome 3) Psoriatic arthritis

33

What characterizes seronegative spondyloarthropathies?

It?s a group of joint disorders characterized by 1) Lack of rheumatoid factor 2) Axial skeleton involvement 3) HLA-B27 association

34

What does ankylosing spondylarthritis involve?

the sacroiliac joints and spine.

35

In whom does ankylosing spondylarthritis arise?

in young adults, most often male

36

How does ankylosing spondyloarthritis present?

with low back pain; involvement of vertebral bodies eventually arise leading to fusion of the vertebrae - bamboo spine

37

What are the extra-articular manifestations for ankylosing spondylarthritis?

They include uveitis and aortitis (leading to aortic regurgitation)

38

What is reiter syndrome characterized by?

the triad of arthritis, urethritis, and conjunctivitis.

39

In whom does Reiter syndrome arise?

in young adults (usually males) weeks after a GI or Chlamydia trachomatis infection

40

Psoriatic arthritis is seen in whom?

10% of cases of psoriasis.

41

What does psoriatic arthritis involve?

axial and peripheral joints; DIP joints of the hands and feet are most commonly affected, leading to sausage fingers or toes

42

What is infectious arthritis?

Arthritis due to an infectious agent, usually bacterial

43

What are the causes for infectious arthritis?

1) N. gonorrhoeae 2) S. aureus

44

What is the most common cause for infectious arthritis overall?

N. gonorrhoeae (its seen in young adults)

45

What is the 2nd most common cause of infectious arthritis overall?

S. aureus, and is seen in older children and adults

46

What does infectious arthritis classically involve?

It classically involves a single joint, usually the knee

47

What does infectious arthritis present as?

a warm joint with limited range of motion; fever, increased white count, and elevated ESR are often present

48

What is gout?

Deposition of monosodium urate (MSU) crystals in tissues, especially the joints

49

What is gout due to?

hyperuricemia; related to overproduction or decreased excretion of uric acid

50

Where is uric acid derived from?

purine metabolism

51

What excretes uric acid?

It is excreted by the kidney

52

What is the most common cause of gout?

Primary gout is the most common form;

53

What is the etiology of hyperuricemia?

it is unknown

54

What is secondary gout seen with?

1) Leukemia and myeloproliferative disorders 2) Lesch-Nyhan syndrome 3) Renal insufficiency

55

How does leukemia and myeloproliferative disorders lead to gout?

Increased cell turnover leads to hyperuricemia

56

How does Lesch-Nyhan syndrome lead to gout?

X-linked deficiency of hypoxanthine-guanine phosphoribosyltransferase (HGPRT) (which is the salvage pathway); presents with mental retardation and self-mutilation

57

How does renal insufficiency lead to gout?

decreased renal excretion of uric acid

58

How does gout present?

as exquisitely painful arthritis of the great toe (podagra)

59

Why does gout present as podagra?

1. MSU crystals deposit in the joint, triggering an acute inflammatory reaction.

60

What may precipitate gout?

Alcohol or consumption of meat may precipitate arthritis.

61

What does chronic gout lead to?

1) development of tophi 2) renal failure

62

In gout, what happens in the development of tophi?

white, chalky aggregates of uric acid crystals with fibrosis and giant cell reaction in the soft tissue and joints

63

In gout, why is there renal failure?

Urate crystals may deposit in kidney tubules (urate nephropathy).

64

What are the laboratory findings for gout?

include hyperuricemia; synovial fluid shows needle-shaped crystals with negative birefringence under polarized light

65

What is pseudogout?

It resembles gout clinically, but is due to deposition of calcium pyrophosphate dihydrate (CPPD); synovial fluid shows rhomboid-shaped crystals with weakly positive birefringence under polarized light

66

What is dermatomyositis?

Inflammatory disorder of the skin and skeletal muscle

67

What is the etiology for dermatomyositis?

some cases are associated with carcinoma (e.g., gastric carcinoma)

68

What are the clinical features for dermatomyositis?

1) Bilateral proximal muscle weakness; distal involvement can develop late in disease. 2) Rash of the upper eyelids (heliotrope rash); malar rash may also be seen. 3) Red papules on the elbows, knuckles, and knees (Grotton lesion)

69

What are the laboratory findings for dermatomyositis?

1) Increased creatinine kinase 2) Positive ANA and anti-Jo-l antibody 3. Perimysial inflammation (CD4+ T cells) with peritascicular atrophy on biopsy

70

For dermatomyositis, what is seen on biopsy?

Peritascicular atrophy

71

What is the treatment for dermatomyositis?

corticosteroids.

72

What is polymyositis?

Inflammatory disorder of skeletal muscle

73

What does polymositis resemble?

dermatomyositis clinically, but skin is not involved

74

For polymositis, what is seen on biopsy?

endomysial inflammation (CD8+ T cells) with necrotic muscle fibers is seen on biopsy