Arthropathies Flashcards
_____ have increased frequency of Heberden’s and Bouchard’s nodes
Women
_____ hypothesis: HLA-B27 has a propensity to misfold in the ER, leading to a stress response
Unfolded Protein Hypothesis
______ crystals are rhomboid-shaped and ______ bifringent
Calcium pyrophosphate dehyrate (CPPD); positively
______ have more severe osteoarthritis.
Women
______ hypothesis: homodimers of HLA-B27 heavy chains can trigger activation of Natural Killer (NK) cells through killer cell immunoglobulin-like receptors (KIRs)
Free Heavy Chain
______ hypothesis: induction of autoreactivity to self antigens between epitopes of infecting organism/antigen and a portion of the HLA-B27 molecule (or other self peptides)
Molecular Mimicry
______ hypothesis: make RF and anti-CCP antibodies that may lead to production of immune complexes, enhancing local inflammation
B cell
_______ crystals are enedle shaped and ________ bifringent
monosodium urate; negatively
_______ emigrate from circulation under influence of cytokines, IL-8, and TGFb into the synovium
Neutrophils
_______ hypothesis: may recognize citrullinated peptides, or proteoglycan or collagen altered by enzymatic degradation with presentation of neoepitopes
T cell
_______ hypothesis: microbial peptides that bind to HLA-B27 and then are presented uniquely to CTLs to result in disease
Arthritogenic peptides
_______: arthritis, urethritis, inflammatory eye disease, and mucocutaneous lesions
Reiter’s Syndrome
______: decrease uric acid production in over-producers
Xanthine oxidase inhibitors
______: directly opposed to articular cartilage and marginal bone, responsible for most of the joint tissue destruction
Pannus
______: enhances renal excretion of uric acid in under-excreters
Uricosuric
_____: aggregated deposits of monosodium urate crystals occurring in joints, bones, and soft tissue
Tophi
_____: diminished migration, metabolic, and phagocytic activity of PMNs, may block NLRP3 inflammasome activation in monocytes
colchine
____: renal interstitial, glomerular, and/or tubular deposition of MSU crystals
Gouty nephropathy
Ankylosing Spondylitis Specific Therapy Strategies
Back exercises/Good posture; smoking avoidance (to prevent loss of chest wall function)
Bouchard’s nodes are bone swellings of the ____ joints
PIP
Cause of urethritis in reactive arthritis
Chlamydia
Causes of diarrhea in reactive arthritis (4)
Campylobacter, shigella, salmonella, yersinia
Factors affecting Monosodium Urate solubility (5)
Temperature, Dehydration; Trauma, Proteolytic abnormalities, pH
Gout can result from decreased excretion of uric acid due to activation of _____.
URAT1
Gout can result from increased production of uric acid, due to _____ activity of ______ or deficiency of ______.
increased, phosphoribosyl-pyrophosphate synthetase (PRPP); hypoxanthine-guianine phosphoribosyltransferase (HGPRT)
Heberden’s nodes are bone swellings of the ____ joints
DIP
Igs (typically Ig__) that recognize epitopes in _______.
M; the Fc region of IgG
In ankylosing spondylitis, ______ may contribute to development of calcification at entheses and in joint
TGF-beta, WNT proteins, Bone Morphogenic Proteins (BMPs)
In ankylosing spondylitis, the environmental trigger is unknown but thought to be common to all patients, such as________
normal bowel flora
In osteoarthritis, water content _____, proteoglycan content ______, and chondrocyte numer ______.
increases; increases; initially increases then decreases
In Rheumatoid arthritis, the cellular infiltrate into the synovium primarily consists of ______.
mononuclear cells (lymphocytes and monocytes) and fibroblasts
Inflammatory response depends on ______, promoted by IL-8, _______ chemoattractant protein-1, and cytokines (IL-1 and TNF)
PMNs; neutrophil
Lifestyle/Nutritional changes in treating gout (3)
Weight loss; reduction of high purine foods (meat, shellfish) in diet; limitation of fructose and alcohol consumption
MSU crystals engage ________, activating _________ with IL-1β production
caspase-1; NLRP3 inflammasome
Other gene mutations associated with Ankylosing Spondylitis (5)
ERAP1, IL23R, IL-IR2, ANTXR2, Genes associated with TNF pathway
Recognition of MSU crystals by_____ leads to inflammatory response
TLR2/TLR4
The common HLA allele in Ankylosing Spondylitis is _____.
HLA-B27
The common HLA allele in reactive arthritis, psoriatic spondylitis, and colitic spondylitis is _____.
HLA-B27
The common HLA allele in Rheumatoid Arthritis is _____.
