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Bone Pathology 2 > Arthritis > Flashcards

Arthritis Flashcards

0
Q

What are the 5 types of degenerative arthritis?

A

DJD, DISH, SYnoviochondrometaplasia, neuropathic, erosive OA

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1
Q

What are the three types of arthritis?

A

Degenerative, inflammatory, metabolic

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2
Q

What are 7 types of inflammatory arthritis

A

RA,seronegative spondylopathy, sle, scleroderma, osteitis pubis, osteitis condensen ill, hypertrophic osteoarthropathy.

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3
Q

What are the seronegative spondylopathies

A

AS, psoriatic, reiters, enteropathic

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4
Q

What are the 4 types of metabolic

A

Gout, cppd, had, ochronosis

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5
Q

Out of DJD, inflammatory or metabolic which one is symmetric?

A

Some inflammatory

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6
Q

Out of DJD inflammatory, metabolic which one only effects one joint

A

Metabolic, DJD is variable

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7
Q

Which of the three has osteophytes? Which one has syndesmophytes?

A

DJD - osteophytes, inflammatory- syndesmophytes

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8
Q

Which one more likes causes erosion?

A

Inflammatory, some metabolic

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9
Q

Which one is associated with periostitis?

A

Inflammatory

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10
Q

Which one has decreased bone density?

A

Inflammatory

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11
Q

What is the most common joint disease

A

DJD(aka osteoarthritis)

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12
Q

What is the prevalence for OA

A

M>F until 45, then opposite

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13
Q

What is the pathology of OA?

A 
Focal cartilage degeneration, gradually larger
Synovial hypertrophy
Cartilage metaplasia
Growth of subchondral bone
Deformity of articular surface
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14
Q

What are causes of DJD

A

1-idiopathic

2- trauma, infection,other arthropathies

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15
Q

What is the clinical presentation for OA/DJD?

A 
Insidious onset with intermittent flares
Aching pain
Stiffness (relieved by activity, brought on by rest)
Swelling, crepitus, decreases ROM, 
No lab changes
Muscle atrophy
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16
Q

What are complications of OA/DJD

A

Stenosis and altered biomechanics

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17
Q

What are the locations for OA/DJD

A

Small joints of hands/feet: DIPs,1st metatarsalphalangeal, 1st carpometacarpal joint
Weight bearing: spine, hips, knees
AC joint
Potentially any other joint

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18
Q

Radio graphic findings for OA?

A

Asymmetric distb, nonuniform joint space loss, osteophytes, subchondral sclerosis/cysts, joint subluxation, articular surface deformity, intraarticular osteochondral bodies.

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19
Q

What are common sites for spinal DJD ?

A

Lower Cx and Lx.

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20
Q

What is DJD of the IVD called? What are the clinical features of it?

A

It is called spondylosis.
Clinical features: loss of disc ht, osteophytes, end plate sclerosis, vacuum cleft phenomenon, retrolisthesis, central stenosis uncommon, c-spine( intercalary bone, triangular ossicle at anterior disc space)

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21
Q

Uncvertebral joints are usually assc with what type of DJD? And what happens when this occurs?

A

Assc with IVD DJD.

Uncinates sharpen first, then hypertrophic changes, pseudofx in lateral view, IVD narrows.

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22
Q

DJD of the facet joints usually results in anterolisthesis than retro, occurs mostly in cx spine, causes lateral recess stenosis, uncommon in C0-1,1-2 and Thx .

A

True

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23
Q

What part of spine is coastal joint DJD more common and what is the most common change?

A

Lower tx. Sclerosis, osteophytes ( pain mimics visceral disease pain)

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24
Q

What is bastruups syndrome?

A

“Kissing spines” assc with excesss lordosis and DDD. Can be symptomatic or asymtomatic.

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25
Q

How does the SI joint get affected by DJD?

