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Musculoskeletal Physiopathology > Inflammatory Joint Pathologies 3 > Flashcards

Inflammatory Joint Pathologies 3 Flashcards

1
Q

Is systemic lupus erythematosus (SLE) inflammatory?

A

Yes

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2
Q

What are the three most common autoimmune diseases?

A
  1. Rheumatoid arthritis
  2. Systemic lupus erythematosus
  3. Systemic sclerosis
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3
Q

Which systems/anatomical structures are affected by lupus?

A

Multisystem autoimmune disease primarily affecting skin, joints, and kidneys

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4
Q

Which sex is more predominantly affected by lupus?
Of which ethnicity?

A

Females (9:1)
African descent groups

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5
Q

When is the age of onset for lupus?

A

Late teens to 40 years of age

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6
Q

Lupus is often mis-/over-diagnosed as ___

A

fibromyalgia

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7
Q

What is the suspected etiology of lupus?

A
  • Probably genetic component (but doesn’t have to be)
  • May be induced by some medications (such as pain killers and antibiotics)
  • May be triggered by exposure to UV light
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8
Q

What are the general symptoms of lupus?

A

Gradual onset of:

  • Fever
  • Malaise
  • Anorexia
  • Weight loss
  • Alopecia (spotty)
  • Pain and swelling (like rheumatoid arthritis)
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9
Q

Lupus often presents as a self-limiting form of ___

A

rheumatic disorder

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10
Q

What are some physical effects of lupus on joint structure?

A
  • Non-erosive synovitis (and tenosynovitis)
  • Spontaneous tendon rupture
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11
Q

A patient presents with pain and swelling, much like rheumatoid arthritis. They report that “everything hurts”. Upon examination, you find they have a fever and acute necrotizing vasculitis. With more questioning, the patient reports a painful butterfly rash that is accentuated by sunlight.
What is the likely diagnosis?

A

Lupus

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12
Q

A patient presents with spotty hair loss and is noticeably less heavy than you last saw them. They report joint pain and you find that multiple joints are swollen. They also mention that their hands get very white with any temperature drop. Furthermore, they sometimes find erythema on their neck, elbows, and hands.
What is the likely diagnosis?

A

Lupus

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13
Q

A patient with lupus presents with a spontaneous tendon rupture
What are the consequences of this?

A
  • Deformity without arthropathy
  • Attacks collagen, non-erosive
  • Eventual arthritis as instability increases
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14
Q

Lupus has led to deposition of immune complexes and fibrinoid materials in small arteries and arterioles. This has thickened and narrowed small blood vessels.
What is the term for this?

A

Acute necrotizing vasculitis

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15
Q

lupus

How might necrotizing vasculitis affect the kidneys?

A

Leads to fibrosis of kidneys (glomerular damage) and eventually renal failure

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16
Q

lupus

Acute vasculitis of serosal membranes may lead to ___

A

ulceration

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17
Q

What are some of lupus’ effects on the skin?

A
  • Erythema that flares up with other symptoms
  • Painful butterfly rash over bridge of nose and cheeks
  • Sunlight accentuates lesions
  • May appear on neck, elbows, and hands (vasculitis will lead to necrosis)
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18
Q

Is lupus joint involvement bilateral or unilateral?

A

Bilateral and symmetrical

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19
Q

Which joints are primarily affected by lupus?

A
  • Hands
  • Wrists
  • Knees
  • Shoulders

(usually distal)

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20
Q

What are some deformities that may present with lupus?

A
  • Swan neck
  • Boutonniere
  • Hitch-hiker thumb
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21
Q

Are hand deformities from lupus reversible?

A

Subluxations are reversible (deformity without arthropathy)

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22
Q

What is an example of a reversible subluxation in hands besides bony deformities?

A

Non-erosive synovitis

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23
Q

Lupus can cause ___ instability

A

atlanto-axial instability

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24
Q

In the case of lupus, what are some conditions resulting from vasculitis?

A
  • Soft tissue necrosis and calcifications
  • Osteonecrosis
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25
Q

What x-rays are needed before treating a lupus patient?
What are some restrictions on adjusting this patient?

A

Need cervical flexion extension x-rays before treating
No manipulation of upper cervical spine

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26
Q

lupus

How does Boutonniere deformity appear radiographically?

A

Proximal interphalangeal joint is flexed while distal interphalangeal joint is extended

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27
Q

lupus

How does swan neck deformity appear radiographically?

A

Proximal interphalangeal joint is extended while distal interphalangeal joint is flexed

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28
Q

How does soft tissue calcification appear in lupus?
What do these areas represent?

A

Appear diffuse
Represent areas of necrosis

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29
Q

Patients with a diagnosis of lupus have more pain in areas of ___ blood supply

A

less

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30
Q

Patients unaware that they have lupus have what sort of complaint?
How do they recreate the pain?

A

Report bone pain, not joint pain
Cannot recreate the pain

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31
Q

Lupus involves vascular weakening
What are three results of this that can occur at the hip joint?

A
  1. Sclerosis
  2. Flattening
  3. Fragmentation
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32
Q

What are the ESR and CRP levels in someone with systemic lupus erythematosus?

