Exam 1 Pt 4: Joints Flashcards
What is a form of crystal-induced arthritis sometimes known as pseudogout? What does it involve?
Calcium Pyrophosphate Deposition Disease (CPDD, CPPD, chondrocalicinosis, or pseudogout)
accumulation of calcium pyrophosphate crystals in joints/soft tissues inducing inflammation
T/F. Calcium Pyrophosphate deposition disease is more sever than gout.
False. it is less severe than gout
Who is at risk for developing CPDD (calcium pyrophosphate deposition disease)?
- advanced age (over 50)
- family history
- previous joint injury
- affects 1/2 inds living longer than 85 years old
What joints are characteristically involved in CPDD (calcium pyrophosphate deposition disease)?
- knee, shoulder, wrist, hip, elbow, ankle
- most asympotmatic, some acute, subacute or chronic arthritis
- monoarticular or polyarticular
What is HADD?
Hydroxyapatite deposition disease (or calcific tendinitis)
- idiopathic, involves deposition of calcium phosphate (calcium hydroxyapatite) crystals w/in joints and soft tissues
What is the most common joint affected by HADD (hydoxyapatite deposition disease)?
shoulder!!!
- others include: elbow, wrist, hip, ankle
Calcification of the supraspinatus tendon is characteristic of what idiopathic disease?
HADD (hydroxyapatite deposition disease)
What are risk factors for developing HADD (hydroxyapatite deposition disease)?
- advanced age (over 40)
- history of adhesive capsulitis (AKA frozed shoulder)
What involves ossification of the spinal ligaments, specifically the ALL? What locations does the oss. of the ALL occur?
DISH (Diffuse Idiopathic Skeletal Hyperostosis)
- in C and lower T (T7-T11) are MC areas
T/F. The zygopophyseal joints and SI joints are not involved in DISH, and ankylosis does NOT occur.
True.
What condition appears on an x-ray as “flowing oss.” or “candle wax dripping”?
DISH
- produces a “tortuous paravertebral mass” on anterior aspect of spine
How does the motion of the spine change with DISH?
- reduced spinal ROM, and creates spinal “rigidity”
- movements between VBs still exists
- Cervical DISH may cause difficulty swallowing
What are the risk factors for developing DISH?
- male sex
- over age 50
- have hyperglycemia/diabetes
- 1/3 positive for HLA-B27
What are three ways an infection may occur within a joint?
- hematogenous spread
- spread from surrounding soft tissue infs/ osteomyelitis
- traumatic introduction
What condition is characterized by acute joint pain combined with abundant pus formation?
Suppurative arthritis
suppurative = causing production of pus
What are the most common cause of suppurative arthritis?
bacterial infections
Describe the manifestation of joints involved in suppurative arthritis. Any other signs and symptoms that one may have?
red, swollen, very tender to touch and vibration
systemic signs/symptoms of an inf.:
- fever
- malaise
- leukocytosis
- elevated ESR
What is the MC affected joint of suppurative arthritis? Is it usually mono or polyarticular?
(MC = knee
- usually monoarticular
also– hip, shoulder, elbow, wrist, sternoclavicular joints)
What is the most recognized bacterial pathogen to cause suppurative arthritis and in what population?
Staphylococcus aureus in children (above 2) and adults
What bacterial pathogen MC causes forms suppurative arthritis in these populations:
- Children and adults
- Sexually active young adult females
- Sickle cell disease patiens
- Children younger than age 2
- Staphylococcus aureus
- Neisseria gonorrhoeae
- Salmonella spp.
- Haemophilus influenzae
What is Gonococcal Arthritis? Who is MC to get it?
develops following untreated cases of gonnorhea; less severe joint pain, polyarticular pattern; “subacute” course
- MC in females under age 40
What two conditions are our focuse when it comes to Infectious arthritis?
- Suppurative arthritis
2. Lyme Arthritis
What is the MC arthropod-borne disease in the US? What can it develop into?
