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Pathology Unit 2 > Ch 26: Joints > Flashcards

Ch 26: Joints Flashcards

2
Q

What is the difference between a synovial joint and a synarthrosis?

A

synovial joints provide movement, whereas synarthrosis are joints with little/no movement (solid joints) such as those between cranial bones. Synarthroses include: symphysis, synchondrosis, syndesmosis, synostosis

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3
Q

What is the structure and function of the synovium?

A

structure: not true membranes (no basement), 1-3 layers of either type A (macrophages) or B (secrete hyaluronic acid)function: diffusion in/out of joint, ingestion of debris, secretion of enzymes, lubrication of joints

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4
Q

What is arthrogryposis

A

retardation of joint development due to lack of movement. can rarely cause joint fusion

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5
Q

Function of articular cartilage

A

dual role of shock absorption and lubrication of movable joints

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6
Q

Tangential/gliding zone

A

closest to articular surface, contain elongated chondrocytes, collagen type II as “skin” of articular cartilage

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7
Q

Transitional Zone

A

Below tangential zone: collagen transverse to articular surface, chondrocytes more spread out

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8
Q

Radial Zone

A

below transitional zone: small chondrocytes arranged in short columns. separated from calcified zone by TIDE MARK

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9
Q

Calcified zone

A

below radial zone: small chondrocytes in heavily calcified matrix. separated from radial zone by TIDE MARK

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10
Q

Tidemark

A

separation between mineralized and unmineralized cartilage. below the tidemark calcified cartilage is nourished by epiphyseal BV. This is also where cartilage cells are renewed

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11
Q

Subchondral bone plate

A

supports articular cartilage. is deep to calcified zone, directly contiguous with the cancellous bone of the epiphysis

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12
Q

OsteoarthritisDifference between primary and secondary?

A

slowly progressive destruction of articular cartilage. Occurs in elderly or trauma related in youngprimary: intrinsic defects in articular cartilage. “wear and tear arthritis/degenerative joint disease”secondary: known underlying cause (congenital, metabolic, infection, crystal deposits, etc

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13
Q

Chondromalacia

A

subcategory of osteoarthritis: affects patellar surface of femoral condyles in young. causes pain and stiffness

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14
Q

Causes of osteoarthritis?

A
  1. increased unit load2. decrease in resilience of articular cartilage (less water binding)3. stiffness of subchnodral course cancellous bone beneath calcified zone (decrease in shock absorbing microfractures)
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15
Q

COL2A1

A

Gene associated with early onset osteoarthritis

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16
Q

osteophytes

A

large peripheral growths of bone and cartilage (bone spurs)

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17
Q

Sequence of histological changes seen in osteoarthritis

A

Death of chondrocytes, crack in articular cartilage, leakage of synovial fluid, cartilage is progressively worn away and new vessels form. fibrocartilage is deposited, forming a plug, which is then worn away, exposing subchondral bone (becomes thick and eburnated/ivory like). Leakage of synovial fluid into marrow causes “subchondral bone cyst”

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18
Q

Heberden and Bouchard nodes

A

osteophytes at the DIP and PIP joints, respectively

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19
Q

Clinical hallmarks of Osteoarthritis

A

Joint stiffness in the morning that worsens during the day, as well as deep/achy joint pain following activity

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20
Q

Joint mice

A

fragments of cartilage floating in the joint space from disruption on articular surface

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21
Q

Neuropathic joint diseaseMost common cause?

A

rapid and severe form of secondary osteoarthritis, due to neurologic disorder that will fragment the joint. Most common cause today is Diabetic peripheral neuropathy. Previously it was Charcot joint (destruction of knee joints in pts with syphilitic tabes dorsalis)

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22
Q

Rheumatoid Arthritis

A

systemic, chronic inflammatory disease with polyarthritis. It has been contributed to genetic factors, humoral/cellular immunity, infection, and local factors

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23
Q

HLA-DR4

A

gene associated with predisposition to RA

24
Q

Seropositive rheumatoid arthritis

A

positive for rheumatoid factor (RF): many antibodies (mostly IgM, some G+A). directed against Fc portion of IgG. RF is also found in many nonrheumatic disorders such as SLE, collagen vascular disease, dermatomyositis

25
Q

EBV and RA

A

EBV can stimulate the production of RF, and RA patients will have increased numbers of EBV-infected B cells

26
Q

Pannus

A

Seen in RA. “cloak.” forms from mast cells moving over the surface of the articular cartilage and adjacent structures, lymphocytes aggregate and form follicular centers. 8-10 layers deep with multinucleated giant cells. It will erode the articular cartilage (from actions of collagenases).