A

Both elevated

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33
Q

Why do those with chronic lupus experience anemia?

A

Bone marrow fibrosis

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34
Q

Are those with lupus positive or negative for RF factor?

A

Negative

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35
Q

Which noninflammatory involves anti-double-stranded DNA and anti-nuclear antibodies (ANA) while RF negative?

A

Systemic lupus erythematosus

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36
Q

ANA is positive in 95% of those with lupus
Is this specific to lupus?

A

Not specific, positive in several autoimmune conditions

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37
Q

Lupus can decrease renal function
What may be found upon urinalysis of someone with lupus?

A

Elevated creatinine

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38
Q

What are some treatments for lupus?

A
  • Corticosteroids (short-term) or other drug therapy
  • Education
  • Soft tissue work
  • Low impact activity
  • Treat like other inflammatory diseases
  • Do not adjust an unstable joint
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39
Q

Systemic sclerosis is a collagen vascular disorder, similar to ___

A

lupus

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40
Q

Systemic sclerosis involves excess deposition of ___ causing ___
A major component of this is ___

A

deposition of collagen causing organ fibrosis
major component is vasculitis

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41
Q

What is the age of onset for systemic sclerosis?
Which sex is primarily affected by systemic sclerosis?

A

Onset 40-50-years-old
Primarily females

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42
Q

Systemic sclerosis has ___ involvement 80% of the time

A

GI involvement

43
Q

What are some ways the GI system is involved in systemic sclerosis?

A
  • Xerostomia (desert mouth)
  • Loss of peristalsis (difficulty swallowing)
  • Sever reflux (GERD, Barret esophagus, esophageal carcinoma)
44
Q

What is one of the most common causes of death from lupus?

A

Renal failure

45
Q

What is the most common cause of death from systemic sclerosis?

A

Lung disease (COPD, emphysema)

46
Q

Which systems are most commonly affected by systemic sclerosis fibrosis?

A

Pulmonary, renal, and cardiac fibrosis

47
Q

How does systemic sclerosis affect the kidneys and in turn, the cardiovascular system?

A

Renal insufficiency and malignant hypertension

48
Q

What are some musculoskeletal symptoms associated with systemic sclerosis?

A
  • Swelling, arthralgia (many joints)
  • Synovitis
  • Loss of active range of motion
  • Deformity
49
Q

Systemic sclerosis is overdiagnosed as ___

A

fibromyalgia

50
Q

Systemic sclerosis involves increasing ___ activity

A

fibroblastic activity

51
Q

How might vasculitis due to systemic sclerosis appear?

A

Raynaud phenomenon in finger and toe tips, ears, and nose

52
Q

Systemic sclerosis involves a combination of fibroblastic and vascular changes
What are some of these combined changes?

A
  • Acro-osteolysis (finger/toe tips erode, cheekbones and chin erode)
  • Soft tissue calcifications (of necrosed areas and high contact areas)
  • Loss of facial expression (due to tight skin)
53
Q

What are the ESR and CRP levels in a patient with systemic sclerosis?

A

Both elevated

54
Q

When will systemic sclerosis lead to anemia?

A

Once chronic

55
Q

Is systemic sclerosis RF positive or negative?

A

Negative

56
Q

Systemic sclerosis patients are ANA postive 90% of the time
Is ANA specific for systemic sclerosis?

A

No

57
Q

Systemic sclerosis decreases renal function
What may be found in a urinalysis of a patient with systemic sclerosis?

A

Elevated creatinine (and liver enzymes)

58
Q

Is systemic sclerosis inflammatory?

A

Yes

59
Q

Is septic arthritis inflammatory?

A

Infectious and inflammatory

60
Q

What patients are most likely to present with septic arthritis?

A

Immunocompromised children

61
Q

By which methods do microorganism get into a joint in the case of septic arthritis?

A
  • Hematogenous (pneumonia, soft tissue infection moves into synovium)
  • Direct (bone into joint)
62
Q

What are some etiologies of septic arthritis?

A
  • S. aureus (most common)
  • H. influenza
  • Gonococcal infection in sexually active young adults
  • E. coli
63
Q

How is septic arthritis differentiated from gout?

A

Gout has hyperuricemia and takes 7 years to see destruction
Septic arthritis develops within ten days (in extemities)
(need labs)

64
Q

What are some common locations for septic arthritis?

A
  • Knee and hip (most common)
  • Hand (often due to human bite)
65
Q

What is the cause of soft tissue swelling in septic arthritis?

A

Joint effusion distorts fat folds

66
Q

What is the first confirmatory radiographic finding for septic arthritis?

A

Loss of subchondral white line

67
Q

A patient comes in with soft tissue swelling around the knee, seemingly filled with pus. Upon radiographs of the knee, there is a loss of joint space, bone destruction, and a loss of subchondral white line. You ask your patient if they’ve had any recent infections and they report they had a staph infection about a week ago.
What is the likely diagnosis?