Lyme Disease; can develop into Lyme Arthritis when it is untreated
What bacterial spirochete causes lyme disease and how is it transmitted to humans?
Borrelia burgdorferi; transmitted via lxodes deer tick
spirochetal infs– spread throughout body and involve mult. organ systems
Lyme arthritis develpos in about _____ patients with untreated Lyme Disease within ____ of initial infection.
75%; within months
What are the three distinct phases of lyme diseae?
- Early Localized Phase
- Early Disseminated Phase
- Late Disseminated Phase (chronic phase)
(disseminated = to spread throughout organ or body)
What is characteristic on the skin in the Early localized phase of lyme disease?
“bullseye rash”; aka erythema chronicum migrans
What is stage 2, early disseminated phase of lyme disease dominated by?
secondary skin lesions that cover larger areas of the body, like thorax
May have:
- CN dysfxn
- meningitis
- migratory joint pain of large extremity joints
- migratory muscle pain
- carditis
What does the chronic phase of lyme disease manifest like?
- constant polyarthritis and permanent joint distruction
- knees, shoulders, elbows, ankles
- also have meningities, CN dysfxn, myalgia, carditis
- life threatening CNS inflam.
What is the Tx for lyme disease and how effective is it? What if it doesn’t work, then what do we call the disease?
antibiotics–cure rates ~90%
Posttreatment Lyme Disease syndrome
T/F. Primary joint tumors are common and MC malignant.
What do they originate from?
False–they are RARE and MC benign!!
Originate from tissues constituting a joint:
- synovial tissue
- fat
- cartilage
- fibrous tissue
- vascular tissue
What are usually more common than primary joint tumors?
tumor-like lesions
- lesions w/in or near joint that resemble tumors, but ARE NOT true neoplasms
- most commonly develop from trauma of degeneration
What is a collection of degenerative CT that is MC near joint capsule or sheath of wrist or hand?
ganglion cyst (not true cyst b/c no epithelial lining)
Where are ganglion cysts MC? Do they communicate with the joint? What are they filled with?
dorsal or ventral surface of wrist; do not communicate w/ joint; filled with myxoid cartilage
What develops following herniation of synovial fluid w/in synovial joint into periarticular soft tissues?
synovial cysts
Where are the two characteristic locations of synovial cysts?
- popliteal fossa
- near lumbar zygapophyseal joints
What is a synovial cyst formed in the popliteal space called? What are known risk factors for this condition?
Baker cyst
RA and OA
What synovial cysts that form w/in spinal canal called? What does it commonly cause?
Spinal synovial cyst; commonly causes spinal stenosis (narrowing of spinal canal)
What age of individuals MC develop spinal synovial cysts and why? Where is the MC location?
older adults; due to degeneration of zygapophysis joints
MC is posterior to L4 and L5 vert.
Are soft tissue tumors more likely to be benign or malignant?
benign
What percentage of soft tissue sarcomas affect pediatrics?
15%
Malignant soft tissue tumors represent a ____ percentage of all cancer diagsoses, but constitute about ___ percent of all cancer-related deaths.
small (<1%); 2% all cancer-related deaths, telling use they are aggressive
Where are the MC locations of soft tissue tumors?
thigh or retroperitoneal area (abdomen)
Are soft tissue tumors MC sporadic or hereditary?
sporadic
What is the MC soft tissue tumor in adults?
lipoma
What are lipomas? Risk for malignancy? Encapsulated or not?
- benign adipocyte tumor composed of mature adipocytes and are NOT a risk for malignancy
- soft to touch and painless
- encapsulated –therefore more mobile
Where to lipomas characteristically develop?
proximal extremities or torso (trunk)
What is the most common sarcoma of mid-to-later adulthood (age 50-70)?
liposarcoma
What are liposarcomas? Where do they MC develop?
malignant tumor of adipocytes, MC develop in retroperitoneum (therefore not easily detected = poor prognosis)
What is a benign tumor of fibroblasts located w/in superfical fascia?
