Dougherty Part 5 Flashcards
what is the cause of primary osteoarthritis
idiopathic with aging
where does primary osteoarthritis primarily effect men and women
men: hips predominate
women: knees and hands
what are the main causes of secondary osteoarthritis
repeated injuries to a joint
hemochromatosis
obesity
osteoarthritis is also called what and is due to what by what
degenerative joint disease (DJD)
degeneration of cartilage outpaces repair
what are the phases of osteoarthritis
chondrocyte injury
chondrocytes proliferate
chondrocytes drop out with loss of cartilage
what is bone eburnation and when is it seen
exposed bone on surface-looks like polished ivory and underlying bone sclerosis
seen in osteoarthritis
what is an osteophyte (bone spur) and when is it seen
extra bone at joint edge
seen in osteoarthritis
what is seen grossly in osteoarthritis
superficial roughened and cracked cartilage subchondral cysts of synovial fluid bone eburnation joint mice osteophytes
what is joint mice and when are they seen
loose bodies of cartilage
seen in osteoarthritis
what happens to osteoarthritis with use
worsens
what is a heberden node and when is it seen
osteophytes in DIP in women
seen in osteoarthritis
what does a patient with osteoarthritis present with
deep achy pain morning stiffness worsens with use crepitus of joint limited range of motion vertebral osteophytes impinge on nerve roots
osteoarthritis spares what
wrists, elbows, shoulders
what is rheumatoid arthritis
systemic autoimmune inflammatory disease
nonsuppurative proliferative inflammatory synovitis often destroying cartilage with later ankylosis of the joint
who and when are affected by rheumatoid arthritis
females > males
any but most often 40-70
what is pannus
exuberant inflamed synovium
chronic inflammation with T-cells (mostly CD4+), B-cells, plasma cells, macrophages
granulation tissue with hemosiderin
erodes articular cartilage
erodes bone (juxtarticular cysts, subschondral cysts, osteoporosis)
what is the pathogenesis of rheumatoid arthritis
antigen exposure in a susceptible host creating an ongoing autoimmune processes
80% of rheumatoid arthritis patients have what
Rheumatoid factor (non specific)
antibodies to what are found in rheumatoid arthritis that is more specific than RH factor
Citrullin-modified peptides (anti-cyclic citrullinated peptide or CCP Ab)
Rheumatoid arthritis affects what joints
symmetric with small joints before large:
PIP, MCP, MTP
later wrists, ankles, elbow, knees (spares hip)
what is seen in the joints of people with rheumatoid arthritis
swollen, warm, painful, and stiff with inactivity
what is seen on an x-ray of rheumatoid arthritis
juxta-articular osteopenia
bone erosions with narrowing of joint space from loss of articular cartilage
joint effusions
what is seen grossly in late stage rheumatoid arthritis
radial deception of wrist
ulnar deception of fingers
flexion-hyperextension of fingers (swan neck, boutonniere)
synovial cysts
what is a Bakers Cyst and whats its associated with
synovial cyst of the back of knee (popliteal fossa)
rheumatoid arthritis
what is the most common cutaneous manifestation seen in rheumatoid arthritis
rheumatoid nodules
where are rheumatoid nodules found
areas subject to pressure: ulnar aspect of forearm, elbows, occiput, lumbrosacral
what are rheumatoid nodules
fibrinoid necrosis surrounded by macrophages
what happens to blood vessels rheumatoid arthritis
vasculitis:
does not involve kidneys
can be obliterative endarteritis of vasa nervorum and digital arteries
leukocytoclastic venulitis (purpura, skin ulcers, and nail bed infarction)
what are the criteria for rheumatoid arthritis (need 4 of them to diagnose)
AM stiffness more than 2 joints arthritis typical hand joint involvement symmetric arthritis rheumatoid nodules serum rheumatoid factor typical radiologic changes
juvenile idiopathic arthritis is waht
a heterogeneous group by definition before age 16 and present 6 weeks:
oligoarticular (less than 5 joints)
where does juvenile idiopathic arthritis normally affect
large joints:
knees
wrists
what extra-articular manifestations are associated with juvenile idiopathic arthritis
pericarditis myocarditis pulmonary fibrosis uveitis glomerulonephritis growth retardation
what are the two main differences between juvenile idiopathic arthritis and rheumatoid arthritis
absence of rheumatoid factor
absence of rheumatoid nodules
may be ANA positive
what is found in both rheumatoid arthritis and juvenile idiopathic arthritis
pannus formation
morphology of involved joints
seronegative spondyloarthropathites are usually positive for what and negative for what
HLA B27 positive (most)
Rheumatoid factor negative
ankylosing spondyloarthritis aka “rheumatoid spondylitis” is found in what patients
young adults
onset 2-3 decade with low back pain
M > F
at what sites is ankylosing spondyloarthritis found
axial joints:
sacroiliac joints
apophyseal joints of vertebrae
in ankylosing spondyloarthritis what happens to the joints
inflammation of tendon/ligament insertion:
ossification of inflammation
fibrous and boney ankylosis
what complications are involved with ankylosing spondyloarthritis
1/3 hip, knee, shoulder arthritis uveitis aortitis amyloidosis spine fractures
bamboo spine is due to what and seen in what
fusion of the vertebrae
seen in ankylosing spondyloarthritis
reactive arthritis is commonly due to what
genitourinary: chlamydia
GI: shigella, salmonella (diarrhea)
reactive arthritis is also known as
Reiter Syndrome
what is the triad associated with reactive arthritis (reiter syndrome)
arthritis
urethritis or cervicitis
conjunctivitis
sausage toe or finger is due to what and seen in what
digital tendon sheath synovitis
seen in Reiter syndrome
reactive arthritis (weiter syndrome) is associated with what
HLA-B27
some HIV
what joints and in what pattern does reiter syndrome affect
lower extremity: ankles, knees, feet in asymmetric pattern
what extra-articular signs are seen in retire syndrome
balanitis
conjunctivitis
heart condition defects
aortic regurgitation