A

Septic arthritis

68
Q

A patient comes in with an acutely red and swollen proximal interphalangeal joint of the second toe with pus exuding from it. The patient reports that this appeared within a matter of days and is aggravated when they step onto that foot. Upon history, they are a sexually active young adult who has contracted gonococcal infection recently.
What is the likely diagnosis?

A

Septic arthritis

69
Q

Septic arthritis involves rapid loss of joint space and aggressive bone destruction
What can happen to bones in a later stage of septic arthritis?

A

Bone ankylosis (fusion)

70
Q

What are the ESR and CRP levels in a patient with septic arthritis?

A

Both increased

71
Q

What are the alkaline phosphatase levels in a patient with septic arthritis?

A

Normal

72
Q

Is someone with septic arthritis positive or negative for HLA-B27?
For RF?

A

Both negative

73
Q

What may be found in a synovial biopsy of a joint affected by septic arthritis?

A
  • Normal uric acid (differentiates gout)
  • Pus
74
Q

Along with antibiotics, what are some treatments for septic arthritis?

A
  • Aspiration to decompress the joint
  • Irrigation of the joint
  • Decrease motion and weight bearing
  • Joint ankylosis may mean joint replacement surgery
75
Q

Is fungal arthritis inflammatory?

A

Infectious and inflammatory

76
Q

How common is fungal arthritis?

A

Rare

77
Q

Fungal arthritis is often a complication of…

A

neoplastic disease or severely immunocompromised patients (ie HIV/AIDS)

78
Q

Fungal arthritis is frequently associated with involvement of which other organs?

A

Lungs

79
Q

What is one fungus that may cause fungal arthritis?

A

Candida species (yeast)

80
Q

How will fungal arthritis present in the spine?

A

Like Pott’s disease

81
Q

Fungal arthritis is ___ destructive

A

highly

82
Q

How is fungal arthritis treated?

A

Difficult: anti-fungal drugs are toxic to other tissues, especially the liver

83
Q

How is fungal arthritis diagnosed?

A

Diagnosis by biopsy
(cannot differentially diagnose radiographically from bacterial/septic arthritis)

84
Q

Is Lyme disease inflammatory?

A

Yes, it’s a parasitic infection that exhibits a chronic inflammatory response

85
Q

Lyme disease is an infection by what bacterium?

A

Spirochetes: borrelia burgdorferi

86
Q

Spirochete, borrelia burgdorferi, infection causes Lyme disease
What organism transmits this bacterium to humans?

A

Ixodes tick (in nymph stage) during May-July

87
Q

How common is Lyme disease?

A

15,000-20,000 cases annually in the US

88
Q

What ages are affected by Lyme disease?

A

Any age

89
Q

At what stage of Lyme disease are antibiotics most effective?

A

Stage 1

90
Q

Erythema chronicum migrans is a sensitive, non-specific indicator for which infectious joint pathology?

A

Bullseye rash: occurs 3-35 days after tick bite, indicates Lyme disease

91
Q

The following are symptoms of which stage of Lyme disease?

  • Fever
  • Fatigue
  • Malaise
  • Headache
  • Arthralgias
  • Lymphadenopathy
  • Cough
  • Meningeal irritation
  • Migratory myalgia
  • Testicular swelling
  • Brain fog
A

Stage 1 of Lyme disease

92
Q

The following are symptoms of which stage of Lyme disease?

  • Migratory musculoskeletal pain
  • Cardiac and neurologic abnormalities
  • Joint pain is migratory and transient
A

Stage 2 of Lyme disease

93
Q

The following are symptoms of which stage of Lyme disease?

  • Arthralgia
  • Sever arthritis
  • Swollen joints (especially the knee)
  • Skin abnormalities
  • Neurological abnormalities (paresthesia, encephalomyelitis, dementia)
A

Stage 3 of Lyme disease

94
Q

A patient is in stage 1 of Lyme disease
Which cells are involved in the chronic inflammatory response that is taking place?

A

Lymphocytes and plasma cells

95
Q

When does stage 2 of Lyme disease typically begin?

A

Weeks to months following lesion

96
Q

When does stage 3 of Lyme disease typically begin?

A

Months to year post-infection

97
Q

Over 50% of patients with Lyme disease have…

A

arthralgia and severe arthritis

98
Q

What is the histology of stage 3 Lyme disease?

A

Affected joints are like rheumatoid arthritis:
Synovial membrane undergoes villous hypertrophy with mononuclear infiltrate

99
Q

At what point is Lyme disease permanent?

A

Stage 3 when neurologic effects begin (tingling/paresthesia, encephalomyelitis, dementia)

100
Q

If Lyme is suspected, what is used for diagnosis?

A

Antibody titers (IgM and IgG)

101
Q

Early treatment of Lyme disease uses higher doses of…

A

tetracycline or erythromycin

102
Q

Later stages of Lyme disease require long-term, high dose…

A

antibiotic treatment

103
Q

If a patient tells you that they have recently been prescribed tetracycline or erythromycin in a high dose, what should you suspect?

A

Early stage of Lyme disease

104
Q

Joint involvement, such as polyarthralgia) presents in ___% of patients with lupus

A

90%

Musculoskeletal Physiopathology (31 decks)

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