Joint and Soft Tissue Path Flashcards by Christian Wakim

what is the cause of primary osteoarthritis?

aging

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what can cause secondary osteoarthritis?

joint deformity
trauma
morbid obesity
DM
hemochromatosis
thyroid disease
acromegaly
Charcot

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describe osteoarthritis

disease of cartilage: “wear and tear”

evening stiffness
crepitus
limited ROM
worse with use
joints are hard and bony

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what joints are primarily affected in osteoarthritis?

women:
PIP = Bouchards nodes
DIP = Heberden nodes
knees

men:
hips

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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

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describe rheumatoid arthritis

autoimmune proliferative and inflammatory synovitis

morning stiffness
better with use

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what genetic factors predispose someone to RA?

HLA-DRB1

PTPN22 gene

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what cytokines are associated with RA?

IFN
IL17
IL1
TNF
CCP

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what test would you order for suspected RA?

rheumatoid factor
anti-cyclic citrullinated peptide (CCP) antibodies
ESR
CRP

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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

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what will be seen on histo with RA joint?

pannus: edematous, thickened, hyperplastic synovium
synovial hypertrophy with vili
lymphoid aggregates

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what joints are primarily affected in RA?

MCP

PIP

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what will be seen on histo with a rheumatoid nodule?

central necrosis

palisading histiocytes

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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

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describe seronegative spondyloarthropathies

autoimmune T cell response due to environmental factors in predisposed individuals

pathologic changes in ligamentous attachments

associated with HLA-B27

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what is ankylosing spondylitis?

degeneration of vertebrae and sacroiliac joints

possible peripheral joint involvement

affects 20-30 y/o

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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