Module 15 (Joint Pathology)

Question 1

arthritis

Answer 1

inflammation of any joint

Question 2

anklosing spondylitis

Answer 2

(form of arthritis): Chronic, progressive arthritis with stiffening of joints, primarily of the spine.
Bilateral sclerosis (hardening) of the sacroiliac joints is a diagnostic sign. Joint changes are similar to those seen in rheumatoid arthritis, and the condition can respond to corticosteroids and anti-inflammatory drugs.

Question 3

gouty arthritis (gout)

Answer 3

(form of arhtritis): inflammation and painful swelling in and around joints caused by the deposition of uric acid crystals.
A congenital defect in the metabolism of uric acid causes too much of it to accumulate in blood (hyperuricemia). This excess can lead to the formation of uric acid crystals, causing an inflammatory reaction that results in excruciating pain with rapid deterioration of articular cartilage. The joint chiefly affected is the big toe; hence, the condition often is called podagra (pod/o = foot, -agra = excessive pain). Treatment consists of drugs to lower uric acid production (allopurinol) and to prevent inflammation (colchicine and indomethacin) and a special diet that avoids foods that are rich in uric acid, such as red meats, red wines, and fermented cheeses.

Question 4

osteoarthritis (OA)

Answer 4

(form of arthritis): progressive, degenerative joint disease with loss of articular cartilage and hypertrophy or bone (formation of osteophytes, or bone spurs) at articular surfaces
This condition, also known as degenerative joint disease, can occur in any joint, but occurs mainly in the spine, hips, and knees of older people. It is marked by a narrowing of the joint space (due to loss of articular cartilage). Treatment consists of aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation and pain. Low impact aerobic exercise is often helpful, and physical therapy may loosen impaired joints. Figure 15-22 compares a normal joint and those with osteoarthritis and rheumatoid arthritis. End-stage osteoarthritis is the most common reason for joint replacement surgery (total joint arthroplasty). See the clinical case on page 584.

Question 5

rheumatoid arthritis (RA)

Answer 5

(form of arthritis): chronic joint condition with inflammation and pain; caused by an autoimmune reaction against joint tissue, particularly the synovial membrane
The small joints of the hands and feet are affected first, and larger joints later. Women are more commonly afflicted than men. Synovial membranes become inflamed and thickened, damaging the articular cartilage and preventing easy movement (see Figure 15-22). Sometimes fibrous tissue forms and calcifies, creating a bony ankylosis (pathologic union) at the joint and preventing movement. Swollen, painful joints accompanied by pyrexia (fever) are symptoms. Diagnosis is by clinical criteria, blood tests, and x-ray images revealing changes around the affected joints. Treatment consists of heat applications and drugs such as aspirin and other NSAIDs and corticosteroids to reduce inflammation and pain. Disease-modifying antirheumatic drugs (DMARDs) such as methotrexate and gold salts also are used, as well as, even more successfully, biologic medications to change the immune response to synovial tissues.

Question 6

bunion

Answer 6

enlargement of bone or tissue around the joint at the base of the big toe (metatarsophalangeal joint)
Chronic irritation from ill-fitting shoes can cause a buildup of soft tissue and underlying bone. Bunionectomy (removal of a bony exostosis and associated soft tissue) is indicated if other measures (changing shoes and use of anti-inflammatory agents) fail. See Figure 15-23. Another name for a bunion is hallux (great toe) valgus (abnormal angulation of the toe).

Question 6

carpal tunnel syndrome (CTS)

Answer 6

compression of the median nerve as it passes between the transverse ligament, and bones and tendons of the wrist
CTS is caused by compression of the median nerve (see Figure 15-24) in the carpal tunnel. The compression results from swelling and/or inflammation of the flexor tendons. The thumb, the index and long finger and the radial half of the ring finger become dysesthetic (having abnormal sensation to touch).
Treatment consists of splinting the wrist during sleep to immobilize it, use of anti-inflammatory medications, and injection of corticosteroids such as cortisone into the carpal tunnel. If these measures fail, surgical release of the transverse carpal ligament usually is curative.

Question 7

dislocation

Answer 7

displacement of a bone from its joint
Dislocated bones do not articulate with each other. The most common cause of dislocations is trauma. Shoulder dislocation (disruption of articulation between the head of the humerus and the glenoid fossa of the scapula) and hip dislocation (disruption of articulation between the head of the femur and the acetabulum of the pelvis) are examples.
Treatment of dislocations involves reduction, which is restoration of the bones to their normal positions. A subluxation is a partial or incomplete dislocation.

Question 8

ganglion cyst

Answer 8

fluid-filled sac arising from joint capsules or tendons
Most common in the wrist, but can occur in the hand, shoulder, knee, hip, or ankle. See Figure 15-25. Treatment ranges from immobilization and reduced activity to aspiration of fluid, to surgical resection, if necessary.

Question 9

herniation of an intervertebral disc

Answer 9

abnormal protrusion of an intervertebral disc into the spinal canal or spinal nerves
This condition is commonly referred to as a “slipped disc.” Pain is experienced as the inner portion of the disc (nucleus pulposus) presses on spinal nerves or on the spinal cord. See Figure 15-26A. Low back pain and sciatica (pain radiating down the leg) are symptoms when the disc protrudes in the lumbar spine. See Figure 15-26B. Neck pain and burning pain radiating down an arm are characteristic of a herniated disc in the cervical spine. Physical therapy, drugs for pain, and epidural cortisone injections may help initially. In patients with chronic or recurrent disc herniation, microdiscectomy (removal of a portion of the protruding disc) may be advised. See Figure 15-27A showing pieces of a herniated disc after removal. In microendoscopic surgery, the disc is removed by inserting a tube through the skin and aspirating the disc through the tube, while the procedure is visualized through a small fiberoptic scope.

Question 10

Lyme disease (Lyme arthritis)

Answer 10

chronic, recurrent disorder marked by severe arthritis, myalgia, and malaise; cause is a bacterium carried by a tick
It was first reported in Old Lyme, Connecticut, and is now found throughout the United States. It is often marked by a “bull’s-eye” rash at the site of the tick bite. See Figure 15-27B. The condition is treated with antibiotics. In some cases, Lyme disease can affect the nervous system.

Question 11

sprain

Answer 11

injury, often the result of trauma, involving overstretching of the ligaments around a joint
Application of gentle compressive wraps is an immediate measure to relieve pain and minimize swelling. Ice and elevation of the extremity as well as physical therapy are also helpful HINT: Don’t confuse a sprain with a strain, which is an injury involving the overstretching of muscle.

Question 12

systemic lupus erythematosus (SLE)

Answer 12

chronic inflammatory autoimmune disease involving joints, skin, kidneys, central nervous system (CNS), heart, and lungs
This condition affects connective tissue (specifically the protein component called collagen) in tendons, ligaments, bones, and cartilage all over the body. Typically, there is a red, scaly rash over the nose and cheeks (“butterfly” rash) (Figure 15-28). Patients, usually women, experience joint pain in several joints (polyarthralgia), pyrexia (fever), kidney inflammation, and malaise. SLE is an autoimmune disease that is diagnosed by the presence of abnormal antibodies in the blood and characteristic white blood cells called LE cells. Treatment involves giving corticosteroids, hormones made by the adrenal gland that are used to treat inflammatory conditions. New medications that modulate the immune system are being used with increasing success.
The name lupus, meaning wolf, has been used since the 13th century, because more severe (erosive) lupus skin lesions were thought to look like the affected person had been attacked by a wolf.