Flashcards in Patho Exam 2: Joints 2 Deck (65)
Explain Juvenile idiopathic arthritis (JIA)
o Begins before age 16, by definition and persist for a min of 6 weeks
o Generally larger joints than RA
o Often positive Anitnucular antibody
Cause of JIA?
Etiology is unknown, no inciting cause as if prior trauma
7 types of JIA
1: Systemic arthritis: abrupt onset, fever, skin rash, hepatosplenomegaly, serositis ( inflammation of serious tissue)
2: Oligoarthritis: 4 or less joints, absence of psoriasis, HLA-B27 (-), (+) ANA
3: Rh factor positive polyarthritis: similar to adult form
4: Rh factor negative polyarthritis: > 5 joints
5: Enthesitis: Inflammation of a point of attachment of a skeletal muscle to bone B27 (+)
6: Psoriatic arthritis
7: Undifferentiated arthritis
Variety of types based on markers that indicate progression
What are the similarities of adult RA and JIA?
Genetic: HLA (doesn’t have to be, but may be),
Inflammatory synovitis & morphologic changes,
abnormal immunoregulation (Immune System gone haywire)
what are some differences of adult RA and JIA?
what is Pauci?
Oligoarthritis more common in JA,
systemic disease more frequent in JA,
larger joints greater than small joints in JIA,
RF nodules and RF factors are usually absent,
ANA seropositivity is common
>1 joint but less than 5 joints
name the three subtypes
1: Alkalosing Spondylitis ( AKA Rheumatoid spondylitis or marie stumpell diease ( HLA B27)
2: Reactive arthritis (follows GU or GI infection)
•Reiter syndrome (urethral and conjunctival inflammation too) (HLA-B27)
•Arthritis associated with IBD
3:Psoriatic Arthritis (HLA-B27)
what are some common characteristics of seronegative spondyloarthropathies
Dont have RF
+ HLB 27
Sacroilliac and vertebral
Inflammation of the tendons
Systemic involvment: Uveitis, carditis and arotitis
Perferential onset: young men
rheumatoid spondylitis (Marie Stumpell disease)
what is ankylosing spondylitis
Chronic inflammatory arthropathy of vertebral column and sacroiliac joints
May accompany asymmetric peripheral arthritis and systemic manifestations
who is common to have ankylosing spondylitis?
Young men, peak age is 20
Most are positive for what?
What is the manifestations of Ankylosing Spondylitis?
o Begins at sacroiliac joints bilaterally
o Ascends the spinal column involving small joints of posterior elements
o Destruction of joints: Spine becomes fused posteriorly
o Vertebral bodies: Unburdened and become osteoporotic due to < mechanical force….< osteoblasts (main force is on fused posterior elements)
o Eventually vertebral bodies fuse within articulating area
Reiter Syndrome AKA
what is the reiter syndrome triad?
Seronegative polyarthritis, conjunctivitis/uveitis, non-specific urethritis (nongonococcal) or cervicitis
what is the cause of Reiters syndrome
o Follows venereal exposure or episode of bacillary dysentery (some other bacteria, GI for instance or chlamidia): common in HIV+
After the Venereal exposure how long until Reiters symptoms?
Arthritic symptoms within weeks of inciting bout of urethritis or diarrhea
what are the manifestations of Reiters syndrome?
Low back pain and stiffness most common joints affected are the ankles, knees and feet
Cant pee, can't see and climb a tree
How long do episodes of Reiters typically last?
what percent of Reiters will develop Arthritis?
Enteritis associated arthritis
GI infections: Salmonella, shigella, campylobacter
The lipopolysaccharide coat causes the autoimmune reaction
UC or Crohns- autoimmune diease
how long after a Gi infection wil the enteritis associated arthritis persist?
about 1 year
How do you treat UC or crohns related Enteritis associated arthritis?
UC you can resect the affected bowl but in crohns since it is a systemic disorder resection will not treat.
what are the affected joints in Enteritis associated arthritis?
Knees and ankles are most common, can affect the wrist fingers and toes, rare to accompany by alkylosing spondylosis
HLA B 27 + --> Linked to psoriatic spondylitis and inflammation of distal interphalangeal joints
HLA DR4 associated with RA pattern involvement ( Hand, wrist and elbows)
Psoriatic Arthritis effects what?
Peripheral and axial joints
can also have conjunctivitis and Iritis
Not as severe as RA but remission more freq.
Often has an predisposing condition which is what?
what does the infiltrate look like?
Osteomyelitis is the predisposing condition the bacteria that are common are similar to those of Osteomyelitis
usually suppurative ( a lot of WBC)
what are the 4 cardinal signs of Infectios Arthritis?
Fever Leukocytosis, ESR, pain
what joints are commonly infected with infectious Arthritis?
Knee, hip, shoulder, elbow, wrist and then Sternoclavicular joints.
what is more common in drug addicts?