27
Q

Ankylosis

A

destruction of the joint leading to fibrous fusion. Bony ankylosis: bony bridging of joint

28
Q

Rheumatoid nodule

A

extra-articular lesion (usually skin and visceral organs). central zone of necrosis surrounded by epithelioid histiocytes

29
Q

Acute necrotizing vasculitis

A

associated with RA, many organs can be involved

30
Q

Clinical hallmarks of RA

A

morning stiffness that improves with activity. Can be acute, slow progressing,

31
Q

Treatment of RA

A

NSAIDs, corticosteroids, DMARDs (disease modifying antirheumatic drugs)

32
Q

Spondyloarthropathies

A

seronegative for RF, ASSOCIATED WITH HLA-B27ankylosing spondylitis, Reiter syndrome, psoriatic arthritis, and arthritis associated with inflammatory bowel diseaseCommon features: Asymmetric involvement of only a few peripheral joints, sacroiliac/vertebral involvement, tendency to inflame periarticular tendons and fascia, system involvement, preferential onset in young men

33
Q

Ankylosing spondylitis

A

arthropathy of sacroiliac and vertebral column, can cause bony fusion of vertebrae (“bamboo spine”. Patients have low back pain. Associated with AA amyloidosis, aortitis, and uremia

34
Q

Reiter syndrome

A

(reactive arthritis. “can’t see, can’t pee, can’t climb a tree”). triad of arthritis, urethritis, conjunctivitis.

35
Q

Keratoderma blennorrhagica

A

associated with about 50% of reiter syndrome pts: mucocutaneous lesions similar to those of pustular psoriasis on palms, soles, and trunk

36
Q

psoriatic arthritis

A

HLAB27 islinked to psoriatic spondylitis, and HLADR4 has been linked to a more RA etiology

37
Q

Enteropathic Arthritis

A

proposed to be associated with bacterial proteins that are structurally related to HLA-B27, causing abnormal antigen presentation to T-cell receptors. Seen in ulcerative colitis, chron’s, and whipple disease

38
Q

Infectious Arthritis

A

causes: S. aureus and N gonorrhoeae. Classically involves a single joint

39
Q

Juvenile arthris

A

“Still disease” any inflammatory arthritis of childhoodCan include seropositive arthritis, polyarticular disease with or without systemic symptoms, and pauciarticular arthritis (only a few large joints)

40
Q

Lyme arthritis

A

Borrelia burgdorferi infection. chronic Lyme disease complication that is identical to RA

41
Q

Primary Gout

A

hyperuricemia without any other disease

42
Q

Secondary Gout

A

occurs in association with other illness that results in hyperuricemia

43
Q

Causes of hyperuricemia

A

increased de novo purine synthesis, increased cell turnover, decreased purine salvage, decreased uric acid excretion by kidnyes

44
Q

PP-ribose-P

A

elevated in gout, as it is not used by HGPRT to aid in purine salvation. This leads to hyperuricemia

45
Q

Secondary gout causes

A

leukemia/myeloproliferative disorders (increased cell turnover), Lesch-Nyan syndrome (X-linked deficiency of HGPRT), Renal insufficiency, Saturnine gout (lead nephropathy), accelerated ATP catabolism, ethanol intake

46
Q

Tophus

A

white, chalky aggregates of uric acid crystals, with fibrosis and giant cell reaction in soft tissue and joints. Associated with gout

47
Q

Podagra

A

exquisitely painful and red arthritis of the great toe. Seen in about half of patients with acute gout

48
Q

Gout treatment

A

Colchicine and allopurinol

49
Q

PseudogoutPseudo-RA, pseudo-OA, pseudoneurotrophic disease

A

CPPD (calcium pyrophosphate dehydrate) deposition in synovial membranes. acute onset of gout like symptoms. These other pseudos are mimics of clinical symptoms, and due to CPPD deposition

50
Q

Crystals found in synovial fluid: gout vs pseudogout

A

needle shaped and negative birefringence under polarized light (yellow) vs rhomboid shaped and weakly positive birefringence under polarized light (purple)

51
Q

Hemophilia/hemochromatosis/ochronosis

A

blood, iron, and ochronotic pigment involvement in the joints, leading to destruction of articular cartliage

52
Q

Baker cyst

A

herniation of synovium of knee joint into popliteal space. Seen with various forms of arthritis

53
Q

synovial chondromatosis

A

benign, self limiting. hyaline cartilage nodules form in synovial fluid. “grains of sand between gears.” Stimulates synovium to secrete increased fluid and bleeding. If cartilage nodules undergo endochondral ossification –> synovial osteochondromatosis

54
Q

Tenosynovial giant cell tumor

A

benign neoplasm, most common of synovium and tendon sheath. Occurs aslocalized or diffuse (PVNS…pigmented vilonodular synovitis)invades joint and erodes the bone

Pathology Unit 2 (17 decks)

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