Joint pathology

Question 1

Osteoarthritis (degenerative joint disease)

Answer 1

• progressive degeneration of articular cartilage, most common type of arthitis
• most often due to wear and tear
• major risk factor is age
• hips, lower lumar spine, knees, DIPs, and PIPs are common sites

Question 2

presentatio of OA

Answer 2

-joint stiffness in the morning that worsens during the day

Question 3

pathologic features of OA

Answer 3

• disruption of cartilage that lines the articular surface; fragments of cartilage floating in the joint space (joint mice)
• eburnation of the subchondral bone
• osteophyte formation

Question 4

what are heberden nodes?

Answer 4

-osteophyte formation in DIP

Question 5

bouchard nodes

Answer 5

-osteophytes in PIP

Question 6

What type of collagen is degraded by matrix metalloproteinases?

Answer 6

-type 2

Question 7

Rheumatoid arthritis

Answer 7

• chronic, systemic autoimmune disease
• women of late childbearing age
• associated with HLA DR4

Question 8

what is hallmark of RA

Answer 8

• synovitis leading to formation of a pannus

- leads to destruction of cartilage and ankylosis (fusion) of the joint

Question 9

What is a pannus?

Answer 9

-inflammed granulation tissue

Question 10

clinical features of RA

Answer 10

• arthiritis with morning stiffness that improves with activity*
• symmetric involvement of PIP joints (swan neck deformity)
• small joints are affected before large ones
• DIP are usually spared
• fever, malaise, weight loss, and myalgia
• Rhematoid nodules
• Vasculitis
• Baker cysts
• pleural effusions

Question 11

What is a baker cyst?

Answer 11

• swelling of bursa behind the knee

- think of RA when you see this

Question 12

lab findings for RA

Answer 12

• IgM autoantibody against Fc portion of IgG (rheumatoid factor), marker of tissue damage and disease activity
• neutrophils and high protein in synovial fluid

Question 13

Complications of RA

Answer 13

• anemia of chronic disease

- secondary amyloidosis

Question 14

What is the other thing that we have autoantibodies to in RA?

Answer 14

-citrullinated peptides (CCPs)

Question 15

What is the characteristic finding on the patient’s wrist for RA?

Answer 15

• radial deviation of wrist

- ulnar deviation of the fingers

Question 16

What can we give RA patients to help with the pain?

Answer 16

-TNF antagonists

Question 17

Juvenile Idiopathic Arthritis (JIA)

Answer 17

-heterogeneous group of disorders of unkown cause that present with arthritis before age 16 and persist for at least 6 weeks

Question 18

Seronegative spondyloarthropathies

Answer 18

• group of joint disorders characterized by:
• lack of rheumatoid factor
• axial skeleton involvement
• HLA-B27 association

Question 19

What does ankylosing spondyloarthritis involve?

Answer 19

• SI joints and spine
• young male adults
• low back pain… bamboo spine
• uveitis and aortitis (leads to aortic regurg)

Question 20

What is Reiter syndrome?

Answer 20

• triad of arthritis, urethritis, and conjunctivitis

- “can’t see, cant’ pee, can’t climb a tree”

Question 21

when do we see Reiter syndrome(reactive arthritis)?

Answer 21

-young male adults weeks after a GI or chlamydia infection

Question 22

What is seen in 10% of cases of psoriasis and involves the axial, and peripheral joints?

Answer 22

• psoriatic arthritis

- gives us sausage fingers or toes

Question 23

What do 90% of ankylosing spondylitis have?

Answer 23

• HLA-B27

- also HLA-Cw6 alleles

Question 24

What is reiter syndrome referred to in robbins?

Answer 24

-Reactive Arthritis**

Question 25

Enteritis associated arthritis

Answer 25

- caused by GI infection - knees and ankles, abrupt onset - lasts for about a year, then generally clears up (unlike reactive arthritis)

Question 26

infectious arthritis

Answer 26

- usually bacterial - N gonorrhoae most common cause - S aureus older children and adults - single joint.... knee - presents as a warm joint with limited ROM, fever, increased white count and elevated ESR are often present

Question 27

What kind of suppurative arthritis predominates in children younger than 2?

Answer 27

-H influenza

Question 28

If someone has sickle cell disease, what infection are they prone to?

Answer 28

-Salmonella

Question 29

Mycobacterial arthritis

Answer 29

- weight bearing joints | - central caseous necrosis

Question 30

Lyme Arthritis

Answer 30

- Borrelia burgdorferi - deer ticks - arthritis in late stage - 1 or 2 joints affected at a time - look for anti-borrelia antibodies

Question 31

Gout

Answer 31

- monosodium urate - hyperuricemia - purine metabolism... excreted by kidney usually excretes uric acid - prime gout is most common form... etiology of hyperuricemia unkown

Question 32

secondary gout

Answer 32

- leukemia and myeloproliferative disorders... increased cell turnover - lesch-Nyhan syndrome: deficiency in HGPRT.. mental retardation and self mutilation - renal insufficiency: decreased renal excretion of uric acid

Question 33

How does acute gout present?

Answer 33

- painful arthritis of the great toe - inflammatory rxn initiated - alcohol and consumption of meat may precipitate arthritis

Question 34

What does chronic gout lead to?

Answer 34

- development of tophi- white chalky aggregates of uric acid crystals with fibrosis and giant cell reaction in the soft tissue and joints - renal failure- urate crystals may deposit in kidney tubules (urate nephropathy)

Question 35

what will we see in the synovial fluid with gout?

Answer 35

-needle shaped crystals with negative birefringence under polarized light

Question 36

What is pseudogout?

Answer 36

- 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

Question 37

what are tophi again?

Answer 37

- pathognomonic hallmark of gout | - large aggregations of urate crystals surrounded by an intense inflammatory rxn of foreign body giant cells

Question 38

What is a ganglion

Answer 38

- small cyst that is almost always located near a joint capsule or tendon sheath - no communication with joint space - popliteal space in the setting of rheumatoid arthritis (Baker cyst)

Question 39

Tenosynovial giant cell tumor

Answer 39

- term for several closely related benign neoplasms that develop in the synovial lining of joints, tendon sheaths, and bursae - knee in 80% of cases - localized variant is the most common mesenchymal neoplasm of the hand