A

Lower 2/3’s of the joint. Joint space loss hard to see on X-rays ( mild changes). Subchondral sclerosis seen with osteophytes.

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26
Q

How does DJD affect the hip joint?

A

M/C affects the superior portion. Large subchondral cysts. Femoral head goes superior and laterally. Osteophytes best seen on lateral/infermedial portion. Medial femoral neck buttressing. Advanced DJD= malus coaxe senilis

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27
Q

How does DJD affect the knee? (At the femorotibial joint)

A

Affects medial side more than lateral. Do weight bearing films. Osteophytes, cysts and mild sclerosis seen =Sharpening of the tibial plateaus. Osteochondral bodies common.

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28
Q

How does DJD affect the patellofemoral joint?

A

Osteophytes at superior and inferior poles. “Tooth” sign. ( enthesopathy)

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29
Q

What are uncommon sites for DJD

A

Ankle, inter tarsal, GH, elbow, wrist ( except Ray 1), metacarpalphalangeal, suspected secondary DJD

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30
Q

What are treatments for DJD?

A

Diet, STM, chiro, monitor for complications

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31
Q

Is erosive OA is symmetric?

A

Yes, symmetric DIP and PIP involved

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32
Q

What population does EOA usually affect?

A

Females 30-50 years old

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33
Q

What is the onset of EOA

A

Acute inflammatory episodes with chronic progression

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34
Q

Approximately how many EOA pt develops RA

A

15%

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35
Q

What are key radio graphic changes for EOA?

A

Severe DJD, central erosions, gull wing sign, periostitis

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36
Q

What are some DDx for EOA

A

DJD. RA . Psoriatic.

37
Q

Which of the EOA DDx conditions affect dips and which one affects pip

A

EOA and DJD and psoriatic affect dip

EOA, DJD and RA affect pip

38
Q

Of EOA, DJD, RA and psoriatic which one has lab changes (esr inc)

A

All but DJD. RA has rf presence too

39
Q

Of EOA, DJD, RA and psoriatic which ones have central erosions? Which ones marginal? Which ones none?

A

Central EOA, marginal RA psoriatic, none- DJD

40
Q

What does DISH stand for?

A

Diffuse Idiopathic Skeletal Hyperostosis

41
Q

What happens in DISH

A

Spinal (esp. ALL) and extraspinal ligaments and tendons calicify and ossify.

42
Q

DISH occurs in what percentage of the US popn

A

12% of the US popn over 40

43
Q

What are symptoms of DISH

A

Asymptomatic to sometimes mild pain/stiffness. 20% experience dysphagia. Joint motion is usually unaffected. Decreased lordosis, increased kyphosis

44
Q

What are common sites of involvement for DISH?

A

M/C in Tx/Lower Cx/Upper Lx Spine. Superior SI joint. Extraspinal/enthesopathy”whiskering” (pelvis, patella, calcaneus, elbow)

45
Q

What are clinically significant changes of DISH

A

OPLL in 50%. 50% also have DIABETES. Spinal stenosis d/t involvement of PLL, Ligamentum Flavum. Predisposition to new bone formation complicates joint prostheses.

46
Q

What are radiographic findings of DISH

A

Thick flowing hyperostosis anterior to spine. 4 continous levels. Disc spaces maintained. No facet involvement. Lucent cleft seperates from anterior vertebral body and horizontal clefts at IVD

47
Q

What are some DDX for DISH

A

DISH, DDD, AS, Psoriatic/Reiters

48
Q

How is the IVD different in DDD versus DISH/AS/Reiters/Psoriatic

A

IVD in DDD is decreased and maintained in DISH, Psoartic/Reiters and also in AS (ballooned SI fusion early)

49
Q

What is the ossification pattern of DISH/DDD/AS/Psoartic

A

DISH- thick flowing mid body. DDD- nonmarginal “claw”. AS- Thin marginal. Psoartic- Thick, non marginal.

