Arthritis Pathology

Question 1

Types of arthritis

Answer 1

Osteoarthritis, rheumatoid arthritis, gout, infectious arthritis

Question 2

Osteoarthritis pathogenesis

Answer 2

Polymorphisms in prostaglandin synthesis and Wnt signaling pathways, obesity, lack of exercise, aging, particulars of joint architecture

Question 3

Osteoarthritis pathology

Answer 3

Irregular cartilage and bone response with eventual eburnated joint surface and osteophytes, fibrillary tears in hyaline cartilage, subchondral cyst, sclerotic subcondral bone, some mild inflammation, eventual complete lose of hyaline cartilage

Question 4

Osteoarthritis diagnosis

Answer 4

Hx of deep achy pain, stiffness, old age, see narrowing of joint space, osteophytes, subchondral cysts on x-ray

Question 5

Osteoarthritis treatment

Answer 5

Symptomatic relief of pain, exercise regimen, supplements, joint replacement

Question 6

Rheumatoid arthritis pathogenesis

Answer 6

Genetically susceptible person exposed to a trigger, ensuing inflammatory response becomes self-targeting, causes destruction of local tissues

Question 7

Rheumatoid arthritis pathology

Answer 7

Small joints involved more than large joints, symmetrical, damage encompasses surrounding soft tissue including joint capsule, ligaments and tendons, pannus (corrosive pathologic tissue that destroys the joint and surrounding tissue)

Question 8

Rheumatoid arthritis diagnosis

Answer 8

Usually 40-70 yo female with fatigue, malaise, generalized musculoskeletal pain that becomes localized, deformed joints have characteristic abnormalities, see anti-citrullinated protein antibodies, rheumatoid factor on serologic tests, see joint effusions, loss of joint space on x-ray

Question 9

Rheumatoid arthritis treatment

Answer 9

Corticosteroids, methotrexate, TNF antagonists

Question 10

Gouty arthritis pathogenesis

Answer 10

Acute and chronic phases, deposition of urate crystals around joints that stimulates an inflammatory response, causes high amount of urate crystals through reduced renal excretion, overproduction, potentiators such as alcohol, obesity, lead poisoning, certain drugs

Question 11

Gouty arthritis pathology

Answer 11

Acute presents with neutrophilic inflammation and needle-like crystals, chronic presents with gouty tophus, joint destruction sometimes to ankylosis

Question 12

Gouty arthritis diagnosis

Answer 12

Abrupt excruciating pain with warmth and redness, usually involves great toe, hyperuricemia, gouty tophus contains polarizable needle-like urate crystals

Question 13

Gouty arthritis treatment

Answer 13

Symptomatic, sometimes joint replaced, no alcohol, weight reduction, avoidance of certain foods and drugs

Question 14

Infectious arthritis pathogenesis

Answer 14

Infection of a joint causing acute inflammation sometimes with chronic sequelae, can be heamtogenous or direct spread from adjacent tissue, typically bacterial

Question 15

Infectious arthritis pathology

Answer 15

Inflammatory reaction to infection leads to joint damage

Question 16

Infectious arthritis diagnosis

Answer 16

Clinical presentation and microbiology cultures

Question 17

Infectious arthritis treatment

Answer 17

Medication for underlying infection

Question 18

OA vs RA pain with movement

Answer 18

OA movement increases pain, RA movement decreases pain

Question 19

OA vs RA pattern of affected joints

Answer 19

OA asymmetrical and are limited to one set of joints such as the finger joints like DIP and PIP or large weight-bearing joints like the knees and hips, RA symmetrical and typically affects small joints and large joints on both sides of the body like both hands (MCPs), both wrists or elbows, balls of both feet

Question 20

OA vs RA age of onset

Answer 20

OA most commonly over the age of 50, RA usually 20-40 years

Question 21

OA vs RA cause

Answer 21

OA caused by normal wear and tear with aging, injury, obesity, heredity, joint overuse from sports, RA is an autoimmune disease with no known cause

Question 22

OA vs RA speed of onset

Answer 22

OA is slowly over year, RA is relatively rapid over weeks to months

Question 23

OA vs RA joint symptoms

Answer 23

OA joints are painful asymmetrically without swelling, typically in bigger joints and localized with variable, progressive course, RA joints are painful, swollen and stiff symmetrically and typically in small joints, systemic with exacerbations and remissions

Question 24

OA vs RA clinical presentation

Answer 24

OA in one or several joints, enlarged, cool and hard on palpation, limited ROM, RA joints are swollen, red, warm, tender, and painful, several joints involved, limited ROM

Question 25

OA vs RA presence of systemic symptoms

Answer 25

OA systemic symptoms are not present, RA frequent fatigue and a general feeling of being ill are present

Question 26

OA vs RA duration of morning stiffness

Answer 26

OA morning stiffness lasts less than an hour, tends to get worse later throughout the day, RA morning stiffness lasts longer than one hour, worse in the AM, stiffness occurs in AM and periods of rest

Question 27

OA vs RA disease process

Answer 27

OA normal wear and tear, breakdown of the articular cartilage, RA is autoimmune, inflammation of the synovial lining of the joint (pannus)

Question 28

OA vs RA radiographic manifestations

Answer 28

OA joint space narrowing, osteophytes, subchondral cysts, subchondral sclerosis, RA joint space narrowing, soft-tissue swelling, osteopenia (soft bones), marginal erosions