22: Joint Pathology - Carnevale Flashcards
characterized by degeneration of the cartilage resulting in structural or functional failure of synovial joints
- osteoarthritis
- aka degenerative joint disease
most common form of arthritis
osteoarthritis
s/s osteoarthritis
- deep achy pain that worsens with use
- morning stiffness
- crepitus
- limited ROM
- can lead to joint deformity but not fusion
heberden nodes
- prominent osteophytes at the DIP joints
- common in women
what parts of the body are usually spared with osteoarthritis?
wrists, elbows, shoulders
due to osteophytes at the PIPs
bouchard nodes
early v. late OA
- early (erosion) = chondrocytes proliferate, edema, inflammation, extracellular matrix production, metalloprotease activation, which act together to remodel the cartilage and initiate changes in the synovium and subchondral bone
- late (osteophytes) = repetitive injury and chronic inflammation lead to chondrocyte drop out, marked loss of cartilage, and extensive subchodrl bone changes (microfractures, bone thickening and sclerosis, cyst formation, osteophyte formation)
tx osteoarthritis
pain management, activity modification and joint replacement
autoimmune disorder that may affect many tissues and organs but principally attacks the joints, producing a nonsuppurative proliferative and inflammatory synovitis
RA
5F:1M
what is the joint pattern for RA?
- hands ( MCP and PIP )
- feet
- wrist and ankles
- elbow and knee
- uncommon spine
- NO lumbosacral or hips
inflamed synovium
RA
describe RA s/s
- affected joints swollen, warm, painful
- particularly stiff when rising in the morning or following inactivity
- progressive joint enlargement
- decreased ROM evolving to complete ankylosis
- greatest damage in first 4-5 yrs
production of rheumatoid factor, a ____, in _____% of RA cases
- IgM autoAB to Fc portion of autologous IgF
- 80%
- citrullinated peptides CCP contribute to chronic RA
pannus formation
RA
- granulation tisue, synovial and inflamamtory cells, fibrous CT
nonsuppurative, proliferative, desdtructive synovitis
RA
ulnar deviation
RA
inflammation, pannus, bony ankylosis
RA
also see systemic lesions
less than 16 yo and persists for at least 6 weeks
juvenile idiopathic arthritis
joint pattern for juvenile idiopathic arthritis
frequently large joint oligoarthritis - knees, wrists, elbows, ankles
- systemic features too
still’s disease
febrile illness with hepatosplenomegaly, rash, and increased WBc count
- a variant of juvenile idiopathic arthritis
what are the lab results for juvenile idopathic arthritis?
ANA+ no rheumatoid factor or odules
*** 4 unifying features of seronegative spondyloarthopathies
- 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
(usually axial skeleton)
- most common subtype spondyloarthropathy
- 2.5:1 male female
- gradual onset of IBP
- acute anterior uveitis most common extra-articular manifestation
- can lead to sacroiliac fusion and spinal syndesmophyte formation
ankylosing spondylitis
- between 10-40% of pts with psoriasis
- skin disease precedes joint disease in approximately 70% cases
psoriatic arthritis
- 5-29% of pt with IBD develop arthritis
- peripheral arthrits can parallel bowel inflammation and occur in up to 20%
- spndylitis occurs in 3-6%
enteropathic (IBD-assoc) arthrtis
- typical acute asymmetric oligoarticular arthritis 1-3 mo after GI and GU infection
- triad = urethritis, conjunctivitis, and arthritis seen in 35% pts
- keratoderma blenorrhagica and circinate balanitis
reactive arthritis
80% HLAB27 positive
men in 20-30s
enthesitis
seronegative spondyloartopathies
- young adult male
- lower back pain and spinal immobility
- pain worse at rest and improves with mobility
anklyosing spondylitis
gene associated wtih anklyosing spondylitis
approx 90% pts are HLA-B27 positive
“bamboo spine”
ankylosing spndylitis
due to autoimmune reaction initiated by prior infection of GU system or GI tract
reactive arthritis
may be found in pt who are HIV pos
sausage toes
reactive arthritis
kertaderma blenorrhagica
scaly lesions associated with reactive arthritis
gram neg lipopolysaccharides stimulate a range of immunoloigcal responses
enteropathic arthritis
pitting of nails
psoriatic arthritis
sudden painful swollen joint with decreased mobility
suppurative arthritis
fever, leukocytosis, elevated ESR, neutrophils
chronic progressive monoarticular infection caused by m. tuberculosis usually from pulmonary spread
mycobacterial arthritis
chronic results in fibrous akylosis and obliteration of the joint space
monosodium urate within and around joints
gout
common feature of hyperuricemia
after ______ of hyperuricemia gout usually appear
20-30
calcium pyrophosphate deposition
pseudo-gout and chondrocalcinosis
small cyst that is located near joint capsule or tendon sheath
ganglion and synovial cysts
benign neoplasms that develop in the synovial lining of joints, tendon sheaths, and busae
tenosynovial giant cell tumor
knee in 80% of cases