Nodular fasciitis
Where do most cases of nodular fasciitis develop? How do they manifest? MC in what age?
volar (palm-side) of arm, foot, chest, or back
rapidly-enlarging mass that is FIRM
adults
What involves dystrophic calcification of injured soft tissues following trauma? What age group is MC affected?
Myositis ossificans
adolescent or young adult athletes
What are other ways to describe myositis ossificans?
traumatically-induced metaplasia or heterotopic ossification
What does myositis ossificans cause and where is it most likely to occur?
hard and painless mass; most likely proximal extremities about 4-7 wks after initial injury
What represents a group of benign tumors of fibroblasts are invasive and cause painful destruction of tissues?
Fibromatoses
What kind of Fibromatoses are there?
Superficial
Deep (desmoid tumors)
What benign proliferations are common among males and cause firm nodule surrounded by dense collagen?
Superficial fibromatoses
What are two examples of Superficial Fibromatoses?
Pyronine disease
Dupuytren contracture
What is Pyronine disease?
formation of a superficial fibromatosis on dorsolateral penis
What is Dupuytren contracture?
formation of a superficial fibromatosis on the palmar fascia (hand) and typically develops on ulnar side of hand
What are Deep fibromatoses? Who are they more likely to occur in?
develop w/in anterior abdominal wall or limb girdles
- invasive, aggressive, and freq. RECUR after excision
MC in adult females
What is a malignant soft tissue tumor of fibroblasts? Where is it most likely to develop?
Fibrosarcoma
thigh or retroperitoneal space
How does a Fibrosarcoma manifest?
invasive, but slow-growing mass (thigh of retroperitoneal space)
What age group is most likely affected by Fibrosarcomas?
adults (age 35-55)
What characteristcally has a herringbone histological appearance?
fibrosarcoma
- herringbone arrangement of neoplastic fibroblasts
What is the recurrence rate of fibrosarcomas after excision?
about 1/2 come back
By the time Fibrosarcomas re Dx, where have they mets to?
about 25% have already mets to lungs
T/F. Virtually all tumors of skeletal muscle tissues are benign.
False–virtually all are malignant (like Rhabdomyosarcoma)
What is Rhabdomyosarcoma?
a malignant tumor of rhabdomyoblasts–which are precursor cells to skeletal muscle tissue
Where do Rhabdomyosarcomas MC develop?
areas on MINIMAL skeletal muscle tissue
- head or neck
- genitourinary region
- extremities
- trunk
What is the MC soft tissue sarcoma among pediatrics?
Rhabdomyosarcoma
What is the rate or cure of children Dx with Rhabdomyosarcoma?
about 2/3 are cured
adults poorer prognosis
What is leiomyoma? Where does it characteristically develop?
a benign tumor of smooth muscle cells; MC develop in uterus
- also in esophagus, or SI
Leiomyoma found in the uterus are referred to as what? MC among who?
“fibroids”; firm to touch, about 1-2 cm
MC among reproductive age females
What characteristically manifests with “cigar-shaped” nuclei?
Leiomyosarcoma
What are Leiomyosarcomas?
a malignant tumor of smooth muscle cells
- “cigar-shaped” nuclei
- common
How common are leiomyosarcomas?
represent 20% of all soft tissue sarcomas
Where are leiomyosarcomas most likely to be found?
thigh or abdomen (retroperitoneum); firm masses
- uterus–> common form of uterine CA
Leiomyosarcomas found in the uterus are most likely to affect what women?
older (menopausal) females
T/F. Synovial Sarcomas develop from tissues of the joint.
False (they used to believe that)
What soft tissue malignant tumor of “uncertain origin” develop as a PAINLESS mass in young adults 920-40) and are very aggressive?
Synovial sarcoma
What is the MC location for synovial sarcomas?
soft tissues surrounding the knee
- usually surround large joints (only 10% found w/in joint)
What is the prognosis for synovial sarcomas?
very poor prognosis
- less than 30% achieve long-term survival (10 years after Dx)
