E2L18-19 Joints Pathoma Flashcards
What kind of collagen makes up articular cartilage?
Type II
What is the fluid in synovial joints and where does it come from?
Synovium lines the joint capsule and secretes synovial fluid which is made of hyaluronic acid
How do osteoarthritis and rheumatoid arthritis differ as far as how they feel throughout the day?
Osteoarthritis: stiff morning, worse throughout the day, remember this is a wear and tear problem so using it will make it worse
Rheumatoid: stiff in morning but better throughout the day and with use
Patient has pain in hips and knees and DIP/PIP joints that feels worse the more they use them. What would be seen on the articular surfaces of these bones?
These are S/Sx of degenerative joint disease or OA
Articular surfaces would show disrupted cartilage (making joint mice), eburnation (polishing), osteophyte formation
Patient has nodules forming on DIP and PIP joints and the joints are painful. What is the disease and what are these nodules called?
Osteoarthritis (OA)
DIP= Heberden Nodes
PIP= Bouchard Nodes
What joints tend to be affected by OA?
Hips, Knees, Spine (Load bearing areas)
DIP, PIP
Who tends to get rheumatoid arthritis?
Middle-aged women
This corresponds well with the fact that this is an autoimmune disease.
What disease is associated with HLA-DR4?
Rheumatoid arthritis
What is the hallmark of Rheumatoid arthritis?
Synovitis that leads to the formation of Pannus
Pannus: inflammed granulation tissue that has myofibroblasts which contract and pull the joint together (causing ankylosis) or cause the joint to deviate
What joints are involved with rheumatoid arthritis?
PIP, wrists, elbows, ankles, knees
DIP are spared
What other Sx might accompany RA besides joint problems?
This is an immune reaction and therefore there are also Sx of fever, malaise, weight loss, myalgia
Also can have vasculitis, Baker’s cyst, pleural effusions, LAD, interstitial lung fibrosis
What are rheumatoid nodules?
Found in skin and visceral organs
Area of central necrosis and surrounding epithelioid histiocytes
What are the labs assoc. with rheumatoid arthritis?
Most significant finding is rheumatoid factor which is an IgM antibody against the Fc region of IgG
Will also find neutrophils and high protein content in the synovial fluid
What are the potential complications of rheumatoid arthritis?
Anemia of chronic disease
Secondary amyloidosis caused by deposition of AA that is derived from SAA which is made in the liver
What is a seronegative arthropathy?
A disease of the joint that is negative for rheumatoid factor (IgM against Fc of IgG), involves the axial skeleton, is assoc. with HLA-B27
Patient is a young male patient complaining of back pain, x-ray shows “bamboo spine”
What disease does he have and what are the possible complications?
Ankylosing spondyloarthritis
Involves the sacroiliac joints and spine
Can lead to a fusing of the spine (ankylosis) which is called bamboo spine
Complications: Uveitis, Aortitis
Young male recently infected with Chlamydia or had a GI infection and now is experiencing joint pain.
What syndrome does he have and what other Sx classically accompany it?
Reiter’s syndrome classically follows GI or Chlamydia infection in a young male
Triad of Sx: Arthritis, Urethritis, Conjunctivitis
(Can’t see, pee, or climb a tree)
Patient has history of scaly rash that is incurable and develops pain in the joints.
What disease, joints, and classic description?
Psoriasis can cause Psoriatic Arthritis in 10% of cases
Typically involves axial and peripheral joints including the DIP of hands and toes leading to the classical description of “sausage” fingers/toes
Young adult recently Dx with N. gonorrhoeae infection develops swollen, red and painful knee.
What is the disease and what is the 2nd most common causative agent?
Infectious arthritis: involved one joint, usually the knee, warm, limited ROM, fever, increased WBC’s and ESR
Other agent is S. aureus which usually infects older kids and adults
Patient diagnosed with gout, what would be found in a sample of the synovial fluid?
Monosodium Urate Crystals
Needle-shaped, negative birefringence under polarized light (demonstrated by crystals that are lying down being yellow)
Describe formation of uric acid
Uric acid is the breakdown product of purines
Purines become AMP, GMP
AMP becomes hypoxanthine
GMP becomes guanine
HX and G become xanthine
Xanthine becomes UA by enzyme Xanthine Oxidase
What are the causes of gout?
Hyperuricemia from either increased production of uric acid or decreased clearance by the kidney
1) Leukemia & Myeloproliferative: high cell turnover causes increased production of UA
2) Lesch-Nyhan syn.: x-linked deficiency of HGPRT which is an enzyme that salvages Purine breakdown products before they become UA, patient also mentally retarded
3) Renal insufficiency
What is podagra?
fancy name for the inflamed great toe seen in gout
What makes gout worse?
Ingestion of alcohol or meat
