22: Joint Pathology - Carnevale

Question 1

characterized by degeneration of the cartilage resulting in structural or functional failure of synovial joints

Answer 1

• osteoarthritis

- aka degenerative joint disease

Question 2

most common form of arthritis

Answer 2

osteoarthritis

Question 3

s/s osteoarthritis

Answer 3

• deep achy pain that worsens with use
• morning stiffness
• crepitus
• limited ROM
• can lead to joint deformity but not fusion

Question 4

heberden nodes

Answer 4

• prominent osteophytes at the DIP joints

- common in women

Question 5

what parts of the body are usually spared with osteoarthritis?

Answer 5

wrists, elbows, shoulders

Question 6

due to osteophytes at the PIPs

Answer 6

bouchard nodes

Question 7

early v. late OA

Answer 7

• 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)

Question 8

tx osteoarthritis

Answer 8

pain management, activity modification and joint replacement

Question 9

autoimmune disorder that may affect many tissues and organs but principally attacks the joints, producing a nonsuppurative proliferative and inflammatory synovitis

Answer 9

RA

5F:1M

Question 10

what is the joint pattern for RA?

Answer 10

• hands ( MCP and PIP )
• feet
• wrist and ankles
• elbow and knee
• uncommon spine
• NO lumbosacral or hips

Question 11

inflamed synovium

Answer 11

RA

Question 12

describe RA s/s

Answer 12

• 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

Question 13

production of rheumatoid factor, a ____, in _____% of RA cases

Answer 13

• IgM autoAB to Fc portion of autologous IgF
• 80%
• citrullinated peptides CCP contribute to chronic RA

Question 14

pannus formation

Answer 14

RA

- granulation tisue, synovial and inflamamtory cells, fibrous CT

Question 15

nonsuppurative, proliferative, desdtructive synovitis

Answer 15

RA

Question 16

ulnar deviation

Answer 16

RA

Question 17

inflammation, pannus, bony ankylosis

Answer 17

RA

also see systemic lesions

Question 18

less than 16 yo and persists for at least 6 weeks

Answer 18

juvenile idiopathic arthritis

Question 19

joint pattern for juvenile idiopathic arthritis

Answer 19

frequently large joint oligoarthritis - knees, wrists, elbows, ankles
- systemic features too

Question 20

still’s disease

Answer 20

febrile illness with hepatosplenomegaly, rash, and increased WBc count
- a variant of juvenile idiopathic arthritis

Question 21

what are the lab results for juvenile idopathic arthritis?

Answer 21

ANA+ no rheumatoid factor or odules

Question 22

*** 4 unifying features of seronegative spondyloarthopathies

Answer 22

• 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)

Question 23

• 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

Answer 23

ankylosing spondylitis

Question 24

• between 10-40% of pts with psoriasis

- skin disease precedes joint disease in approximately 70% cases

Answer 24

psoriatic arthritis

Question 25

- 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%

Answer 25

enteropathic (IBD-assoc) arthrtis

Question 26

- 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

Answer 26

reactive arthritis 80% HLAB27 positive men in 20-30s

Question 27

enthesitis

Answer 27

seronegative spondyloartopathies

Question 28

- young adult male - lower back pain and spinal immobility - pain worse at rest and improves with mobility

Answer 28

anklyosing spondylitis

Question 29

gene associated wtih anklyosing spondylitis

Answer 29

approx 90% pts are HLA-B27 positive

Question 30

"bamboo spine"

Answer 30

ankylosing spndylitis

Question 31

due to autoimmune reaction initiated by prior infection of GU system or GI tract

Answer 31

reactive arthritis may be found in pt who are HIV pos

Question 32

sausage toes

Answer 32

reactive arthritis

Question 33

kertaderma blenorrhagica

Answer 33

scaly lesions associated with reactive arthritis

Question 34

gram neg lipopolysaccharides stimulate a range of immunoloigcal responses

Answer 34

enteropathic arthritis

Question 35

pitting of nails

Answer 35

psoriatic arthritis

Question 36

sudden painful swollen joint with decreased mobility

Answer 36

suppurative arthritis fever, leukocytosis, elevated ESR, neutrophils

Question 37

chronic progressive monoarticular infection caused by m. tuberculosis usually from pulmonary spread

Answer 37

mycobacterial arthritis chronic results in fibrous akylosis and obliteration of the joint space

Question 38

monosodium urate within and around joints

Answer 38

gout common feature of hyperuricemia

Question 39

after ______ of hyperuricemia gout usually appear

Answer 39

20-30

Question 40

calcium pyrophosphate deposition

Answer 40

pseudo-gout and chondrocalcinosis

Question 41

small cyst that is located near joint capsule or tendon sheath

Answer 41

ganglion and synovial cysts

Question 42

benign neoplasms that develop in the synovial lining of joints, tendon sheaths, and busae

Answer 42

tenosynovial giant cell tumor knee in 80% of cases