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All the things > 18.3 Joints > Flashcards

18.3 Joints Flashcards

1
Q

What are solid joints?

A

Joints that tightly connect bones for structural strength

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2
Q

What are synovial joints for?

A

Allow space for motion

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3
Q

What type of collagen comprises articular cartilage?

A

II

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4
Q

What chemical is secreted from the synovium to lubricate the joint?

A

Hyaluronic acid

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5
Q

What is degenerative joint disease?

A

Progressive degeneration of articular cartilage, usually d/t wear and tear

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6
Q

What are the major risk factors for degenerative joint disease?

A
  • Age
  • Obesity
  • Trauma
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7
Q

What are the joints that are classically affected with degenerative joint disease?

A

Hip
Lower lumbar spine
DIPs
PIPs

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8
Q

How does degenerative joint disease present?

A

Joint stiffness in the morning, that worsens during the day

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9
Q

What happens to joint pain from degenerative joint disease as patients go about their day?

A

Worsens

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10
Q

What are the hallmarks of degenerative joint disease?

A
  • Disruption of cartilage, with fragments broken off
  • Joint space narrowing
  • Osteopenia
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11
Q

What is the eburnation that occurs with degenerative joint disease?

A

wearing of the bone down from bone-bone contact

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12
Q

What are the osteophytes that are seen with DJD? Where are they usually seen?

A

Outgrowths of bone in joint spaces, classically in the DIP and PIPs

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13
Q

What is the HLA haplotype that is associated with RA?

A

HLA-DR4

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14
Q

What is the hallmark of the joints with RA?

A

Pannus formation 2/2 chronic synovial inflammation (inflamed granulation tissue)

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15
Q

What happens to joints with untreated RA?

A

Destruction of cartilage and ankylosis of joints

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16
Q

What are the consequences of myofibroblast cells in the pannus of RA?

A

Cause contraction of the joint (ankylosis), or movement of the joint in difference directions

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17
Q

What happens to the pain associated with RA as patients go through their day?

A

Improves with activity (opposite of OA)

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18
Q

Is the joint involvement with RA symmetric or asymmetric? How about for OA?

A 
RA = symmetric
OA = asymmetric
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19
Q

Which hand joints are affected with RA, and which with OA?

A 
RA = MCPs
OA = DIPs

PIPs are affected in both

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20
Q

What characterizes rheumatoid nodules?

A

Central area of necrosis surrounded by epithelioid histiocytes

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21
Q

What are the two major pulmonary effects of RA?

A
  • Interstitial lung fibrosis

- Pleural effusions

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22
Q

What is rheumatoid factor?

A

IgM autoantibody against the Fc portion of IgG

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23
Q

What are the cells that are found in the synovial fluid?

A

PMNs with protein

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24
Q

What are the two major systemic complications from RA?

A
  • Anemia of chronic disease

- Secondary amyloidosis

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25
Q

What is serum amyloid converted into?

A

AA, which is then depositied into tissues

26
Q

What are the three major characteristics of seronegative spondyloarthropathies?

A
  • Lack of rheumatoid factor
  • Axial skeleton involvement
  • HLA-B27
27
Q

Who is the classic patient that has ankylosing spondylitis?

A

Young males

28
Q

What is the usual presentation of ankylosing spondylitis?

A

LBP with fusion of the vertebrae (“Bamboo spine”)

29
Q

What are the ophthalmologic complications from ankylosing spondylitis?

A

Uveitis

30
Q

What are the vascular effects associated with ankylosing spondylitis?

A

Aortitis, which causes aortic regurg d/t pulling of aorta walls from inflammation on the aortic valves

31
Q

What are the classic symptoms in Reactive (Reiter’s) arthritis?

A

Arthritis
Urethritis
Conjunctivitis

32
Q

What are the infections that usually set off a case of Reiter’s syndrome?

A
  • Chlamydia infection

- GI infection

33
Q

What are the joints that are classically affected with psoriatic arthritis?

A

Axial and peripheral, particularly the DIPs

34
Q

What is the classic hand findings of psoriatic arthritis?

A

Dactylitis (sausage finger)

35
Q

What is the most common bacterial cause of infectious arthritis?

A

Neisseria Gonorrhoeae

36
Q

Who usually gets infectious arthritis 2/2 Staph aureus infx?

A

Older children and adults

37
Q

Who usually gets infectious arthritis 2/2 Neisseria gonorrhea infx?

A

Young adults

38
Q

Is infectious arthritis usually mono or polyarticular?

A

Monoarticular

39
Q

What are the classic features of infectious arthritis?

A

Single, warm, erythematous joint with RROM and systemic symptoms

40
Q

What are the labs that are elevated with infectious arthritis?

A

Leukocytosis

Elevated ESR

41
Q

What is the chemical that is depositied in joints with gout?

A

Monosodium urate

42
Q

What are the two purines?

A

Adenosine

Guanine

43
Q

What are the DNA products that contribute to uric acid formation?

A

Purines

  • adenosine
  • Guanine
44
Q

What is AMP broken down into? What then?

A

Hypoxanthine, then xanthine

45
Q

What is GMP broken down into? What then?

A

Guanine, then xanthine

46
Q

What is the enzyme that converts xanthine into uric acid?

A

Xanthine oxidase

47
Q

What are the two basic processes that lead to gout?

A

Under excretion, vs overproduction

48
Q

What is primary gout?

A

Idiopathic hyperuricemia

49
Q

What is the enzyme that recycles hypoxanthine and guanine?

A

HGRPT

50
Q

What is the enzyme that has increased activity in Lesch-Nyhan syndrome?

A

PRPP

51
Q

What are the causes of secondary gout? (3)

A
  • Leukemia / MPDs
  • Lesch-Nyhan syndrome
  • Renal insufficiency
52
Q

The monosodium urate crystals that are deposited in gout activate what cells to produce the pain?

A

PMNs

53
Q

What is podagra?

A

Acute gout in the great toe

54
Q

Why is it that EtOH consumption increases gout?

A

EtOH competes with uric acid for excretion

55
Q

Why is it that meat precipitate gout attacks?

A

Taking in high levels of DNA

56
Q

What are tophi?

A

Uric acid crystal deposits in soft tissue or joints

57
Q

How does chronic gout lead to chronic renal disease?

A

Uric acid crystals deposit into tubules

58
Q

What are the crystal shapes with monosodium urate? How do they appear undo polarized light?

A

Needle shaped

Negatively birefringent under light

59
Q

What is the color of urate crystals under parallel polarized light? What about perpendicular?

A 
Parallele = yellow
Perp = blue
60
Q

What is pseudogout?

A

Deposition of Calcium pyrophosphate in tissues, leading to gout like s/sx

61
Q

What are the shape of the crystals with pseudogout? How do they appear under polarized light?

A
  • Rhomboid

- Positive birefringence under polarized light

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