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Musculoskeletal Physiopathology > Arthritis & Ankylosis > Flashcards

Arthritis & Ankylosis Flashcards

1
Q

juvenile idiopathic arthritis

How common is seropositive arthritis?

A

Fewer than 10% of juvenile arthritis cases

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2
Q

juvenile idiopathic arthritis

Is seropositive arthritis more common in males or females?

A

Females in 80% of cases

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3
Q

juvenile idiopathic arthritis

___% of those with seropositive arthritis will develop severe disease

A

> 50%

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4
Q

Seronegative polyarticular arthritis without systemic symptoms makes up ___% of juvenile arthritis cases

A

25%

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5
Q

juvenile idiopathic arthritis

Are the majority of those with seronegative polyarticular arthritis without systemic symptoms male or female?

A

90% female

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6
Q

juvenile idiopathic arthritis

Seronegative polyarticular arthritis with systemic symptoms makes up ___% of polyarticular juvenile cases

A

20%

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7
Q

juvenile idiopathic arthritis

Are the majority of those with seronegative polyarticular arthritis with systemic symptoms male or female?

A

60% male

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8
Q

juvenile idiopathic arthritis

Which of the following conditions is more likely to lead to severe arthritis?

  • Seronegative polyarticular arthritis without systemic symptoms
  • Seronegative polyarticular arthritis with systemic symptoms
A

Those with systemic symptoms (25% vs <15% for those without)

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9
Q

juvenile idiopathic arthritis

Name 8 systemic symptoms that may arise with seronegative polyarticular arthritis

A
  • Fever
  • Rash
  • Hepatosplenomegaly (common in mono)
  • Lymphadenopathy (armpits/groin pain with enlarged nodes)
  • Pleuritis
  • Pericarditis
  • Anemia (chronic disease, fatigue)
  • Leukocytosis
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10
Q

juvenile idiopathic arthritis

How many joints are involved in seronegative pauciarticular arthritis?

A

Only a few large joints: knee, ankle, elbow, hip

(less than five)

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11
Q

juvenile idiopathic arthritis

Seronegative pauciarticular arthritis more frequently affects which sex?

A

Females (80%)

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12
Q

juvenile idiopathic arthritis

What sorts of arthritic and ocular damage occur for female seronegative pauciarticular arthritis cases?

A

1/3 of patients have ocular inflammation of the iris and ciliary body
Most have no long-term arthritic or ocular damage, usually self-limiting

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13
Q

juvenile idiopathic arthritis

What sorts of arthritic and ocular damage occur for male seronegative pauciarticular arthritis cases?

A

Few have ocular inflammation of the iris and ciliary body
Most have no long-term arthritic or ocular damage, but some develop ankylosing spondylitis

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14
Q

Inflammatory joint pathologies are characterized by an ___ response

A

osteolytic

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15
Q

Inflammatory joint pathologies have potential for ___ joint fusion

A

fibrous or osseous

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16
Q

Are inflammatory joint pathologies bilateral or unilateral?

A

Bilateral and symmetrical

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17
Q

What are four inflammatory spondyloarthropathies?

A
  • Ankylosing spondylitis
  • Enteropathic arthritis
  • Psoriatic arthritis
  • Reactive arthritis
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18
Q

seronegative spondyloarthropathies

What are the commonalities and differences between ankylosing spondylitis and enteropathic arthritis?

A

Identical in spine, bilateral and symmetrical
Difference is in presence of enteropathic disease

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19
Q

seronegative spondyloarthropathies

What are the commonalities and differences between psoriatic arthritis and reactive arthritis?

A

Identical in spine, can be bilateral asymmetric or unilateral
ie. 1 SI more severe, or only 1 SI involved
Reactive arthritis however is due to bacterial infection and is not an autoimmune disease

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20
Q

What makes seronegative spondyloarthropathies seronegative?

A

Negative for RF

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21
Q

Seronegative spondyloarthropathies are associated with ___ protein on the surfaces of WBCs

A

human leukocyte antigen - 1B27 (HLA-B27)

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22
Q

Does HLA-B27 gene cause seronegative spondyloarthropathies?

