eggzam Flashcards
List 5 Things in a joint that cause pain
- Synovium
- Periostium
- Ligaments
- Subchondral bone
- Joint Capsule
List 4 Pathophysiologcal disease processes of a joint
- Synovitis
- Infection
- Crystal Deposition Disease
- Enthesitis
- Structural or mechanical derangement
List 4 key events occurring in synovitis
- Neovascularisation
- Infiltration of synovium with lymphocytes, plasma cells, and macrophages
- Proliferation of synoviocytes and invasion of inflammatory cells may form granulation tissue – a pannus may form
- Synovial cell hyperplasia occurs and synovium thickens
Compare OA & RA
• Joint Stiffness
o RA
Upon waking, last more than 30-60 minutes
o OA Stiffness
Occurs upon waking or following periods of inactivity, is usually brief 15-30 minutes
• Joint Swelling
o RA
Synovial hypertrophy and synovial effusion
Inflammation of periarticular structures
Degree of swelling caries over time
o OA
Osteophyte formation and bone swelling
Soft tissue swelling can contribute – cysts, thickening and effusion
• Joint Pain
o RA
Occurs both at rest and with motion
Worse at beginning of movement and improves
o OA pain
Occurs mainly only during motion
Improves with rest
List 6 things (descriptors to help diagnose painful Jts)
• Onset of symptoms o Abrupt or insidious • Symmetry of presentation o Asymmetrical or symmetrical • Duration of symptoms o Acute or chronic • Joint Involvement o Migratory, addictive or intermittent • Number of joints involved o Mono, oligo, polyarticular • Distribution o Axial o Peripheral • Distinctive presentation o Enthesitis o Dactylitis o Back pain o Tendonitis • Extra articular manifestations o Systemic SSX o Skin lesions o Ocular lesions
Define: Mono, Oligo & Polyarthitis
Arthritis affecting 1 joint
Arthritis affecting 2-4 joints
Arthritis affecting 4 or more joints
List 3 Manifestations for 3 conditions
Ocular lesions
• RA
• AS
• Reactive arthritis
Consitutional (Systemic) ssx
• RA
• PsA
• SLE
Inflammatory Arthritides
• Septic arthritis
• Gout & psuedogout
• Systemic rheumatic disease manifesting as monoarticular involvement
List four conditions which might cause particular manifestations
SLE • Malar Rash Scleroderma • Dermal induration due to fibrosis Psoriatic arthritis • Psoriasis preceding inflammation Dermatomyositis • Gottron’s papules
Define ESR & CRP
ESR (erythrocyte sedimentation rate)
• Non-specific test to measure inflammation in the body. Rough measure of abmnormal concentration of acute phase proteins and immunoglobulins in the serum for infections, cancer, autoimmune diseases.
CRP
• An acute stage reactant protein synthesised by hepatocytes that detects presence of inflammation due to tissue injuru ,automune disease and infections
What does CRP tell you that ESR Doesn’t?
- More sensitive than ESR
- CRP is independent of factors that affect ESR e.g. anaemia
- CRP is correlated better with disease activity i.e. degree of elevation mirros extent of tissue damage
- CRP levels rise quickly (4-6 hours post injury) – will be elevated before ESER & also disappears before fall of ESR
Another Lab test, define what it is and which condition it is found in. List 3 diseases test might be positive in. Where is this test indicated?
Rheumatoid Factor Define: • A group of autoABs (most commonly IgM) that form immune complexes that deposit in tissue, resulting in complement activation and inflammation Condition found in: • Normal people • Non-rheumatic conditions • Rheumatic conditions Indications • RA • SLE, Ssc, PMDM
5 Indications for particular tests (Joint aspiration)
- To aid ddx of gout & pseudo gout
- To detect presence of gonocci, a mjor cause of joint infection
- To establish dx of infection, arthritis, synovitis or neoplasms involving the joint
- To identify progression of joint disease
- To identify cause of joint effusion
Name a lab test & 4 conditions where the lab test might be increased
ESR • RA • PsA • Autoimmun disease • Polymalgia rheumatic RF • RA • SLE • Ssc • Polymyositis
4 Ominous signs you would see on bone x-ray to make you think malignancy
- Diffusion invasion of bone
- Extensive destruction of bone
- Diffuse periosteal new-bone formation
- Extension of tumour into neighbouring soft tissue
Lab results that might explain a particular condition
• Malignany bone tumour o FBE o ESR o Serum ALP o Serum protein
Bone Malignancy 10 mark question
Osteosarcoma
Definition
• A highly malignant osteoid producing tumour comprised of primitive osteoblasts
Epidemiology
• Most common bone tumour (22%)
• 20-30s & peak around 60s
Risk Factors
• Genetic factors: Germ-line mutations the p53 gene, Rb gene mutations
• Osteogenesis imperfecta
• Areas of rapid bone growth: Tumours arise at sites of maximal bone growth
• Paget’s disease
• Radiation: especially post-radiotherapy for childhood solid organ tumours
Histology
• Spindle shaped cells with variable cytologic atypia
• High grade intramedullary types
• Presence of osteoid and new bones
Distribution
• Any boen buyt especially long bone metaphysis (knee/proximal humerus)
Pathology
• Osteosarcoma destroy and replaces bone alternating areas of bone loss + abnormal bone
• Quick spread to periosteum and surrounding tissues (bone grows replacing ST)
• Originates within metaphysis, may cross epiphyseal plates
Dx
• Clinical Picture
• Later confirmed by imaging and other procedures
Clinical Picture
• Pain and mass occurring near joint = most common presentation
• Pain is constant gets worse PM
• Pain gradually increases in severity
• Lump/swelling increases in size, hard, fixed to deep structure, modestly tender
• Swelling/erythema on over lying tissue d/t increased tumour vascularity
Lab investigations
• Including ESR
• +/- in serum ALP
Radiological Findings
• Variable
• Hazy osteolytic areas
• Dense osteoblastic areas
• Poor definition of endosteal margin
• Cortical breaching as tumour extends into adjacent tissue
• Sunburst sign: streaks of new bone extend outwards from cortex
• Codman’s triangle – periosteal elevation
• Pulmonary metastasis
DDx
• Stress #, OM benign bone lesions, ewing’s sarcoma
TTX
• Surgical amputation/chemo
Px
• 60% live past 5 years, 80% long term survival
