18.3 Joints Flashcards
What are solid joints?
Joints that tightly connect bones for structural strength
What are synovial joints for?
Allow space for motion
What type of collagen comprises articular cartilage?
II
What chemical is secreted from the synovium to lubricate the joint?
Hyaluronic acid
What is degenerative joint disease?
Progressive degeneration of articular cartilage, usually d/t wear and tear
What are the major risk factors for degenerative joint disease?
- Age
- Obesity
- Trauma
What are the joints that are classically affected with degenerative joint disease?
Hip
Lower lumbar spine
DIPs
PIPs
How does degenerative joint disease present?
Joint stiffness in the morning, that worsens during the day
What happens to joint pain from degenerative joint disease as patients go about their day?
Worsens
What are the hallmarks of degenerative joint disease?
- Disruption of cartilage, with fragments broken off
- Joint space narrowing
- Osteopenia
What is the eburnation that occurs with degenerative joint disease?
wearing of the bone down from bone-bone contact
What are the osteophytes that are seen with DJD? Where are they usually seen?
Outgrowths of bone in joint spaces, classically in the DIP and PIPs
What is the HLA haplotype that is associated with RA?
HLA-DR4
What is the hallmark of the joints with RA?
Pannus formation 2/2 chronic synovial inflammation (inflamed granulation tissue)
What happens to joints with untreated RA?
Destruction of cartilage and ankylosis of joints
What are the consequences of myofibroblast cells in the pannus of RA?
Cause contraction of the joint (ankylosis), or movement of the joint in difference directions
What happens to the pain associated with RA as patients go through their day?
Improves with activity (opposite of OA)
Is the joint involvement with RA symmetric or asymmetric? How about for OA?
RA = symmetric OA = asymmetric
Which hand joints are affected with RA, and which with OA?
RA = MCPs OA = DIPs
PIPs are affected in both
What characterizes rheumatoid nodules?
Central area of necrosis surrounded by epithelioid histiocytes
What are the two major pulmonary effects of RA?
- Interstitial lung fibrosis
- Pleural effusions
What is rheumatoid factor?
IgM autoantibody against the Fc portion of IgG
What are the cells that are found in the synovial fluid?
PMNs with protein
What are the two major systemic complications from RA?
- Anemia of chronic disease
- Secondary amyloidosis
What is serum amyloid converted into?
AA, which is then depositied into tissues
What are the three major characteristics of seronegative spondyloarthropathies?
- Lack of rheumatoid factor
- Axial skeleton involvement
- HLA-B27
Who is the classic patient that has ankylosing spondylitis?
Young males
What is the usual presentation of ankylosing spondylitis?
LBP with fusion of the vertebrae (“Bamboo spine”)
What are the ophthalmologic complications from ankylosing spondylitis?
Uveitis
What are the vascular effects associated with ankylosing spondylitis?
Aortitis, which causes aortic regurg d/t pulling of aorta walls from inflammation on the aortic valves
What are the classic symptoms in Reactive (Reiter’s) arthritis?
Arthritis
Urethritis
Conjunctivitis
What are the infections that usually set off a case of Reiter’s syndrome?
- Chlamydia infection
- GI infection
What are the joints that are classically affected with psoriatic arthritis?
Axial and peripheral, particularly the DIPs
What is the classic hand findings of psoriatic arthritis?
Dactylitis (sausage finger)
What is the most common bacterial cause of infectious arthritis?
Neisseria Gonorrhoeae
Who usually gets infectious arthritis 2/2 Staph aureus infx?
Older children and adults
Who usually gets infectious arthritis 2/2 Neisseria gonorrhea infx?
Young adults
Is infectious arthritis usually mono or polyarticular?
Monoarticular
What are the classic features of infectious arthritis?
Single, warm, erythematous joint with RROM and systemic symptoms
What are the labs that are elevated with infectious arthritis?
Leukocytosis
Elevated ESR
What is the chemical that is depositied in joints with gout?
Monosodium urate
What are the two purines?
Adenosine
Guanine
What are the DNA products that contribute to uric acid formation?
Purines
- adenosine
- Guanine
What is AMP broken down into? What then?
Hypoxanthine, then xanthine
What is GMP broken down into? What then?
Guanine, then xanthine
What is the enzyme that converts xanthine into uric acid?
Xanthine oxidase
What are the two basic processes that lead to gout?
Under excretion, vs overproduction
What is primary gout?
Idiopathic hyperuricemia
What is the enzyme that recycles hypoxanthine and guanine?
HGRPT
What is the enzyme that has increased activity in Lesch-Nyhan syndrome?
PRPP
What are the causes of secondary gout? (3)
- Leukemia / MPDs
- Lesch-Nyhan syndrome
- Renal insufficiency
The monosodium urate crystals that are deposited in gout activate what cells to produce the pain?
PMNs
What is podagra?
Acute gout in the great toe
Why is it that EtOH consumption increases gout?
EtOH competes with uric acid for excretion
Why is it that meat precipitate gout attacks?
Taking in high levels of DNA
What are tophi?
Uric acid crystal deposits in soft tissue or joints
How does chronic gout lead to chronic renal disease?
Uric acid crystals deposit into tubules
What are the crystal shapes with monosodium urate? How do they appear undo polarized light?
Needle shaped
Negatively birefringent under light
What is the color of urate crystals under parallel polarized light? What about perpendicular?
Parallele = yellow Perp = blue
What is pseudogout?
Deposition of Calcium pyrophosphate in tissues, leading to gout like s/sx
What are the shape of the crystals with pseudogout? How do they appear under polarized light?
- Rhomboid
- Positive birefringence under polarized light