A

No, makes individuals more susceptible:
8% of population has gene; 2% develop spondyloarthropathies

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23
Q

A patient is 20-40 years old and has back pain and stiffness with elevated CRP and ESR. Radiographs demonstrate marginal syndesmophytes in the spine and enthosophytic ossification outside the spine/SI joints.
What is the likely diagnosis?

A

Seronegative spondyloarthropathy: ankylosing spondylitis or enteropathic arthritis

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24
Q

A patient is 20-40 years old and has back pain and stiffness with elevated CRP and ESR. Radiographs demonstrate non-marginal syndesmophytes (parasyndesmophytes) in the spine and enthosophytic ossification outside the spine/SI joints.
What is the diagnosis?

A

Seronegative spondyloarthropathy: psoriatic or reactive arthritis

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25
Q

Which portions of the spine are primarily involved in seronegative spondyloarthropathies?

A

Sacroiliac and thoracolumbar involvement

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26
Q

seronegative spondyloarthropathies

Where do syndesmophytes occur?
Where do enthesophytes occur?

A

Syndesmophytes are in the spine where the disc inserts into end plates
Enthesophytes ossify outside the spine/SI joints where ligaments attach to bone

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27
Q

Psoriatic arthritis favors the ___ extremity
Reactive arthritis favors the ___ extremity

A

Psoriatic favors upper
Reactive favors lower

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28
Q

Rhizomelic arthropathy occurs at the root of the limb (shoulders, hips)
Which types of seronegative spondyloarthropathy may display this peripheral joint involvement?

A

Ankylosing spondylitis or enteropathic arthritis

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29
Q

Ankylosing spondylitis and enteropathic arthritis may have peripheral joint involvement at the ___ limb
Psoriatic and reactive arthritis may have involvement at the ___ limb

A

Ankylosing spondylitis and enteropathic arthritis are at root of the limb
Psoriatic and reactive arthritis are at distal limb

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30
Q

seronegative spondyloarthropathies

Syndesmophytes create inflammation around discs and facets
What is the result of this?

A

Ankylosis
(rheumatoid arthritis does not like to result in this)

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31
Q

What are some treatments for seronegative spondyloarthropathies?

A
  • Low impact, regular activity
  • Anti-inflammatory diet
  • Drug therapy: NSAIDs early on, maybe DMARDs
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32
Q

What is the age of onset for ankylosing spondylitis?

A

15-30 years old

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33
Q

Ankylosing spondylitis is relatively common in the US.
What is the first symptom?

A

Low back pain

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34
Q

What sort of rhizomelic joint involvement may be present with ankylosing spondylitis?

A

1/3 of patients have hip and shoulder involvement, decreasing range of motion

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35
Q

90% of patients with ankylosing spondylitis are ___ positive

A

HLA-B27

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36
Q

Which sex is more commonly affected by ankylosing spondylitis?

A

Males (10:1)

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37
Q

What are the initial symptoms of ankylosing spondylitis?

A

May be transient, lasting only one or two days, may be only stiffness

  • Pain and stiffness over SI joints (focal, bilateral)
  • Severe and relieved by movement
  • Maximal pain in morning (evening and night if after inactivity)
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38
Q

Patient presents with a kyphotic posture and reports pain and stiffness over both their SI joints. They report their pain is most severe in the morning and relieved by movement. If they were inactive throughout the day, they have pain in the night as well. Upon examination, their joints are rigid with loss of mobility.
What is the likely diagnosis?

A

Ankylosing spondylitis

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39
Q

Why does ankylosing spondylitis lead to kyphotic posture?

A

Progressive shortening of inflamed ligaments

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40
Q

5% of patients with ankylosing spondylitis develop ___

A

AA amyloidosis and uremia

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41
Q

With ankylosing spondylitis, ___ involvement is rare, but possible

A

severe cardiac

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42
Q

Late ankylosing spondylitis can affect ___ ligaments and may decrease chest expansion

A

costotransverse ligaments

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43
Q

Late ankylosing spondylitis can affect costotransverse ligaments.
How does this present?

