Joint and Soft Tissue Pathology I Flashcards
osteoarthritis
defective repair
osteoarthritis clinical
sx in 50yo
younger person with osteoarthritis
look for underlying cause**
heberden nodes
osteophytes at distal interphalangeal joint - common in women
DIP
osteoarthritis
PIP
rheumatoid arthritis
scope knee - see granulation tissue, red/ragged, bloody
osteoarthritis
ulnar deviation and PIP joint swelling
rheumatoid arthritis - autoimmun
rheumatoid arthritis
CD4 T cells autoimmune response
tx of RA
TNF antagonist
fibrous ankylosis
RA over time - cartilage destroyed and pannus bridges to opposing bone
can fusion - bony ankylosis if ossifies**
tell patient to stretch to avoid this
pannus
mass of edematous synovium in RA
rheumatoid subQ nodules
common cutaneous lesion with RA
resemble necrotizing granulomas
Rh factor
with RA
-increased risk for vasculitis
if see granuloma
need to acid fast stain
-to rule out TB
diagnosis of RA
Xray findings
sterile cloudy synovial fluid that is liquidy
Rh factor and anti-CCP Ab
anti-CCP Ab
screening test for RA
juvenile idiopathic arthritis
unknown cause
arthritis before age 16 for 6 weeks
more in large joints
often ANA seropositive
ANA test
positive in juvenile idiopathic arthritis
seronegative spondyloarthropathies
pathologic change of ligament attachments
with HLA-B27
HLA B27
ankylosing spondylitis
ankylosing spondylitis
can lead to SI and vertebral fusion
30-40yo with lower back pain and spinal immobility
ankylosing spondylitis
reactive arthritis
reiter syndrome
association with HLA-B27 and ankylosing spondylitis
can’t see, can’t pee, can’t climb a tree
reiter syndrome - reactive arthritis
triad of arthritis, urethritis, conjunctivitis
enteritis associated arthritis
associated with GI infection
-yersinia, salmonella, shigella, campylobacter
knees and ankles
wrists fingers toes
underlying disease- crohns
pencil in cup on Xray
psoriatic arthritis
involves DIPs in asymmetric distribution
infectious arthritis
heme spread
sudden development of acute painful swollen joint that has restricted ROM
fever, leukocytosis, elevated sed rate
commonly knee
diagnosis of infectious arthritis
joint aspiration
ID of causative agent
gram negative diplococci bacterial arthritis
sailor returns home
neisseria gonorrhea
lyme arthritis
borrelia burgdorferi - deer tick - ixodes ricinus
late stage - develop arthritis
diagnosis of lyme arthritis
serologic test for anti-borrelia Abs
gout
crystals of monosodium urate
pseudogout
crystals of basic calcium phosphate
majority of gour
90% primary - idiopathic
HGPRT deficiency
can cause gout
-involved in DNA salvage pathway
hyperuricemia
above 7-8mg/dL
-precipitate out of solution
gout clinical
usually appear 20-30yo
genetic predisposition - X-linked issue with GHPRT
URAT1 and GLUT9
gout
lifestyle promoting gout
alcohol
obesity
drugs
lead toxicity
stages of gout
acute arhritis
chronic tophaceous gout
chronic tophaceous gout
after 12 years
-juxtarticular bone erosion - loss of joint space - severe crippling disease can occur
pseudogout clinical
calcium pyrophosphate crystals
age 50yo
85yo - 30-60%
coffin lids
calcium pyrophosphate - pseudogout
YIPA
yellow in parallel
- axis is parallel gives yellow
- axis not parallel gives blue
for gout**
BIPA
blue in parallel
- axis in parallel gives blue
- axis not parallel gives yellow
for pseudogout