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PATHO FINAL EXAM NMS SECTOR CH 12--13--14--15 > CH 13--DISEASES OF JOINTS > Flashcards

CH 13--DISEASES OF JOINTS Flashcards

1
Q

Osteoarthritis (OA) Degenerative Joint Disease (DJD)

Features:

  • Degenerative disease of articular cartilage in weight bearing joints of older persons
  • Incidence: most common form of _________
  • Age: elderly people (80% at 70 years)
  • Sex: more frequent in females
A

arthritis

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2
Q

Osteoarthritis (OA) Degenerative Joint Disease (DJD)

Etiology: not exactly known, 2 theories:

  1. ______________theory:
    Osteoarthritis as age-dependent degenerative process:
    - incidence increases with age
    - affects mainly weight-bearing joints
    - joint stress (obesity), altered lines of weight bearing (rickets), trauma & injuries accelerate disease
A

Biomechanical

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3
Q

Osteoarthritis (OA) Degenerative Joint Disease (DJD)

2._____________theory: = Osteoarthritis as biochemical & metabolic changes in old age:
- diminution of proteoglycan concentration
in matrix
- increased level of collagenase & proteoglycan-degrading enzymes
- non-specific synovitis → release of inflammatory mediators

A

Biochemical

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4
Q

Osteoarthritis (OA) Degenerative Joint Disease (DJD)

Pathological lesions:
1. Death of ___________ & decreased proteoglycans
2. Vertical __________ extending in full thickness of
articular cartilage, then deeper into subchondral
bone
3. Detachment of pieces of ___________

A

chondrocytes

cracks

cartilage

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5
Q

Osteoarthritis (OA) Degenerative Joint Disease (DJD)

  1. Non-specific ________ (mild, no pannus formation)
  2. _________ metaplasia of synovial membrane & cartilage:
    - Heberden’s nodes: distal interphalangeal joints (DIPs)
    - Bouchard’s nodes: proximal interphalangeal joints (PIPs)

Degenerative osteoarthritis—there is prominent “______” of the vertebrae. Osteoarthritis increases with age beyond 50. Generally, a few large joints are involved, such as hip or knee.

A

synovitis

Osseous

lipping

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6
Q

Osteoarthritis (OA) Degenerative Joint Disease (DJD)

Clinical features:

  1. Morning stiffness & pain
  2. ________ & crackling sound caused by exposed
    bones rubbing against each other
  3. ___________: effusion (secondary synovitis) &
    restricted movements
  4. NO evidence of acute inflammation:
    - NO local tenderness
    - NO heat
    - NO ankylosis or obliteration of joint cavity
  5. Commonly involve:
    - hip
    - knee
    - cervical & lumbar spines
    - proximal & distal interphalangeal joints of hands
    - usually asymmetric
A

Crepitus

Swelling

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7
Q

Rheumatoid Arthritis

Features:

  • A ___________disease
  • _________ disease, involves different tissues particularly joints → synovitis & ankylosis
  • Incidence: 1% of world population
  • Sex: more frequent in females (75%)
  • Age: 20-40 years
A

systemic

Autoimmune

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8
Q

Rheumatoid Arthritis

Etiology:
1—__________disease:
Formation of IgM antibodies (rheumatoid factor)
against Fc of IgG
2—Genetic:
Significant association with HLA-DR4
3—Pathogenesis:
Immune complexes (IgG & rheumatoid factor) →
activation of complement → inflammatory lesions
(type III hypersensitivity)

A

Autoimmune

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9
Q 
Rheumatoid Arthritis
Pathological Lesions:  Joints
1. \_\_\_\_\_\_\_\_\_\_\_\_\_\_:
- lymphocyte, plasma cell & neutrophil  infiltration
- lymphocyte nodules, fibrinoid necrosis
- proliferation of inflamed synovial tissue resulting in:
 (a) finger-like projections (villi)
 (b) pannus
2. Periarticular inflammation myositis &  muscle atrophy
3. Synovial fluid
- sterile
- abundant immunoglobulins
A

Synovitis

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10
Q

Rheumatoid arthtritis,

There is a central area of ______ necrosis surrounded by palisading macrophages and a chronic inflammatory infiltrate.

