Joints

Question 0

What other risk factors for osteoarthritis

Answer 0

Obesity
Age
Trauma

Question 1

What is degenerative joint disease/osteoarthritis ?

Answer 1

Progressive degeneration of articular cartilage Due to mechanical wear and tear

Question 2

How does an osteoarthritis patients present?

Answer 2

Go to sleep – > joint gets rest – >

Wake up Joint stiffness @ morning – >

use joints = increase wear+tear (cartilage loss start medially = bowlegged) ->

Increase pain during day

Question 3

What are the pathologic features of osteoarthritis

Answer 3

Destruction of cartilage lining the articular surface –>

Joint mice – cartilage fragments fall into joint space

Eburnation of subchondral bone – bone rubbing against bone = polish

SUbchondral cysts
Sclerosis+Synovitis

Heberden’s nodes (DIP)
Osteophytes
Bouchard nodes (PIP)

Question 4

Treatment of osteoarthritis?

Answer 4

Paracetamol NSAIDs intra-articular glucocorticoids

Question 5

What is rheumatoid arthritis?

Answer 5

Autoimmune inflammatory destruction

of synovial joints

mediated by cytokines & HSR 3 + 4

Question 6

What is the aetiology + risk factors for rheumatoid arthritis ?

Answer 6

HLA-DR4
Autoimmune = middle-aged woman
Rheumatoid factor positive = anti-IgG
Anti-cyclic citrullinated peptide AB = more specific
Mediated by cytokines + HSR3+4

Question 7

What joints are involved in osteoarthritis is

Answer 7

Lower lumbar

Knee

Elbow

Distal + proximal interphalangeal joint

Question 8

What is the hallmark of rheumatoid arthritis?

Answer 8

Synovitis inflammation of the Synovium

Question 9

Explain how synovitis can lead to clinical features

Answer 9

Synovitis – >produce thick pannus granulation tissue = BV, fibroblasts, myofibroblasts = contract – >

– ankylosis = fusion of joint -> joint space narrowing
– Deviation of joints diff direction eg. ulnar deviation
– Destroy articular cartilage due to pannus taking over

Synovitis – >
inflammatory process wear away @bone – > osteopenia

Question 10

What is the clinical hallmark Of rheumatoid arthritis

Answer 10

Morning stiffness improves with activity

Patient sleep – >joints rest – >
inflammatory process occurs @joints – >
damage joints – > wake-up + move joints – >
squeeze joints free of him inflammatory debris – > improvement

Question 11

Which joints are involved in rheumatoid arthritis?

Answer 11

SYMMETRIC

Proximal interphalangeal joint

Elbow + Wrists (metacarpophalangeal joint )

Knee + ankle

Question 12

Patient presents with

• fever weight loss myalgia
• Rheumatoid nodules, vasculitis, Baker’s cyst,
• lymphadenopathy, interstitial fibrosis, pleural effusion, pleuritis

Explain the fever weight loss and myalgia
Explain rheumatoid nodules and Baker’s cyst

Answer 12

Fever weight loss and myalgia due to inflammatory process i.e. systemic autoimmune disease

Rheumatoid nodules @skin + visceral organs with central area of necrosis surrounded by epithelioid histiocytes

Baker’s cyst = swelling of bursa behind knee

Question 13

What would you find in the labs with rheumatoid arthritis?

Answer 13

Auto IgM against FC portion of IgG Ie rheumatoid factor

Question 14

What would we find inside the synovial fluid in rheumatoid arthritis

Answer 14

Neutrophils + high-protein

Question 15

What are the complications of rheumatoid arthritis

Answer 15

Chronic inflammatory state – >produce acute-phase reactant e.g.