50
Q

What is OPL

A

thickening/ossification of PLL. Strong associatino with DISH (85%) can exist independantly. can be asymptomatic. may produce myelopathy (esp in Cx. spine). Dense strip paralleling posterior vertebral body margins (CT/MRI)

51
Q

What is the treatment for DISH?

A

none. address symptoms. monitor for cx stenosis. conservatively tx for stenosis or surgery.

52
Q

What is neuropathic arthropathy

A

secondary to loss of sensory/proprioceptive info. (diabetes, alcholism, tabes dorsalis, paralysis, syringomyelia). essentially severe, destructive DJD

53
Q

What are the 6 D’s of neuropathic arthropathy’s radiographic findings

A

Distended joint, Density increase, Debris, Dislocation, Disorganization, Destruction. (atrophic/resorption)

55
Q

What are the clinical presentation of neuropathic arthropathy

A

May develop over weeks, months, years. Signs of neurologic loss, early: recurrent painless effusions. painless instability. enlargement. crepitus “Bag of Bones”

56
Q

What is Synoviochondrometaplasia?

A

metaplastic changes in sWhatynovium produce cartilaginous bodies (which may or may no calicify/ossify and may or may not be free within joint capsule)

57
Q

What is another name of Synoviochondrometaplasia?

A

Chondromatosis and Osteochondromatosis.

58
Q

What are radiographic features of SCM

A

Multiple round/oval well defined lesions (osseous/cartilag. densities within the joint capsule.
Cannot see on plain film if not calcified/ossified (approx 20% are)..athroscopy/mri if not
Erosive defects and/or signs of DJD may be seen in surrounding bone/joint

59
Q

What are Signs and Symptoms of SCM

A

Asymptomatic, Joint locking, Crepitus, Pain, Effusion, Reduced motion, Secondary DJD. Symtoms are usually mild and chronic with slow progressive increase

60
Q

What is the age and gender for SCM

A

20-50 YO. M:F 3;1

61
Q

Where is is more likely to be found?

A

70% at knee

can occur at any joint with synovium. elbow/hip/ankle/shoulder/wrist

62
Q

What are potential DDx for SCM

A

Osterochondritis dissecans, Single Osteochondral body (defect in host bone), Ossicle secondary to DJD, Neuropathic Arthroprathy, PVNS, Normal Sesamoids.

63
Q

What is the prognosis and treatment for SCM

A

Significant risk of secondary DJD. Questionable rare risk of malignant transformation, surgical removal indicated, recurrent is uncommon.

64
Q

What is RA

A

Generalized CT disorder, Autoimmune, Targets synovial tissue, Bilateral symmetry, Progressive

65
Q

What sites does RA usually effect

A

Articulations (hand, feet, larger joints, cx spine), heart lungs, BV’s, NS, eyes and reticuloendothelial tissue.

66
Q

What are the Pathological features of RA

A

antigen/antibody complex deposited in synovium with resulting inflammatory cascade. Acute synovitis: edema, congestion, effusion, hyperemia. Synovial proliferation= pannus

67
Q

What is pannus?

A

hypertrophied vascular granulation tissue.

68
Q

What is the pathalogical feature of RA

A

Pannus erodes bone and articular cartilage
Enthesopathy (mostly at SP but largely uncommon in RA)
Rheumatoid nodules (20% of pts)

69
Q

What lab tests are positive for RA

A

RF, ESR, CRP, NN Anemia, Synovial fluid elevations, Synovium Biopsy

70
Q

What are the peak demographics for RA

A

Onset 20-60, peaks at 40-50. F>M X3 till age 40 then 1:1.

71
Q

Where do changes for RA usually begin?