A

Decreased chest expansion: decrease in normal breathing without a history of smoking

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44
Q

Which portion of the SI joints are initially involved in enteropathic arthritis?

A

Lower 2/3 of SI on iliac side

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45
Q

A patient’s radiograph demonstrates that the lower 2/3 of their SI joints on the iliac sides have erosions at the margins with a rosary bead appearance. Sclerosis of the SI margins is also visible bilaterally.
What is the diagnosis?

A

Enteropathic arthritis

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46
Q

A patient’s radiograph demonstrates marginal lesions in the cervical spine, syndesmophytes, with a bamboo appearance. The spine can be described as “dagger sign”, “trolley track sign”, or “rail road sign”.
What is the likely diagnosis?

A

Ankylosing spondylitis (osseous ankylosis present)

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47
Q

Ankylosing spondylitis can involve decreased proprioception and sensation.
What might this increase the risk of?

A

Pathological fracture (painless)

48
Q

Where on the vertebrae do these bony growths occur?
Osteophytes:
Marginal syndesmophytes:
Non-marginal syndesmophytes:

A

Osteophytes: corner of endplate
Marginal syndesmophytes: corner of endplate connecting to corner of adjacent endplate
Non-marginal syndesmophytes: Past the corner of endplate (not in mid portion) connecting to past the corner of endplate of adjacent vertebrae

49
Q

arthritis & ankylosis

Ulcerative colitis and Crohn’s disease are associated with ___ in 20% of cases, and with ___ in 10% of cases

A

seronegative arthritis in 20% of cases
spondylitis in 10% of cases

50
Q

What usually precedes an outbreak of enteropathic arthritis?

A

Diarrhea
Gut symptoms usually are increased before and during arthritis attacks

51
Q

What are some associated causes of enteropathic arthritis?

A
  • Ulcerative colitis
  • IBS
  • Crohn’s disease
  • Gastrointestinal infection (less common)
52
Q

Which pathology has axial and extremity involvement identical to ankylosing spondylitis?

A

Enteropathic arthritis

53
Q

What are the clinical manifestations of enteropathic arthritis?

A
  • Axial and extremity involvement (same as ankylosing spondylitis)
  • Migratory and transient peripheral arthritis
  • Flare ups usually subside in six weeks
54
Q

What are some treatments for enteropathic arthritis?

A
  • Antibiotics (maybe)
  • Bowel resection in ulcerative colitis
  • Symptomatic management
55
Q

How does enteropathic arthritis present radiographically?

A

Same as ankylosing spondylitis (SI and spine involvement)

56
Q

7-10% of patient with ___ develop psoriatic arthritis

A

psoriasis (skin disease)

57
Q

psoriatic arthritis

Where is psoriasis usually located?

A

Extensor surfaces around elbows, knees, and on the scalp

58
Q

At what age does a patient with psoriatic arthritis typically develop joint symptomatology?

A

30-50 years old

59
Q

Are psoriatic arthritis joint symptoms more often severe or mild?

A

Usually mild and slowly progressive, but occasionally severe and mutilating

60
Q

20% of patients with psoriatic arthritis have ___ involvement

A

SI joint

61
Q

Which joints are primarily affected by psoriatic arthritis?

A

Peripheral joints: distal interphalangeal joints of hands and feet in an asymmetrical distribution

62
Q

Psoriatic arthritis is histologically similar to, but usually less severe than ___

A

rheumatoid arthritis

63
Q

___ is histologically similar to, but usually less severe than rheumatoid arthritis

A

Psoriatic arthritis

64
Q

How is psoriatic arthritis less severe than rheumatoid arthritis?

A

More frequent remissions and less joint destruction

65
Q

What genetic factors are involved in the pathogenesis of psoriatic arthritis?

A

HLA haplotypes: HLA-B27 and HLA-Cw6

66
Q

What are two histological features of psoriatic arthritis?

A

Hyperkeratosis and parakeratosis

67
Q

psoriatic arthritis

What is hyperkeratosis?

A

Over proliferation of keratinocytes
Normal cell doubling time is 21 days; psoriasis cell doubling time is 3 days

68
Q

psoriatic arthritis

What is parakeratosis?

