Joints

Question 1

What joints predominate in osteoarthritis in men and women?

Answer 1

Men - hips

Women - Knees and hand

Question 2

What is bone eburnation?

Answer 2

Exposed bone on surface, cartilage is bone

Underlying bone sclerosis

Question 3

What are joint mice?

Answer 3

Loose bodies of cartilage

Question 4

What are osteophytes?

Answer 4

Extra bone at joint edge

Bone spurs

Question 5

How does osteoarthritis present?

Answer 5

Achy pain

Morning stiffness, gets worse with use

Crepitus of joint

Limited RoM

Question 6

What are Heberden nodes?

Answer 6

Osteophytes at DIP in women

Question 7

What is Rheumatoid arthritis?

Answer 7

Systemic autoimmune inflammatory disease

Synovitis often destroying carilage with later ankylosis of the joint

Question 8

What is a pannus?

Answer 8

Exuberant inflamed synovium

Chronic inflammatory cells (Mostly CD4+ T cells)

Granulation tissue

Question 9

What is the pathogenesis of RA?

Answer 9

Ag exposure in a susceptible host creating an ongoing autimmune process

80% have Rheumatoid Factor

Ab to Citrullin-modified peptides

Question 10

Describe the synovial fluid in RA?

Answer 10

High protein content

Low mucin content

Question 11

What joints does RA typically affect?

Answer 11

PIP, MCP, MTP (more proximal than OA)

Wrists, ankles, elbow, knees

Question 12

What is a major presentation difference between RA and OA with regards to movement?

Answer 12

RA - feels better with movement

OA - gets worse

Question 13

Describe hand deviation in RA.

Answer 13

Radial deviation of the wrist

Ulnar deviation of the fingers

Swan neck deformity

Question 14

What do you see on an xray of RA?

Answer 14

Juxta-articular osteopenia

Bone erosions with narrowing of joint space

Joint effusions

Question 15

What are Rheumatoid nodules?

Answer 15

Most common cutaneous manifestation of RA

Fibrinoid necrosis surrounded by macrophages

Question 16

What is Juvenile idiopathic arthritis?

Answer 16

Heterogeneous group by definition before age 16 and present 6 weeks

Oligoarticular, Polyarticular, Systemic

Question 17

What are seronegative spondyloarhtropathies?

Answer 17

Immune mediated pathology in ligamentous attachments

Many are HLA B27 +

RF negative

Question 18

What joints are common in ankylosing spondyloarthritis?

Answer 18

Sacroiliac joints

Apophyseal joints of the spine

Question 19

What is Ankylosing spondyloarthritis?

Answer 19

Inflammation of tendon/ligament insertion

Ossification of inflammation

Fibrous and boney ankylosis

Question 20

What do you see on an xray of ankylosing spondylitis?

Answer 20

Bamboo spine

Ossification of the SI joint

Question 21

What is reiter syndrome?

Answer 21

Reactive arthritis

Appendicular noninfectious arthritis

Occurs after a primary infection

HLA B27 +

Question 22

What is the classic triad associated with reiter syndrome?

Answer 22

Arthritis

Urethritis or cervicitis

Conjunctivitis

Question 23

What is enteritis-associated arthritis?

Answer 23

GI infection: Salmonella, shigella, campylobacter

Most often abrupt in knees and ankles

Generally clears in < 1 year

Question 24

What is psoratic arthritis?

Answer 24

Insidious

Involves the DIP joint

Pencil cup deformity

Question 25

How is infectious arthritis acquired?

Answer 25

Hematogenous spread

Question 26

What is the most common pathogen that causes infectious arthritis in <2 year old patients?

Answer 26

H. influenzae

Question 27

What is the most common pathogen that causes infectious arthritis in Adolescent/young adults?

Answer 27

Gonococcus

Question 28

What is the most common pathogen that causes infectious arthritis in Elderly and children > 2 years?

Answer 28

S. aureus

Question 29

What is the most common pathogen that causes infectious arthritis in sickle cell disease?

Answer 29

Salmonella

Question 30

How does infectious arthritis present?

Answer 30

Predisposing conditions: ID, drug abuse Swollen hot joint

Question 31

How does infectious arthritis from lyme disease present?

Answer 31

Remitting/migratory arthritis in large joints knees>shoulders?elbows?ankles

Question 32

What is gout?

Answer 32

Uric acid from purine metabolism Crystals are negative birefringent End point of hyperuricemia

Question 33

What are the causes of primary gout?

Answer 33

Uknown HGPRT defect

Question 34

What are the causes of secondary gout?

Answer 34

Increased nucleic acid turnover from AML treatment Chronic renal disease

Question 35

What is the pathogeneis of gout?

Answer 35

Monosodium urate precepitates out from supersaturated synovial fluid Negative birefringence Low temperatures Crystals initiate inflammation

Question 36

What are the phases of gout?

Answer 36

Asymptomatic Acute arthritis Intercritical gout Chronic tophaceous gout

Question 37

What are tophi?

Answer 37

Large deposits of urate that are pathognomic of gout

Question 38

What are the risk factors for gout?

Answer 38

Age Genetics Heavy drinking Obesity Thiazides Lead toxicity

Question 39

What is calcium pyrophosphate crystal deposition disease (CPPD)?

Answer 39

Pseuodgout Crustals first seen in articular matrix, menisci, and intervertebral disc Positive birefringent

Question 40

What is a ganglion cyst?

Answer 40

Cyst near joint or tendon sheath Wrist is most common No communication with joint space

Question 41

What is a synovial cyst?

Answer 41

Connected to joint capsule or bursa

Question 42

What is a baker cyst?

Answer 42

Politeal synovial cyst often in setting of RA

Question 43

What is a tenosynovial giant-cell tumor?

Answer 43

Macrophages and giant cells with hemosiderin and lipid vacuoles

Question 44

What is diffuse tenosynovial giant cell tumor?

Answer 44

Pigmented Villonodular Synovitis Red/brown to yellow from hemosiderin Mostly knee Locking or swelling

Question 45

What is a localized tenosynovial giant-cell tumor?

Answer 45

Well circumscribed Slow growing, painless Fingers and wrists Most common soft tissue tumor of the fingers