A

Changes typically being at the metacarpophalangeal joint and PIP, wrist and LATER progress to larger joints and spine

72
Q

What are some physical findings for RA

A

Fatigue, Malaise, Weakness, Fever, Morning stiffness that lasts more than one hour, Pain with motion/tenderness. ST swelling/Joint Effusion, no redness, Bilateral/Symmetrical jt swelling (except DIP), Subcutaneous nodules

73
Q

What are key Radiographic findings for RA

A 
Periarticular ST swelling, osteoporosis, Marginal erosions****. Bilateral symmetry, site and degree. Uniform joint space loss. 
Periostitis, single or solid layer
Lareg pseudocyts
Deformaties
Secondary DJD
Ankylosis
74
Q

What are causes for the deformity

A

Cartilage loss, capsule changes, tendon rupture/contracture, msl weakness, osseous destruction

75
Q

Where does RA affect the hand?

A

MCP, PIP, NOT DIPS. You will see spindle digit / sT swelling, marginal erosions esp. in radial margins of 2nd and 3rd MC head esp in Norgaard ot ballcatcher’s view.

76
Q

What are some hand deformities called in RA

A

1) Boutinere: DIP extension, PIP flexion
2) Swan neck: DIP flecion, PIP extension
3) Zig-Zag:Ulnar deviation at MCP joint, Radial deviation of carpals

77
Q

At the wrist what bone is most effected by RA

A

Ulnar styloid erosion. (also radiocarpal joint, triquetrum-pisiform)

78
Q

What is the Spotty carpal sign assc with

A

gout, TB, Sudeck’ atrophy

79
Q

What in the foot is affected by RA

A

Metatarsalphalangeal joint (MTP) and 1st IP and calcaneus erosions (plantar aponeurosis, achilles tendon insertion)

80
Q

What is the Lanois deformity

A

Fibular deviation and flexion of the foot, due to RA

81
Q

What part of the spine does RA affect the most

A

Cx spin 50-80%. few at TL. In Cx spine you will see dens erosion, C1/2 instability, Pseudobasilar invagination, facet involvement, stairstepping and IVS involvment. ** Pencil sharp SP**

82
Q

What are the other joints that RA effects

A

Hip, Knee, SI joint, Shoulder, Elbow and Ankle

83
Q

How does RA affect the Chest?

A

Pericarditis, Pulmonary nodules, Diffuse interstitial fibrosis, pleural effusions, Rib erosions

84
Q

What is the treatment for RA

A

Refer out to Rheumotologist (DMARDS, life modification, support)

85
Q

What is the prognosis for RA

A

Wide prognosis, variable with severity and onset

86
Q

What is JRA

A

one of the several forms of juvenile chronic polyarthritis. Similar to adult onset RA. before age 16. prognosis is good

87
Q

What is seropositive JRA and seronegative JRA

A

Seropositive: RF positive, adult form, poorest prognosis. 10% of pts
Seronegative: 3 presentations. Polyarticular, Pauciarticular, and classic systemic disease

88
Q

What is a key radiographic findings for JRA

A

Ankylosis frequent at the wrist, ankle and cx facets with ballooned epiphysis or premature fusion. more frequent periosteal response and changes are similar to adults but less destructive

89
Q

What is AS

A

It is a chronic inflammatory process that has no known etiology. Found to largely affect the axial skeleton. Affects younger males. Bony akylosis/Ligament ossification, enthesopathy. aka Marie Strumpells Ds

90
Q

What are key clinical features of AS

A

Onset usually 15-35 YO, M»»F 9:1. LBstiffness, ache, esp in early AM. Involves the eyes, heart and great vessels, lungs, GI, GU tracts. Increased ESR and positive HLAB27

91
Q

What is the pathology for AS

A

Synovial joints: inflammation, synovial proliferation, pannus, cartilage and bone destruction, fibrosis/anylosis
Entheses: Inflammation leading to erosion and repair leading to ossification

92
Q

What are radiographic findings for AS

A

Starts in the SI joints/ TL. Erosion leads to ankylosis. Typically bilateral and symmetric

Bone Pathology 2 (1 decks)

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