A

Persistence of nuclei in stratum corneum cells

69
Q

A patient reports that they had some swelling around their joints which has progressed to swelling of the digits resembling sausages. They have hand stiffness and pain in an asymmetrical distribution. Upon further examination, you discover a silvery, scaly rash with well-defined margins and pinpoint hemorrhagic foci in a 4-5cm area. Patient’s fingernails also display some pitting.
What is the diagnosis?

A

Psoriatic arthritis

70
Q

psoriatic arthritis

How does a psoriatic skin rash appear?

A

4-5cm area of reddish plaques with inflamed borders and well-defined margins
Neutrophilic pustules may be present

71
Q

psoriatic arthritis

What is dactylitis?

A

Sausage digits (swelling of digits) preceded by spindle digits (swelling around joints)

72
Q

The stiffness and pain involved in psoriatic arthritis is comparable to ___, but has an asymmetrical distribution

A

rheumatoid arthritis and ankylosing spondylitis (increased pain with inactivity)

73
Q

psoriatic arthritis

Rash flares coincide with ___

A

joint symptoms

74
Q

___% of patients with psoriatic arthritis will show some nail pitting

A

80%

75
Q

Psoriatic arthritis can involve onycholysis
What is this?

A

Painless separation of the nail from the bed

76
Q

What are three deformities resulting from progressive marginal erosions due to psoriatic arthritis?

A
  • Fluffy periostitis
  • Mouse ear deformities (created by fluffy periostitis)
  • Pencil-in-cup deformities (central erosion distally, peripheral erosion proximally; sharp proximal end fits into central erosion of distal bone)
77
Q

What bone density is found in a radiograph of psoriatic arthritis?

A

Normal bone density
(rheumatoid arthritis has periarticular osteopenia)

78
Q

What are some radiographic characteristics of psoriatic arthritis?

A
  • Marginal erosions, deformities
  • Normal bone density
  • Uniform narrowing of joint space
  • Asymmetrical sacroiliitis
  • Osseous ankylosis
79
Q

A patient’s radiographs display non-marginal syndesmophytes (parasyndesmophytes) in the spine and SI joints.
Their hand radiographs demonstrate osseous ankylosis with remnants of mouse ear deformities.
What is the likely diagnosis?

A

Psoriatic arthritis

80
Q

Reactive arthritis occurs almost exclusively in ___

A

men

81
Q

What is the age of onset for reactive arthritis?

A

20s-30s

82
Q

What is the triad of symptoms for reactive arthritis?

A

“Can’t see, can’t pee, can’t dance with me”

  • Conjunctivitis/uveitis
  • Non-gonococcal urethritis/cervicitis
  • Polyarthritis (prefers SI and LE)
83
Q

90% of reactive arthritis cases are associated with which gene?

A

HLA-B27

84
Q

What is the most common cause of reactive arthritis?

A

Chlamydia or gonorrhea

85
Q

Reactive arthritis follows ___

A

venereal exposure or bacterial dysentery (shigella)

86
Q

20% of HLA-B27 positive men contract ___ after dysentery

A

reactive arthritis

87
Q

Reactive arthritis typically follows venereal exposure or bacterial dysentery, but can also affect ___

A

HIV patients

88
Q

Which inflammatory joint pathology was first described in 1916 when it was seen in military populations, especially Prussian military officers?

A

Reactive arthritis

89
Q

What is generally the earliest symptom of reactive arthritis?

A

Urethritis (burning and frequency)

90
Q

What can precede the onset of urethritis presentation due to reactive arthritis?

A

Perfuse watery diarrhea

91
Q

How does conjunctivitis present with reactive arthritis?

A

Mild and bilateral, lasting days to weeks, generally self-limiting

92
Q

How does asymmetrical polyarthritis present with reactive arthritis?

A

Involves knees, ankles, and feet; can manifest as Achilles tendonitis and SI joint issues

93
Q

A patient presents with complaints of Achilles tendonitis and unilateral SI pain. They also have conjunctivitis. When you ask if they have had any GI changes, they report that they had diarrhea a while ago and have had some burning during urination.
Which inflammatory joint pathology is the likely diagnosis?

