Connective Tissue Disorders Flashcards
Gout
Age: men, postmenopausal women
Joints: monoarticular or oligoarticular
Special features: podagra, rapid onset of attack, polyarticular gout, tophi
Synovial fluid: crystals, high WBC, PMN
Associated with: hyperuricemia from purine metabolism end product
- deficiency of HGPRT (enzyme of salvage pathway)
Factors: age and duration of hyperuricemia; genetic predisposition; heavy alcohol consumption; obesity; drugs (thiazides); lead toxicity
Light microscopy: monosodium urate crystals in the joints
Gouty nephropathy: MSU crystals in renal medullary interstitium
Acute: neutrophils
Chronic: fibrosis in addition to crystals with pannus destroying cartilage
Septic arthritis
Age: any age
Joints: usually large joints
Special features: fever, chills
Synovial fluid: high WBC, PMN, culture
Bacterial: Staph, strep, gonococcus, H. influenzae, gram negative bacilli
TB: monoarticular disease with osteomyelitis or hematogenous dissemination from a visceral site of infection; pannus over articular cartilage with bone erosion
Lyme: dissemination of organism to joints remitting and migratory in large joints one or two at a time
Viral: alphavirus, parvovirus B19, rubella, EBV, hep B/C, HIV
Osteoarthritis
Most common joint disease, insidious onset
Age: increases with age
Joints: weight bearing, hands
Synovial fluid: noninflammatory
Cause: AGE, obesity, muscle strength, joint stability, structure, alignment
Path: chrondocytes injury related to aging and genetic factors; in early OA inflammatory, collagen, proteoglycans, proteases remodel matrix; late OA repetitive injury and chronic inflammation
Light microscopy/gross: joint mice and bone eburnation with osteophytes at margins of articular surface
Clinical: achy pain that worsens with use, morning stiffness, crepitus, limited ROM
- hips, knees, lower lumbar, cervical vertebrae, prox and distal interphalangeal joints
Rheumatoid arthritis
Age: any age, predominantly women ages 20-50 year
Joints: symmetrical, small joints disease in infiltration of synovial stroma by perivascular inflammatory infiltrate; increased vascularity due to vasodilation and angiogenesis; aggregation of organizing fibrin of synovium; accumulation of neutrophils, osteoclastic activity in bone, pannus formation
- pannus - mass of synovium and synovial stroma infl cells, granulation tissue, fibroblasts
Skin: rheumatoid nodules common cutaneous lesion in pressure spots –> epithelioid histiocytes, lymph, plasma cells
BV: vasa nervorum and digital arteries and medium to small size arteries
Path: proliferation of synovial intimal layer to form a pannusinvades cartilage and bone
- autoantibodies of IgM to Fc portion of autologous IgG
- anti-CCP antibodies
- increased MMP which upregulate RANKL
Special features: rheumatoid nodules, extra-articular
Synovial fluid: high WBC, PMN
Clinical: nonsuppurative proliferative and inflammatory synovitis progresses to destruction of articular cartilage and ankylosis of joints
- swollen, warm, painful, stiff following inactivity
- joint effusions, juxtaarticular osteopenia with erosions and narrowing of joint space
Reactive arthritis (Reiter syndrome)
Reactive arthritis defined by triad of arthritis, NGU or cervicitis and conjunctivitis
Age: young males, HLA-B27
Joints: oligoarticular, asymmetrical
Special features: urethritis, conjunctivitis, skin, mucous membrane
Synovial fluid: moderate WBC, half PMN
Associated with: HIV, Shigella, Salmonella, Yersinia, Campylobacter, Chlamydia
Clinical: sx develop within several weeks of urethritis or diarrhea, joint stiffness, low back pain ankles and kenes are affected
Spondyloarthropathy
Age: young to middle aged men
Joints: axial skeleton, pelvis (sacroiliac joints)
Special features: uveitis, aortic insufficiency, enthesopathy
Systemic lupus erythematosis
Age: women in childbearing years
Joints: hands, knees
Special features: nonerosive joint disease, autoantibodies, mononuclear, multiorgan disease
Synovial fluid: low to moderate WBC, 100% ANA
Juvenile idiopathic arthritis
Age: children
Types: systemic arthritis, rheumatoid factor positive, oligoarthritis, enthesitis related arthritis
- systemic has abrupt onset
- oligoarthritis HLAB27 younger than 6 less than four joints
- enthesitis is male children under 6
- rheumatoid factor in first 6 months or teenage girls
Ankylosing Spondyloarthritis
Chronic synovitis with destruction of articular cartilage and bony ankylosis of sacroiliac and apophyseal joints
Gender: more often in men, HLAB27
Present: low back pain
Clinical: fracture of spine, uveitis, aortitis, amyloidosis
Enteritis-Associated Arthritis
GI - Yersinia, Salmonella, Shigella, Campylobacter
Clinical: knees, ankles, wrists, fingers, toes
Psoriatic Arthritis
Chronic inflammatory arthropathy affecting peripheral and axial joints, etheses with psoriasis
- related to HLA-B27DIP affected first in asymmetric distribution in more than 50% of patients associated with sausage-like finger
- conjunctivitis and iritis, no other extra articular manifestations
Pseudo-gout
Calcium pyrophosphate crystal deposition - intra articular crystal formation
Age: > 50
Auto dom from ANKH
Crystals are smaller
Joints: mono or polyarticular with knees, wrists, elbows, shoulders, ankles
Ankylosing spondylitis - HLA association
B27
Postgonococcal arthritis - HLA association
B27
Acute anterior uveitis - HLA association
B27
