Joint and Soft Tissue Path Flashcards
what is the cause of primary osteoarthritis?
aging
what can cause secondary osteoarthritis?
joint deformity trauma morbid obesity DM hemochromatosis thyroid disease acromegaly Charcot
describe osteoarthritis
disease of cartilage: “wear and tear”
evening stiffness crepitus limited ROM worse with use joints are hard and bony
what joints are primarily affected in osteoarthritis?
women:
PIP = Bouchards nodes
DIP = Heberden nodes
knees
men:
hips
what is the progression of osteoarthritis?
- increased water content and decreased proteoglycans causes cracks in matrix
- hunks of cartilage are sloughed off = joint mice
- subchondral bone rubs together = eburnation
- bone prevents stress by forming subchondral cysts
- osteophytes form causing neuro deficits
describe rheumatoid arthritis
autoimmune proliferative and inflammatory synovitis
morning stiffness
better with use
what genetic factors predispose someone to RA?
HLA-DRB1
PTPN22 gene
what cytokines are associated with RA?
IFN IL17 IL1 TNF CCP
what test would you order for suspected RA?
rheumatoid factor
anti-cyclic citrullinated peptide (CCP) antibodies
ESR
CRP
what is the typical presentation of RA?
20-40 y/o F boutonniere deformity OR swan neck deformity ulnar deviated fingers radial deviated wrist joints are warm, soft and tender
what will be seen on histo with RA joint?
pannus: edematous, thickened, hyperplastic synovium
synovial hypertrophy with vili
lymphoid aggregates
what joints are primarily affected in RA?
MCP
PIP
what will be seen on histo with a rheumatoid nodule?
central necrosis
palisading histiocytes
what are some systemic manifestations of RA?
benign pericarditis
granulomatous inflammation of the aorta
increased LFTs
nodular hyperplasia of the liver
secondary Sjogrens
scleritis
pulmonary disease
peripheral neuropathy
cervical vertebral subluxation
vasculitis
describe seronegative spondyloarthropathies
autoimmune T cell response due to environmental factors in predisposed individuals
pathologic changes in ligamentous attachments
associated with HLA-B27
what is ankylosing spondylitis?
degeneration of vertebrae and sacroiliac joints
possible peripheral joint involvement
affects 20-30 y/o
what are complications of ankylosing spondylitis?
uveitis
aortitis
amyloidosis
what is reactive arthritis?
triad of sx:
arthritis
urethritis/cervicitis
conjunctivitis
who is likely to develop reactive arthritis?
MEN 20-30s
previous GI or GU infection
HIV infection
what joints are affected in reactive arthritis?
ankles
knees
feet
spine
what cardiac abnormalities are seen in reactive arthritis?
cardiac conduction abnormalities
aortic regurgitation
what is enteritis associated arthritis?
sudden arthritis in knees and ankles lasting about 1 yr
occurs after Yersinia, Salmonella, Shigella or Campylobacter infection
what is the etiology of enteritis assoc. arthritis?
lipopolysaccharides of outer cell membrane stimulate immunological response
what is psoriatic arthritis?
arthritis affecting the ligaments and tendons of peripheral and axial joints
only 10% of cases associated with psoriasis
what is the presentation of psoriatic arthritis?
radiographic “pencil in cup” deformity at DIP
nail pitting
onycholysis
describe infectious arthritis
microorganisms seed joints via hematogenous spread
can cause soft tissue abscess or osteomyelitis
rapid joint destruction causing permanent deformity
what organisms can cause infectious arthritis in healthy adults?
s. aureus
strep spp.
neisseria gonorrhea
what organism causes infectious arthritis in healthy young children?
H. flu
what is the presentation of infectious arthritis?
acutely painful, swollen joint restricted ROM fever leukocytosis increased ESR
what is the presentation of gonococcal infectious arthritis?
sexually active woman complement deficiency tenosynovitis vesicular pustules negative synovial fluid culture and gram stain
how do you diagnose septic arthritis?
aspiration = purulent fluid
how is Lyme disease-associated arthritis different from typical septic arthritis?
develops days or weeks after skin lesion
what is gout?
transient attacks of acute arthritis due to crystallization of monosodium urate within joints
urate precipitation signals cytokines to recruit leukocytes
what factors predispose someone to gout?
age > 30 y/o genetics alcohol consumption obesity thiazide diuretics lead toxicity
what diseases can cause secondary gout?
leukemia
CKD
Lesche-Nyhan syndrome
what is the presentation of gout?
excruciating joint pain
localized hyperemia
warmth
50% in first metatarsophalangeal joint
what is calcium pyrophosphate crystal deposition?
pseudo-gout or chondrocalcinosis
causes chalky, white friable deposits
sporadic, hereditary or secondary
what factors can cause secondary CPPD?
previous joint damage hyperparathyroidism hemochromatosis hypothyroidism DM ochronosis
what will be seen on histo in CPPD?
oval blue-purple aggregates
+ birefringent, rhomboid crystals
what is a ganglion cyst?
cyst on the joint capsule or tendon sheath
due to cystic or myxoid degeneration
lacks cell lining
what is the presentation of a ganglion cyst?
firm, fluctuant, pea-sized translucent nodule on the wrist
what is a synovial cyst?
herniation of synovium through joint capsule
ex: baker’s cyst
