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-Accumulation of uric acid crystals in gout
-Recurrent periods of acute arthritis and eventually formation of tophi – aggregates of uric acid crystals
-Peripheral joints are affected most frequently
-Treated with drugs (anti-inflammatory, allopurinol – prevents uric acid formation), lifestyle (weight management), diet (sufficient fluid intake) surgery; can lead to renal failure


4 stages of gout:

Asymptomatic hyperuricemia
Acute gouty arthritis (acute inflammatory phase that resolves)
Intercritical gout (‘remission’ phase)
Chronic tophaceous gout (joint destruction)



Accumulation of calcium pyrophosphate crystals in pseudogout
Knees> wrists>elbows>shoulders
>50 yrs, no gender bias
Disease can be monoarticular though multiple joints can be involved


Infectious Joint Disease-Lyme disease

is caused by bacterium (Borrelia burgdorferi) transmitted by deer tick bite
Stage 1: lyme disease produces an erythema marginatum skin rash with a "bull's-eye" pattern (red with white center) due to proliferation of spiral bacteria, may be accompanied by fever & flu-like symptoms, resolves in a few weeks
Stage 2: dissemination of bacteria via blood causing secondary skin lesions, lymphadenopathy, joint, muscle (heart), nerve involvement
May find serum anti-Borrelia antibodies
Stage 3: 2-3 yrs after initial infection causes chronic joint arthritis, heart failure, palsy
Mainly affects large joints (knees)
Treated with antibiotics


Ganglion cysts

Common on wrist, defend of CT
Not to be confused with carpel tunnel syndrome where median nerve is compressed, presenting with pain, tingling, but little to no swelling


Joint tumors

-Tenosynovial giant cell tumor (TGCT) refers to group of benign neoplasms of the synovium
20-40 yrs
-Translocation of collagen 6A3 promoter gene to M-CSF gene resulting in enhanced M-CSF production
-Diffuse TGCT usually affects knee with pain, swelling and reduced mobility, can be aggressive
-Localized TGCT usually presents as a slow growing, painless, solitary mass affecting wrist & finger tendon sheaths


Tumors of Adipose Tissue

-Lipomas are benign tumors of adipocytes
- Liposarcoma is a rare malignant adipose tumor arising in deep adipose tissue
-Because they arise in the retroperitoneum, complete surgical excision usually is not technically feasible


uncommon response to injury in soft tissue that can mimic a tumor-like condition

Nodular fasciitis
-e.g. plantar fasciitis (localized proliferation of fibroblast-like cells in fascia that grows and then spontaneously involutes/ self-limiting)



-Uncommon, slow-growing proliferations of fibroblast-like cells with extensive collagen production, tumor-like but do not metastasize
-Grow in a infiltrative fashion into adjacent tissue
-Superficial fibromatoses as exemplified by palmar fibromatoses is a hypocellular fascial fibrotic lesion of the palm of hand or sole of the foot that causes dysfunction of digits
-Deep fibromatoses as exemplified by abdominal fibromatoses (desmoid tumors) are soft tissue masses in the abdomen that may kill by local extension



-Malignant tumors consisting of infiltrative masses of fibroblasts
-Slow-growing, unencapsulated tumors with hemorrhagic and necrotic areas that occur mostly in adults with long latent period


inflammatory condition of muscle associated with collagen vascular disease or as a paraneoplastic syndrome

--Parasitic myositis can result from ingestion of Trichinella spiralis


rupture of muscle cells that can lead to release of myoglobin



Skeletal Tumors: Rhabdomyosarcoma

-Skeletal muscle tumors are rare, but tumors of smooth muscle are common
-Rhabdomyosarcoma is a malignant sarcoma in childhood (


Smooth Muscle Tumors: Leiomyoma & Leiomyosarcoma

-Leiomyomas are benign tumors of smooth muscle
-Leiomyomas are sharply circumscribed
-Leiomyomas are extremely common in the uterine myometrium (fibroids)

-Leiomyosarcomas are the malignant counterparts of leiomyomas