2.1.2 Bone and Joint Pathology II Flashcards
What is this an image of?
Pseudogout
The crystals first develop in the articular cartilage, menisci, and intervertebral discs, and as the deposits enlarge, they may rupture and seed the joint. The crystals form chalky, white friable deposits, which are seen histologically in stained preparations as oval blue-purple aggregates
What are the clinical symptoms associated with RA?
What are some of the criteria to diagnose RA?
Morning stiffness
Arthritis in 3 or more joint areas
Arthritis of typical hand joints
Symmetric arthritis
Rheumatoid nodules
Serum Rheumatoid Factor
Typical radiographic changes
What is Rheumatoid Arthritis?
Proliferative and inflammatory synovitis
Destruction of the articular cartilage and ankylosis of the joints
Autoimmune disease triggered by exposure of a genetically susceptible host to an unknown arthritogenic antigen
Activation of CD4+ helper T cells - releasing cytokines - IL-1 and TNF
Destruction of joint
What are the skin and blood vessel symptoms associated with RA?
What is pannus formation associated with RA?
Mass of synovium and synovial stroma consisting of inflammatory cells, granulation tissue and fibroblasts
It can grow over articular cartilage and cause erosion.
What are some possible results of osteoarthritis?
Articular cartilage is degraded
Friction smooths and burnished the exposed bone - eburnation
Dislodged pieces of cartilage may tumble in the joint
Osteophytes - bony out growths
Who are the main culprits in infectious arthritis?
What is this an image of?
Diagram of osteoarthritis
Describe the pathogenesis of osteoarthritis
Draw a chart describing the process of Rheumatoid Arthritis pathogenesis?
Summarize the other diseases in this lecture
What are the clinical symptoms of osteoarthritis?
Morning stiffness
Crepitus
Aggravated by activity
Limitation of range of movement
Impingement on spinal foramina by osteophytes
Heberden’s nodes = prominent osteophytes at DIP
What are these images of?
Gouty Arthritis
Draw a diagram pointing out the differences between Osteoarthritis and Rheumatoid Arthritis.
Left - Osteoarthritis
Right - Rheumatoid
What are the characteristics of Lyme arthritis?
Lyme Arthritis
Lyme arthritis is caused by infection with the spirochete Borrelia burgdorferi, which is transmitted by deer ticks of the Ixodes ricinus complex. It is the leading arthropod borne disease in the United States. In its classic form, Lyme disease progressively involves multiple organ systems, as outlined in Chapter 8 . The initial infection of the skin is followed within several days or weeks by dissemination of the organism to other sites, especially the joints.
Approximately 60% to 80% of untreated individuals with the disease develop arthritis during the late stage. The arthritis primarily involves large joints, especially the knees, shoulders, elbows, and ankles in descending order of frequency. Usually one or two joints are affected at a time, and the attacks last for a few weeks to months, migrating to new sites. Spirochetes can only be identified in about 25% of joints with arthritis but the diagnosis can be confirmed by serologic testing for anti-Borrelia antibodies. The majority of individuals respond to antibiotic therapy
What are some key histological findings associated with Rheumatoid Arthritis?
Intense inflammatory infiltrate - leading to possible germinal centers
Synovial hyperplasia
What is this an image of?
Gouty Arthritis
Monosodium Urate crystals
What is this an image of?
Osteoarthritis
You can see osteophyte on the far left
What are the characteristics of Reactive Arthritis (Reiter’s Disease)?
Reactive Arthritis
Reactive arthritis is defined by a triad of arthritis, non-gonococcal urethritis or cervicitis, and conjunctivitis . Most affected individuals are men in their 20s or 30s, and more than 80% are HLA-B27 positive. This form of arthritis also affects individuals infected with the human immunodeficiency virus (HIV). The disease is probably caused by an autoimmune reaction initiated by prior infection of the genitourinary system ( Chlamydia ) or the gastrointestinal tract ( Shigella, Salmonella, Yersinia, Campylobacter ).
Arthritic symptoms develop within several weeks of the inciting bout of urethritis or diarrhea. Joint stiffness and low back pain are common early symptoms. The ankles, knees, and feet are affected most often, frequently in an asymmetric pattern. Synovitis of a digital tendon sheath produces the sausage finger or toe, and ossification of tendo-ligamentous insertion sites leads to calcaneal spurs and bony outgrowths. Patients with severe chronic disease have involvement of the spine that is indistinguishable from ankylosing spondylitis. Extra-articular involvement manifests as inflammatory balanitis, conjunctivitis, cardiac conduction abnormalities, and aortic regurgitation. The episodes of arthritis usually wax and wane over several weeks to 6 months. Almost 50% of affected individuals have recurrent arthritis, tendonitis and lumbosacral pain.
What is this an image of?
Rheumatoid nodule composed of central necrosis rimmed by palisaded histiocytes.
What is osteoarthritis? What is the difference between primary and secondary?
Osteoarthritis, also called degenerative joint disease, is characterized by degeneration of cartilage that results in structural and functional failure of synovial joints.
What is this an image of?
Gouty Tophus
Tophi are the pathognomonic hallmark of gout They are formed by large aggregations of urate crystals, surrounded by an intense inflammatory reaction of foreign body giant cells. ( Fig. 26-47 B,C ). Tophi may appear in the articular cartilage, ligaments, tendons, and bursae. Less frequently they may occur in soft tissues (earlobes, fingertips) or kidneys. Superficial tophi can ulcerate through the overlying skin.
What are these images of?
Pseudogout crystals
What are the characteristics of Juvenile Rheumatoid Arthritis (JRA)?
What are the characterisitic hand deformities associated with RA?
What are these images of?
Osteoarthritis
What are the characteristics of Pseudogout?
What is this an image of?
Septic Arthritis
What are the characteristics of gouty arthritis?
What are the characteristics of Psoriatic Arthritis?
Psoriatic arthritis is a chronic inflammatory arthropathy associated with psoriasis that affects peripheral and axial joints and entheses (ligaments and tendons). Susceptibility to the disease is genetically determined and related to HLA-B27 and HLA-Cw6 alleles. Symptoms manifest between the ages of 30 and 50. It develops in more than 10% of the psoriatic population, usually concurrently or following the onset of skin disease. Although the sacroiliac joints are involved in 20% of patients, this is predominantly a peripheral arthritis of the hands and feet. The distal interphalangeal joints of the hands and feet are first affected in an asymmetric distribution in more than 50% of patients, producing the characteristic “pencil in cup” deformity (unlike RA, which you will recall typically involves the proximal interphalangeal joints). Histologically, psoriatic arthritis is similar to rheumatoid arthritis. Psoriatic arthritis, however, is usually not as severe, remissions are more frequent, and joint destruction is less frequent.
What is this an image of?
Heberden’s Nodes
What are the characteristics of Seronegative Spondyloarthropathies?
Seronegative Spondyloarthropathies
The spondyloarthropathies are also a heterogeneous group of disorders that are unified by the following features:
- Pathologic changes in the ligamentous attachments rather than synovium
- Involvement of sacroiliac joints, with or without other joints
- Absence of rheumatoid factor
- Association with HLA-B27
The manifestations are immune mediated and are triggered by a T-cell response presumably directed against an undefined antigen, likely infectious, that may cross-react with native molecules of the musculoskeletal system (molecular mimicry).
In this normal joint what are the covered parts?
What is this an image of?
RA of the hand
Characteristic features include diffuse osteopenia, marked loss of the joint spaces of the carpal, metacarpal, phalangeal, and interphalangeal joints, periarticular bony erosions, and ulnar drift of the fingers.
Summarize Osteoarthritis and RA