HLA-DR4 with QKRAA
Which arthropathy? abrupt onset of painful, warm, red, swollen joint often during night or early morning
Gout
Which arthropathy? Activation of URAT1
Gout
Which arthropathy? Anti-CCP (Anti-cyclic citrullinated protein) antibody in 70%
Rheumatoid Arthritis
Which arthropathy? Associated with previous trauma
Osteoarthritis
Which arthropathy? asymmetric, oligoarticular lower extremity arthritis; knees and ankles most common
Reactive Arthritis
Which arthropathy? C1/C2 commonly involved
Rheumatoid Arthritis
Which arthropathy? Can result from increased activity of phosphoribosyl-pyrophosphate synthetase (PRPP) or deficiency of hypoxanthine-guianine phosphoribosyltransferase (HGPRT)
Gout
Which arthropathy? Carpometacarpal joint involvement
Osteoarthritis
Which arthropathy? Constitutional and end organ symptoms, nodules on extensor surfaces and tendon sheaths,
Rheumatoid Arthritis
Which arthropathy? cystic changes of subchondral bone, osteophyte formation
Osteoarthritis
Which arthropathy? decreased joint space superiorly with relative medical preservation in the hip
Osteoarthritis
Which arthropathy? DIP joints often spared
Rheumatoid Arthritis
Which arthropathy? Disease of cartilage
Osteoarthritis
Which arthropathy? Disease of entheses
Reactive Arthritis
Which arthropathy? Disease of synchondroses
Ankylosing Spondylitis
Which arthropathy? Disease of synovium
Rheumatoid Arthritis
Which arthropathy? Elevated ESR; ANA(-), RF(-)
Ankylosing Spondylitis and Reactive Arthritis
Which arthropathy? elevated serum uric acid with no gouty arthritis, tophi (monosodium urate deposites in joints, bones, or soft tissue), or uric acid nephrolithiasis (>7mg/dL)
Asymptomatic Hyperuricemia
Which arthropathy? enthesopathy: Achilles tendinitis and/or plantar fasciitis (20%)
Reactive Arthritis
Which arthropathy? ESR/CRP elevated
Rheumatoid Arthritis
Which arthropathy? Gull wing changes in IP joints
Osteoarthritis
Which arthropathy? hallux valgus
Osteoarthritis
Which arthropathy? Heberden’s (DIP) and Bouchard’s nodes (PIP)
Osteoarthritis
Which arthropathy? HLA-DR4
Rheumatoid Arthritis
Which arthropathy? increased males 45 years old
Osteoarthritis
Which arthropathy? Infectious diarrhea or urethritis preceding onset of arthritis by 2-4 weeks
Reactive Arthritis
Which arthropathy? inflammatory peripheral arthritis (10-20% of patients with IBD) that follows activity of IBD; axial arthritis resembling AS (5% of patients with IBD) that does not follow activity of IBD
Colitic arthropathies
Which arthropathy? juxta-articular osteopenia, symmetric loss of joint space
Rheumatoid Arthritis
Which arthropathy? loss of cartilage space
Osteoarthritis
Which arthropathy? Male:Female- 5-10:1; onset from childhood to age 40-50; Caucasians predisposed
Reactive Arthritis
Which arthropathy? May involve cricoarytenoid cartilage, ossicles of inner ear, or the TMJ
Rheumatoid Arthritis
Which arthropathy? medial compartmental disease of knee
Osteoarthritis
Which arthropathy? Metacarpophalangeal joint involvement
Rheumatoid Arthritis
Which arthropathy? morning stiffness, soft tissue swelling around joints, pain, improves with activity
Rheumatoid Arthritis
Which arthropathy? MTP joint of great toe most often involved, followed by insteps, ankles, heels, knees, wrists, fingers, and elbows
Gout
Which arthropathy? pain with use, Improvement with rest
Osteoarthritis
Which arthropathy? peripheral arthritis preferentially affects upper extremities DIP, PIP, and MCP joints asymmetrically; axial arthritis resembles that of reactive arthritis
Psoriatic Arthritis
Which arthropathy? Peripheral joints, symmetric pattern, particularly hands and feet
Rheumatoid Arthritis
Which arthropathy? rarely significant symptoms before age 40
Osteoarthritis
Which arthropathy? Spontaneously result in 3-10 days
Gout
Which arthropathy? squaring of first carpometacarpal joint
Osteoarthritis
Which arthropathy? stiffness (usually less than 30 minutes), localized to joints
Osteoarthritis
Which arthropathy? Type I Fluid (200-2000 WBCs, 25% PMNs)
Osteoarthritis
Which arthropy? asymptomatic intervals between acute attacks
Intercritical Gout
Which arthropy? Back deformities and reduced chest expansion late in disease course
Ankylosing Spondylitis
Which arthropy? calcium pyrophosphate dehydrate (CPPD) crystals and chondrocalcinosis (calcification of cartilage)
Pseudogout
Which arthropy? Consequence of abnormal pyrophosphate metabolism
Pseudogout
Which arthropy? crystals are released by shedding of pre-formed crystals in the cartilage matrix
Pseudogout
Which arthropy? crystals do not form by spontaneous precipitation
Pseudogout
Which arthropy? development of subcutaneous, synovial, or subchondral bone deposits of monosodium urate crystals; commonly on digits of hands and feet, olecranon bursa, extensor surface of forearm, Achilles tendon, and ear antihelix (less frequently)
Chronic tophaceous gout
Which arthropy? Global loss of spine range of motion
Ankylosing Spondylitis
Which arthropy? inflammatory back pain: insidious onset lasting >3 months, prolonged morning stiffness >30-60 minutes, improvement of pain with exercise
Ankylosing Spondylitis
Which arthropy? male:Female- 7:3; onset 16-40 years old; Caucasians predisposed
Ankylosing Spondylitis
Which arthropy? mutations of ank gene (ANKH), which facilitates _______ deposition
Pseudogout; Calcium Pyrophosphate Dehydrate (CPPD)
Which arthropy? Peripheral arthritis of shoulders and hips (25%)
Ankylosing Spondylitis
Which arthropy? SI joint tenderness
Ankylosing Spondylitis
Which arthropy? sudden onsets of severe pain, swelling, warmth, and redness in the knee; wrist and ankle less frequently
Pseudogout