A

fibrinoid

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11
Q

Rheumatoid arthtritis,

Extra-articular lesions:

  1. _______________ nodules:
    - 25% of patients
    - over bony prominences
    - round, firm non-tender
  2. Cardiovascular system:
    - __________with effusion
    - vasculitis
  3. Lung:
    - ___________ with effusion
    - rheumatoid nodules
    - diffuse interstitial fibrosis
  4. C.N.S.:
    - peripheral neuropathy
    - carpal tunnel syndrome (median nerve)
  5. Eye:
    - nodular scleritis
    - keratoconjuctivitis
A

Subcutaneous

pericarditis

pleurisy

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12
Q

Clinical features of rheumatoid arthritis:—1 OF 2

1. Onset:
Gradual, prodromal symptoms:
- malaise (a vague feeling of discomfort)
- weight loss
- periarticular pain or stiffness
2. Polyarthritis:
- \_\_\_\_\_\_\_\_\_\_\_\_\_
- involves \_\_\_\_\_\_\_  \_\_\_\_\_\_\_\_of hands & feet especially 
 metacarpaphalngeal & proximal 
3. Symptoms:
- pain and morning stiffness (one hour)
- swelling of joints
- weakness of grip
- difficulty in walking
- weight loss
4. Signs:
- swelling of affected joints
- tenderness & pain on moving joints
- limitation in range of motion
- \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ involvement
A

symmetric

small joints

symmetrical

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13
Q

Clinical features of rheumatoid arthritis:—2 OF 2

Course:
- progressive, relapses & remissions
- eventual ankylosis, joints immobilized in
deformed positions:
(a) ___________deviation of fingers
(b)______–___________deformity:
–Flexion of the metacarpophalangeal joints
–Hyperextension of the proximal interphalangeal joints
–Flexion of the distal interphalangeal joints
(c) _______–___________deformity:
– Extension of the metacarpophalangeal joint
– Flexion of the proximal interphalangeal joints
– Extension of the distal interphalangeal joint

A

ulnar

swan-neck

button-hole

**The hands of a patient with advanced arthritis show
swelling of the metacarpal phalangeal joints and the
classic ulnar deviation of the fingers.

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14
Q

Hand deformity—–rheumatoid arthritis

This autoimmune disease leads to synovial proliferation and joint destruction, typically in a symmetrical pattern involving small joints of hands and feet, followed by wrists, ankles,
elbows, and knees. Rheumatoid factor can be identified
serologically in most, but not all, RA patients.

Laboratory findings:

  1. Rheumatoid factor in ___% of cases
  2. Blood:
    - ↑ Erythrocyte Sedimentation Rate (ESR)
    - moderate hypochromic anemia
  3. X-Ray:
    - NARROW joint space
    - Joint EROSION
    - Bone____________
A

80

osteoporosis

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15
Q

8 Variants of Rheumatoid Arthritis

  1. Juvenile Rheumatoid Arthritis (JRA)
  2. Sjogren’s syndrome
  3. Felty’s syndrome
  4. Ankylosing spondylitis
  5. Reiter’s syndrome
  6. Behçet’s syndrome
  7. Enteropathic (colitic) arthritis
  8. Psoriatic arthritis
A

JUST BE FAMILIAR WITH THE NAMES AND A KEY WORD TO SPARK THE TIE-IN!

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16
Q

8 Variants of Rheumatoid Arthritis—1 OF 8

Juvenile Rheumatoid Arthritis AKA “Still’s Disease”

Features:
1— Young patient (under _____ years)
2— Onset: acute with fever, leukocytosis, skin rash, ↑ lymph nodes
3— Arthritis: - Monoarticular
- _________ joints (knee, ankle)
4— Rheumatoid nodules & Rheumatoid factor are usually absent
5— ____% undergo complete remission

A

16

Large

50

17
Q

8 Variants of Rheumatoid Arthritis—2 OF 8

_____________ syndrome

Features:
RA, and: Autoimmune destruction of SALIVARY & 
lacrimal glands →
- keratoconjuctivitis sicca
- xerostomia
A

Sjogren’s

18
Q

8 Variants of Rheumatoid Arthritis—3 OF 8

__________ syndrome

Features:
- Long standing RA
- SPLENOmegaly → anemia
neutropenia
thrombocytopenia
A

Felty’s

“I FELTY YOUR SPLENY”

19
Q

8 Variants of Rheumatoid Arthritis—4 OF 8

Ankylosing Spondylitis
A———Features:
- Incidence: 0.5% of U.S. population
- Sex: more frequent in ______ (8:1)
- Age: 15-30
- Etiology:
- autoimmune disease
- ___________: strongly associated with
HLA-B27 (in 90% of patients)
B———-Clinical features:
1. Sacroiliac joint:
- low back pain & morning STIFFNESS in YOUNG males
- TENDERNESS over the joint
2. Spine:
- ascending back pain
- spasm of para-lumbar muscles → LOSS of lumbar lordosis, poor LUMBAR motion
- DECREASED chest expansion (costovertebral joints)
- kyphosis - fusion of vertebrae (bamboo spine)
3. Extra-articular:
i. DEGENERATION of wall of AORTA → dilation & incompetence of aortic valve
ii. EYE: iridocyclitis → decreased visual acuity

A

males

genetic

**BONE BRIDGES—-FUSE one vertebral body to the next
across the intervertebral discs. Portions of the intervertebral disc are replaced by BONE MARROW. Bony bridges also fuse the POSTERIOR elements,a condition termed ANKYLOSIS!!
.

