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CLINICAL PATHOLOGY > Diseases of musculoskeletal system - joint and bone > Flashcards

Diseases of musculoskeletal system - joint and bone Flashcards

1
Q

What are Arthritides?

A

Pain and stiffness of a joint

Inflammation of the joint

Not one single disease but hundreds of diseases

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2
Q

Acute vs. Chronic arthritis

A

Acute is pain, heat, redness and swelling

Chronic types include:
Rheumatoid and Osteo

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3
Q

Osteoarthritis

A

Commonest type of joint disease

  • degenerative joint disease
  • Progressive erosion of articular cartilage
  • formation of bony spurs and cysts at the margins of joints
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4
Q

Epidemiology of OA - Who gets it and why?

A

Ageing phenomenon

No apparent initiating cause

Secondary OA- knee in basket ball players and elbow in baseball players

Underlying systemic diseases such as diabetes and marked obesity

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5
Q

In men and women, where are most common places of OA seen?

A

Knees and hands in women and hip in men

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6
Q

Pathogenesis of OA

A

Chondrocytes-
cellular basis of OA

Chondrocytes produce interleukin-1 – initiates matrix breakdown

Prostaglandin derivatives induces the release of lytic enzymes – prevents matrix synthesis

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7
Q

What is primary OA?

A

Abnormal stresses in weight bearing joints

Affects fingers, knees and cervical and lumbar spines

Involvement of fingers- Herberden’s or Bouchard’s nodes

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8
Q

What is rheumatoid arthritis?

A

Chronic systemic disorder-principally affecting the joints

Producing a non suppurative proliferative synovitis- destruction of articular cartilage and ankylosis of joints

Also affects skin, muscles, heart, lungs and blood vessels

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9
Q

Clinical features of RA

A

Malaise, fatigue and generalised musculoskeletal pain to start off

joints are swollen, warm, painful and stiff in the morning or after activity

slow or rapid disease course over 4-5 years

small joints of the hands and feet are affected - leads to a deformed joint

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10
Q

Pathogenesis of RA

A

Genetic susceptibility-65-80%-
HLA- DR4 &DR1 or both

Primary exogenous arthritogen- EBV,other viruses, Borrelia

Autoimmune reaction within the synovial membranes- CD4 positive T-cells

Mediators of joint damage: e.g.

Cytokines-
IL-1-6 and TNF

-alpha&beta

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11
Q

Criteria for rheumatoid arthritis diagnosis

A 
Morning stiffness
Arthritis in 3 or more joint areas
Arthritis of hand joints
Symmetric arthritis
Rheumatoid nodules
Serum Rheumatoid factor

(4 of the above)

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12
Q

What is rheumatoid factor?

A

Present in most but not all RA patients

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13
Q

In RA diagnosis the analysis of synovial fluid - confirms presence of…

A

Neutrophils

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14
Q

How does RA present in the skin?

A

Rheumatoid nodules

Commonest cutaneous manifestation in areas of pressure

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15
Q

RA affects which other organs?

A

Lung
Spleen
Heart

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16
Q

Which 4 arthritides lack the rheumatoid factor?

A

Ankylosing spondylitis

Reiter’s syndrome

Psoriatic arthritis

Enteropathic arthritis

17
Q

What is gout?

A

A group of disorders producing hyperuricemia

Uric acid is the end product of purine metabolism

Deficiency of the enzymes involved

18
Q

Clinical features of Gout

A

Acute arthritis
Chronic arthritis
Tophi in various sites
Gouty nephropathy

19
Q

Transient attacks of acute arthritis crystallization of urates within and about joints leads to what?

A

chronic gouty arthritis and deposition of masses of urates in joints and other sites- tophi

20
Q

What is pyogenic osteomyelitis and how does it present?

A 
Systemic illness-fever
Presents:
malaise 
chills
marked pain
21
Q

Diagnosis tools for pyogenic osteomyelitis

A

X-ray lytic focus of bone destruction surrounded by zone of sclerosis

Blood cultures are positive

Biopsy- if needed shows sheets of neutrophils

22
Q

What is pyogenic osteomyelitis caused by and how does it spread?

A

Caused by bacteria
Hematogenous spread
Extension from a contiguous site
Direct implantation

23
Q

What is infective arthritis?

A

Acutely painful and swollen joints with restricted movements

24
Q

What is infective arthritis caused by?

A

Bacterial-
Staphylococcus, Streptococcus,
Gonococcus,
Mycobacteria

25
Q

How does infective arthritis present?

A

Fever, leucocytosis and elevated ESR

26
Q

What is osteoporosis?

Where does it affect?

A

Increased porosity of the skeleton

Reduction in bone mass

Localised or entire skeleton

Primary or secondary

27
Q

When is onset of osteoporosis usually?

A

Primary-age and postmenopausal

28
Q

What are risk factors of osteoporosis?

A

Physical activity
Muscle strength
Diet
Hormonal status

29
Q

Clinical features of osteoporosis?

A

Vertebral factures
Kyphosis
Scoliosis

30
Q

What causes secondary osteoporosis?

A

Endocrine disorders-

Hyperparathyroidism,

Type1 diabetes

Neoplasia-Multiple myeloma

Malnutrition

31
Q

What is Paget’s disease?

A

Osteoclast dysfunction

Caused by Paramyxovirus

32
Q

What is the clinical presentation of Paget’s disease?

A

Pain is most common symptom

Chalk stick type fractures

33
Q

When does Paget’s disease first present?

A

Begins in the 5th decade
More common in males
Axial skeleton and proximal skeleton is most commonly involved

34
Q

Types of tumours due to Paget’s disease

A

Giant cell tumours are benign

Malignant:
Osteosarcoma
Chrondrosarcoma
Malignant fibrous histiocytoma

35
Q

What is Osteomalaica?

How does it present clinically?

A

Defects in matrix mineralization

Related to lack of Vit D

Decreased bone density - too little bone-osteopenia

Skeletal deformities are not seen

36
Q

What is renal osteodystrophy?

A

Skeletal changes of chronic renal disease

37
Q

Clinical symptoms and presentation of renal osteodystrophy

A

Increased osteoclastic bone resorption

Delayed matrix mineralization

Osteosclerosis

Growth retardation

Osteoporosis

CLINICAL PATHOLOGY (56 decks)

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