HEPCIDIN– >Block ability to use Fe2+ stored in macrophages – > ANEMIA OF CHRONIC DISEASE

SAA – > Converted to AA – > deposit in tissues = SECONDARY AMYLOIDOSIS

Question 16

What is gout

Answer 16

Depositions/precipitation of mono sodium urate crystals in tissues e.g. joints leading to acute inflammatory monoarthritis

Question 17

What is the most common form of gout

What causes primary gout

Answer 17

Primary gout – 90% = under excretion of uric acid

Exacerbated by thiazides

Idiopathic

Question 18

What are the two main reasons of hyperuricaemia

Answer 18

Push too much uric acid into blood

Not filter enough from blood

Question 19

What are the three reasons of secondary gout

Answer 19

Leukaemia + myeloproliferative disorders e.g. tumour lysis syndrome:
increased cell turnover – > increased nuclei turnover – > increased breakdown of purines + pyrimidines –> increased uric acid @ joints

Lesch Nyhan syndrome = X-linked
Decreased HGPRT – >

Hyperuricaemia
Gout
Pissed off {Self-mutilation (bite lips + fingers)} Retardation
dysTonia

Renal insufficiency = can’t excreta uric acid

Question 20

How does a patient with acute gout present

Answer 20

Deposition of uric acid (MSU) + joints

Eat meat = XS DNA + RNA +
Alcohol = compete with uric acid to be excreted ->

XS uric acid MSU crystals – >
Acute inflammation - crystals activate neutrophils – >

Painful arthritis of great toe = PODAGRA @metatarsophalangeal (MTP) joint

Question 21

How does a patient with chronic gout present

Answer 21

Long-standing acute gout – >

1.developed TOPHI =
white chalky aggregates of URIC acid crystals
+ Fibrosis + giant cell rxn
@Soft tissue + joints
E.g. Achilles tendon, external ear, olecranon bursa

2.renal failure
Uric acid deposit @tubules of kidney -> damage

Question 22

What do we see in the labs for gout

Answer 22

Hyperuricaemia

Needle shaped crystals with
Negative birefringent under polarised light

yeLLow under paraLLel light / lay LOW = yelLOW
Blue under perpendicular

Question 23

What is pseudogout

Answer 23

Deposition of calcium pyrophosphate

Question 24

What do we see histologically in pseudogout

Answer 24

Rhomboid crystals Weak positive birefringence @polarised light

Question 25

How does a patient presented with pseudogout

Answer 25

Pain + effusion in joint

Question 26

What joints are affected in pseudogout What age does it affect What gender does it affect

Answer 26

Knee >50 years Affects male + females equally as

Question 27

What's the diseases are pseudogout associated with

Answer 27

Haemochromatosis osteoarthritis hyperparathyroidism

Question 28

In a+c gout How does the patient present generically

Answer 28

A symmetric joint distribution | Swollen red painful joints

Question 29

Explain three things about seronegative spondyloarthropathies

Answer 29

1. lack rheumatoid factor 2. involve axial skeleton – spine + large joints of central skeleton 3. Associated with HLA– B 27

Question 30

What's joints does ankylosing spondylitis affect

Answer 30

Sacroiliac joints - lower back pain Spine - fusion of vertebrate = bamboo spine – > morning stiffness

Question 31

Apart from joint issues what 2 other things occur in ankylosing spondylitis

Answer 31

Aortitis = inflammation – >aneurysm – >Pull on aortic valve – >aortic regurgitation Uveitis

Question 32

Patient comes in to click and says he can't see, can't Pee, can't climb a tree. What the diagnosis and what symptoms does he have

Answer 32

Reactive/Reiter syndrome Conjunctivitis urethra to this arthritis + periostitis of Achilles tendon with planter fascia

Question 33

When does reactive/reiter syndrome occurring?

Answer 33

Post G I infection e.g. shigella yersinia salmonella Post chlamydia infection

Question 34

How is the patient with Psoriatic Arthiritis present

Answer 34

Joint pain + stiffness Affect the axial + peripheral joints – DIP of hands + feet = dactylitis = sausage finger/toes X-ray = pencil in cup deformity

Question 35

Patient presents with joint pain and stiffness on x-ray his fingers look like a pencil in a cup. His fingers or sausages like. What's the diagnosis

Answer 35

Psoriatic arthritis

Question 36

Explain the Pathphys of rheumatoid arthritis

Answer 36

Look at pic on 05/03/15