B6-007 CBCL Arthritis Flashcards
wear and tear destroys articular cartilage
osteoarthritis
inflammation induces formation of pannus which erodes articular cartilage and bone
rheumatoid arthritis
pain in weight bearing joints after use that improves with rest
osteoarthritis
asymmetric joint involvement, no systemic symptoms
osteoarthritis
in osteoarthritis, knee cartilage loss begins [medial/lateral]
medial
osteophytes
osteoarthritis
asymmetric joint space narrowing
osteoarthritis
subchondral sclerosis, cysts, and loose bodies
osteoarthritis
synovial fluid WBC <2000
osteoarthritis
spares MCP
osteoarthritis
morning stiffness lasting >1 hr
rheumatoid arthritis
juxta-articular osteopenia
rheumatoid arthritis
symmetric joint space narrowing and soft tissue swelling
rheumatoid arthritis
spares DIP and 1st CMC
rheumatoid arthritis
deposition of calcium pyrophosphate crystals within the joint space
pseudogout
associated with hemochromatosis, hyperparathyroidism, and joint trauma
pseudogout
chondrocalcinosis on xray
pseudogout
rhomboid crystals under polarized light
pseudogout
acute treatment of pseudogout
NSAIDs, colchicine, glucocorticoid
**same as acute gout
prophylaxis for pseudogout
colchicine
common pathogens causing septic arthritis [3]
S. aureus
Streptococcus
N. gonorrhoeae
synovial fluid WBC >50,000
septic arthritis
osteophytes are consistent with
OA
involvement of the MCP is typical of
RA
a synovial fluid count > 2000 WBC is consistent with […] arthritis
inflammatory
causes of secondary OA [4]
diabetic neuropathy
trauma
genetic conditions
metabolic causes
best recommendation for a patient with OA
graduated exercise plan
is there evidence that hyaluronic acid injections have good efficacy?
no
most common type of arthritis associated with the leading cause of disability
OA
crepitus is associated with
OA
three types of cartilage
hyaline
fibrocartilage
elastic cartilage
what type of cartilage is found in articular cartilage?
hyaline
what type of cartilage is found in the respiratory tract?
hyaline
what type of cartilage is found in the external ear, epiglottis, and eustachian tube?
elastic
what type of cartilage is found in intervertebral discs, minisci, and pubic symphsis?
fibrocartilage
the primary collagen type in articular cartilage is
type II
what type of collagen is found in hyaline and elastic cartilage?
type II
what type of collagen is found in bone, tendon, dentin, and skin?
type I
what type of collagen is found in fibrocartilage?
type I
the collagen fibers in articular cartilage are arranged in […] anchored at the subchondral plate
overlapping arcades
wolff’s law states
bone responds in the direction of stress
damage to […] leads to surface fissures
type II collagen arcades
loss of the collagen structure allows fissures to form in the articular cartilage which allows fluid to enter the bone creating
subchondral cysts
complete loss of articular cartilage and exposure of underlying bone
eburnation
what type of crystals are seen in OA?
calcium pyrophosphate dihydrate cystals
eburnated bone shows pressure […]
necrosis
damage to the tide mark is seen in
hemochromatosis
invasion of blood vessels is seen in
RA
what common factor leads to destruction of the joint in gout and septic arthritis?
inflammation
surface erosion that leads to the damage of type II collagen fibers
OA
hemarthrosis can be a cause of
secondary OA
**evaluate for hemophilia
ANA is sensitive for
SLE
a parvovirus IgM should be done with
initial symptoms
fifth’s disease is associated with
parvovirus
chondrocalcinosis/calcium deposition in cartilage structures
pseudogout
stickler syndrome is a cause of secondary OA due to
collagen mutation
next best step for a child presenting with joint hypermobility?
collagen mutation genetic testing
best treatment for a child with hypermobility
physical therapy to strengthen muscles and improve joint mechanics
cartilage degradation products that lead to propagation of osteoarthritis changes
DAMPs
mediate cartilage degradation
MMPs
pannus formation and synovial lining hyperplasia are consistent with
RA
if a patient with OA does not respond to therapies and continues to have severe pain, what is the next best step?
referral to orthopedic surgery
central erosion “gull wing” sign is associated with
erosive OA
pencil in cup change is consistent with
psoriatic arthritis
periarticular erosion
periarticular osteopenia
symmetric joint space narrowing
RA
activation of osteoblasts due to decreased sclerostin results in increased […] causing bone formation
Wnt signaling,
periarticular erosion is associated with
RA
periarticular osteopenia is associated with
RA
[…] is frequently seen in erosive osteoarthritis affecting the DIPs and PIPs
central erosion
diabetic neuropathy is a risk factor for
secondary OA
charcot joint due to diabetic neuropathy
collapse of the midfoot with absence of pain
charcot joint
medication that inhibits CD20 cells
rituximab
inhibit phospholipase A2
corticosteroids
chondrocyte proliferation is consistent with
OA
CMC arthritis
dactylitis is a common presentation of
psoriatic arthritis
hook like osteophytes on the MCPs
hemochromatosis
ulnar styloid erosion is associated with
RA
[…] is indicated when there is high concern of internal derangement
MRI
causes death of the vascular bone below the tidemark
avascular necrosis
separation of the cartilage and bone at the level of tidemark is most commonly seen in
hemachromatosis
**iron accumulates at tidemark
separation of the cartilage and bone at the level of the subchondral plate
avascular necrosis
corticosteroids inhibit
phospholipase A2
loss of proprioception leads ultimately to instability
charcot joint
first line imaging study
Xray
inhibitor of serotonin and norepinephrine
duloxetine
junction of hyaline and calcified cartilage
tidemark
subchondral plate is normally
thin
subchondral bone is destroyed, so exposed bone is trabecular
RA
in RA, the involvement of […] lining the tendon sheaths causes morning stiffness
synovium
lymphocytes cause vessels to invade into the articular cartilage
RA
in OA, as articular cartilage degrades, the subchondral bone
thickens
in OA, the mixture of degradation and repair can lead to abnormal loading and cause […]
avulsion fractures
in OA, avulsion injuries and repair leads to
osteophytes