20
Q

8 Variants of Rheumatoid Arthritis—5 OF 8

______________ Syndrome

1–History of recent infection e.g. Chlamydia
2–(___________) or Salmonella, Shigella,
3–Campylobacter (intestinal infection)

Clinically:

  1. THE EYES HAVE ___________________
  2. Non-Gonococcal urethritis with discharge
  3. Mucocutaneous ULCERS on urethral meatus & glans PENIS!!
  4. Arthritis = ASYMMETRIC
    - LARGE joints (sacroilliac, knee, ankle)
A

Reiter’s “REITER HAS AN ULCER ON HIS PENIS”!!

urethritis

CONJUNCTIVITIS

21
Q

8 Variants of Rheumatoid Arthritis—6 OF 8

_____________ syndrome—–Is a SYSTEMIC vasculitis

Features:

  1. Neurological: encephalitis, ______, cranial nerve palsy
  2. Eye: CORNEAL ulceration, uveitis, OPTIC neuritis
  3. Oral & genital ulcers
  4. Arthritis is found asymmetric and in large joints (knee, ankle)
A

Behcet’s

convulsions

22
Q

8 Variants of Rheumatoid Arthritis—7 OF 8

ENTEROPATHIC (colitic) arthritis

1——Features:
Arthritis associated with inflammatory disease of _____:
- ulcerative colitis
- Crohn’s disease

2——Clinically:
Type I: Peripheral arthritis: (in 20%)
- ASYMMETRIC
- LARGE joints (knee, ankle, wrist, elbow)
- deformity is uncommon
Type II: -Ankylosing spondylitis in 10% of
patients with ulcerative colitis
-_________ involvement may appear BEFORE any
clinical evidence of Inflammatory Bowel
Disease

A

intestine

joint

23
Q

8 Variants of Rheumatoid Arthritis—8 OF 8

PSORIATIC arthritis

Features:

  • Arthritis associated with psoriasis of fingers and nails (7% of patients)
  • Arthritis:
  • ASYMMETRIC
  • DISTAL interphalangeal joints:
  • ___________ ___________ and DEFORMITY

EX. A patient with psoriasis shows large, confluent,
sharply demarcated, erthematous plaques on the trunk.
SEE SLIDE 63

A

sausage swelling—-SLIDE 62

24
Q

Osteoarthritis VS Rheumatoid Arthritis

A

-SEE SLIDE 64

25
Q

Gout (Gouty Arthritis)

Features:
Results from deposition of _______ ______crystals in CT, whenever uric acid (end-product of purine metabolism) in blood exceeds 7 mg/dL

Etiology:
1-----Primary (90%):
- enzymatic abnormality
- familial, X-linked defect (male)
2----Secondary (10%):
- increased breakdown of purine:↑ uric  acid synthesis e.g. leukemia
- decreased ureate excretion 
 e.g. chronic renal failure.

Clinical Features:
1— Deposition of sodium urate crystals in synovial membrane causes acute synovitis↓ = swollen, red, hot, tender________
2— Mainly 1st metatarsophalangeal joint (GREAT TOE)
3— General: fever, TACHYCARDIA, leukocytosis
4— Attack persists for few days, subsides & tends to
recur within few weeks (triggered by ALCOHOL,
STRESS, high purine food)

A

sodium urate

joint

**REMEMBER!!

Gouty arthritis –results from deposition of sodium urate crystals in joints. The joint most often affected is the first MP joint (big toe). Acute attacks are characterized by severe pain, swelling, and erythema of the joint.

26
Q

Chronic tophaceous gout:

–1- _______——- result from prolonged deposition of urate crystals into large masses → inflammatory reaction.
2— Site: i. ear
ii. around joints (tendons, ligaments)
iii. pressure points (e.g. olecranon)
iv. synovial membrane & articular cartilage → erosion of cartilage & subchondral bone
v. kidney: between renal tubules → renal failure & urate stones

**Chronic gout leads to deposition of urates into a chalky mass known as a “tophus”. Such tophi can DESTROY the joint and adjacent bone). In most, but not all, cases there is ___________

A

Tophi—-Gouty tophi project from the fingers as rubbery
nodules. SEE SLIDE 70

hyperuricemia.

Diagnosis:

  • Clinical: monoarthritis, big toe
  • High uric acid level in blood
  • Synovial fluid: needle-shaped crystals

PATHO FINAL EXAM NMS SECTOR CH 12--13--14--15 (12 decks)

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