A

Reactive arthritis

94
Q

A patient presents with lower extremity complaints and mentions they have a mild conjunctivitis going on. Upon examination of the patient’s palms, feet, then trunk, you find mucocutaneous lesions similar to pustular psoriasis.
Which inflammatory joint pathology is the likely diagnosis?

A

Reactive arthritis

95
Q

How might reactive arthritis affect the skin?

A

Mucocutaneous lesions (similar to pustular psoriasis): keratoderma blennorrhagica on palms, soles of feet, and trunk

96
Q

20-50% of reactive arthritis cases develop:

A
  • progressive arthritis
  • tendonitis
  • lumbosacral pain
97
Q

Reactive arthritis is identical to ___ in the spine

A

psoriatic arthritis

  • Bilateral asymmetric or unilateral sacroiliitis
  • Non-marginal syndesmophytes
98
Q

Why can’t reactive arthritis patients dance?

A

Lower extremity involvement: inflammatory changes to the forefoot joints

99
Q

What is lover’s heel?
Which inflammatory joint pathology features this change?

A

Lover’s heel: inflammatory erosion from the retrocalcaneal bursa adjacent to the Achilles tendon insertion, inflammatory enthesitis at the plantar fascia origin
Due to reactive arthritis

100
Q

A patient’s radiograph demonstrates inflammatory erosion from the retrocalcaneal bursa adjacent to the Achilles tendon insertion and inflammatory enthesitis at the plantar fascia origin.
What is this called and what is the most likely diagnosis?

A

Lover’s heel
Likely reactive arthritis

101
Q

What are other names for juvenile idiopathic arthritis?

A
  • Juvenile rheumatoid arthritis (JRA)
  • Juvenile chronic arthritis (JCA)
102
Q

What is juvenile idiopathic arthritis?

A

Inflammatory arthropathy with an onset prior to 16 years of age

103
Q

Seropositive juvenile arthritis is also called ___

A

Still disease

104
Q

juvenile idiopathic arthritis

What are the two types of seronegative juvenile arthropathies?

A
  • Polyarticular
  • Pauciarticular
105
Q

juvenile idiopathic arthritis

What are the relevant lab findings for seropositive arthritis?

A
  • RF positive
  • ANA positive
  • HLA-D4 positive
106
Q

Is Still disease/seropositive juvenile arthritis polyarticular or monoarticular?

A

Polyarticular

107
Q

juvenile idiopathic arthritis

Which sex is most affected by Still disease?

A

Female

seropositive juvenile arthritis

108
Q

juvenile idiopathic arthritis

> 50% of patients with seropositive arthritis will develop ___

A

severe disease

109
Q

juvenile idiopathic arthritis

What are the two subcategories of seronegative polyarticular arthritis?

A
  • Without systemic symptoms (arthritis only)
  • With systemic symptoms
110
Q

juvenile idiopathic arthritis

What joints are most commonly affected by pauciarticular arthritis?

A
  • Knee
  • Ankle
  • Elbow
  • Hip
111
Q

juvenile idiopathic arthritis

What are the two subcategories of seronegative pauciarticular arthritis?
Which is more common?

A

Female > Male

(the categories are by sex)

112
Q

juvenile idiiopathic arthritis

What are the relevant lab findings for female seronegative pauciarticular arthritis?

A
  • RF negative
  • ANA positive
  • HLA positive

more common in females

113
Q

juvenile idiopathic arthritis

What are the relevant lab findings for male seronegative pauciarticular arthritis?

A
  • RF negative
  • ANA negative
  • HLA-B27 positive

less common in males

114
Q

Which type of juvenile idiopathic arthritis is typically self-limiting?

A

Seronegative pauciarticular arthritis

115
Q

juvenile idiopathic arthritis

What is a potential long term concern for males with seronegative pauciarticular arthritis?

A

Ankylosing spondylitis

116
Q

Which type of juvenile idiopathic arthritis can have ocular inflammation of the iris and ciliary body?

A

Seronegative pauciarticular arthritis

more common in females

Musculoskeletal Physiopathology (32 decks)

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