2nd half of Arthritis Lecture (slide 56 on) Flashcards
Calcium Deposition Diseases: -calcium can be deposited in joint _____
soft tissues in a number of entities
Calcium Deposition Diseases: -Calcification can be in:
articular cartilage, menisci, tendons, soft tissues, and bursae
**Chondrocalcinosis is technically the term for a condition of calcification of soft tissue articular structures as seen on imaging studies, calcifications seen in _____
cartilage, menisci, cruciate ligaments, and synovium with calcium compound crystals.
Chondrocalcinosis is found in a number of disease processes including: (hint: there’s a lot)
Calcium Pyrophosphate Dihydrate Crystal Deposition Disease (CPDCDD is sometimes called Chondrocalcinosis and Pseudogout!!), Pseudogout, Tophaceous Pseudogout, Osteoarthritis, Familial CPPDDD, Basic Calcium Phosphate Crystal Deposition Disease, gout, hyperparathyroidism, hemochromatosis, hypophosphatasia, hypomagnesemia, ochronosis, Wilson’s Disease, acromegaly and entities mimicking rheumatoid arthritis, osteoarthritis and neuropathic arthropathy.
Calcium Pyrophosphate Dihydrate Crystal Deposition occurs in a number of disease entities, including the following:
Pseudogout, Tophaceous Pseudogout, Familial Calcium Pyrophosphate Dihydrate Deposition, and Osteoarthritis, pseudoosteoarthritis, pseudorheumatoid arthritis, and pseudoneuropathic arthropathy. (notes: just know that calcium will deposit into soft tissue, BUT there are also disease processes that deposit calcium into the joints)
Chondrocalcinosis is the condition of ______ _____ _____ calcifications as seen on medical imaging studies.
articular soft tissue
Calcium Pyrophosphate Dihydrate crystals are deposited in ______
articular soft tissues in a number of disease entities –>Need a joint aspiration to determine
Pseudogout is one of several disease entities in which calcium pyrophosphate dihydrate crystals are deposited in the _______
articular soft tissues
_______ is the MC of the calcium deposition arthropathies
pseudogout -The source of confusion: Pseudogout is also known as Calcium Pyrophosphate Deposition Disease, Calcium Pyrophosphate Dihydrate Deposition Disease, and Chondrocalcinosis, and some include it in a separate category as one of the CPPD Disease
Pseudogout: -is a disease of _____ -symptoms? -____ deposits cause an inflammatory gout-like process
-It is a disease of aging -It may be asymptomatic -Synovial (and fibrous and hyaline articular cartilage) Calcium Pyrophosphate crystal deposits cause an inflammatory gout like process
Gout itself is the accumulation of:
articular monosodium urate monohydrate crystals
Calcium Deposition – Chondrocalcinosis
note yellow arrows (Ca 2+ deposition)
Calcium Deposition – ChondrocalcinosisCPPDD
-**Note evidence of laxity of scapholunate ligament
Avascular Necrosis=Osteonecrosis aka Aseptic Necrosis: -usually seen in the _____ -how common?
-**femoral head -Increasingly common, accounts for 10% of Total Hip Replacements
Femoral Head is an end organ system with poor collateral circulation. Compromise of the arterial supply, especially the _____ _____ artery, causes ischemia.
**medial circumflex artery
Femoral head avascular necrosis can be seen 2/2: (lots of things)
-Trauma -Vasculitis -Vasospasm–>decompression -Circulating microemboli: –Hemoglobinopathies (Sickle Cell Disease) –Fat emboli –Hypercoagulable States –Decompression Sickness -Steroid Therapy -Alcoholism -Pancreatitis -Dialysis
Normal Hip: Normally there are thickened and prominent _______ seen in the Femoral Head. Maximal strength with minimal mass in response to _______
*trabeculae -mechanical stress.
Normal Hip MR: note _____
*symmetry
Avascular Necrosis: -imaging findings?
-Note mild osteoarthritis characterized by joint space narrowing, periarticular sclerosis and osteophytosis. -Note superimposed flattening of the femoral head indicating osteonecrosis with subchrondral fracture and buckling of the underlying trabeculae -Note: distorted trabeculae and collapse of subchondral bone
Describe Avascular Necrosis in the scaphoid bone -This is seen with which demographic?
-Similar phenomenon occurs in Scaphoid bone with compromised circulation -Seen with: alcoholism, steroids, Bends, arterial embolism/thrombosis, & Sickle Cell Anemia.
Avascular necrosis: -describe the circulation to the femoral head -Tx?
The blood supply to the Femoral head is primarily via the *Medial circumflex femoral artery, and to a lesser extent the *Lateral Circumflex artery. -There is also blood flow via the artery to the Ligamentum teres (a branch of the Obturator artery) -Compromise to this latter artery can also lead to Avascular Necrosis of the Femoral Head –tx of AVN–> replace the femoral head usually since you usually lose integrity of articular surfaces
Neuropathic ArthropathyCharcot’s Joint: describe this condition
-risk factors? (which Pt demographic)
=loss of deep sensation and proprioception–>leads to recurrent trauma and progressive destruction, degeneration, and disorganization of the joint. (they have repeated
- Also to be considered is neuromediated vascular reflex causing hyperemia and bone resorption.
- Diabetes, trauma, steroids, alcoholism, neurological and spinal disorders
Neuropathic ArthropathyCharcot’s Joint: -signs?
Joint effusions, destruction of articular surfaces, bone fragmentation, subluxation, osteophytosis, sclerosis
Neuropathic joint
