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Rheum Lectures > Joint Diseases > Flashcards

Joint Diseases Flashcards

1
Q

Osteoarthritis is characterized by what?

A

Joint cartilage breakdown causing painful and stiff joints.

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2
Q

T or F. Osteoarthritis usually affects many joints.

A

F: usually only affects ONE joint. Particularly those that bear a lot of stress i.e. hip, back, knee, or hand joints. Not usually seen in a symmetric pattern.

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3
Q

What are the symptoms of osteoarthritis?

A

Painful use of the joint, painful periods after joint use, discomfort during significant weather changes, swelling, stiffness, bony lumps in hands and finger joints, decreased flexibility.

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4
Q

Bony growth in osteoarthritis patients is a result of what?

A

The body’s attempt to repair the joint but this actually makes it more difficult.

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5
Q

What are the risk factors for osteoarthritis?

A
  1. Gender: females > males
  2. Age: typically > 45 yo
  3. Joint Injuries
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6
Q

T or F. There is a lot of inflammation in the joint with osteoarthritis.

A

F: inflammation is minimal

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7
Q

Pathophysiology of RA?

A

CD4+ T cells aggregate and secrete cytokines to attract B cells and macrophages that form the inflammatory response. Does not come from wear and tear of the joints.

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8
Q

Epidemiology of RA?

A

Women b/t the ages of 20-50

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9
Q

Symptoms of RA?

A
  1. Swelling esp in small joints of hands and feet
  2. Loss of range of motion
  3. Loss of muscular strength
  4. Low grade fever
  5. Fatigue
  6. Stiffness esp after sleeping or sitting still
  7. Malaise
  8. Deformity eventually
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10
Q

What is responsible for extra-articular manifestations in RA?

A

Rheumatoid Factor immune complexes which are IgM antibodies to Fc receptors of their own IgG.

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11
Q

Joints in RA are most affected by what?

A

An inflammatory synovitis with destructive pannus formation.

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12
Q

Erosion of cartilaginous joint surfaces leads to what in RA?

A

Ulnar deviation of fingers with swan neck abnormalities.

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13
Q

Which joints are usually affected first in RA? Then which joints?

A
  1. Small joints of hands and feet
  2. Wrists
  3. Elbows
  4. Ankles
  5. Knees
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14
Q

What is a pannus? What does it do?

A

Membrane of granulation tissue. After years, it proliferates and can contribute to joint destruction. Pannus spreads over and erodes the articular cartilage and even bone leading to fibrosis of the joint.

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15
Q

What makes up a rheumatoid nodule?

A

An acellular center of eosinophilic material surrounded by palisaded histiocytes and other cells +/- rim of granulation tissue.

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16
Q

Where do rheumatoid nodules most often occur?

A

Extensor surfaces. Sometimes pericardium, aortic valve, and lung parenchyma. They can virtually occur anywhere.

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17
Q

Synovium of an RA patient will contain what?

A
  1. Exudate: neutrophils, fibrin, hyperplastic and synovial cells
  2. Proliferation of vascular connective tissue which later fills with polys, T cells, and plasma cells
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18
Q

What cells are present in the pannus?

A

Macrophages, fibroblasts, and osteoclasts.

19
Q

What are the signs and symptoms of gout?

A

Begins with sudden stiffness in the joints followed by pain. It may swell and become warm/red. Fever. Skin lump that is white and chalky and may drain a chalky material.

20
Q

Which joints are usually affected in gout?

A

Great toe, knee, and ankle joints. Usually multiple joints are affected.

21
Q

Pathophysiology of gout?

A

Over production of gout or kidneys cannot clear enough uric acid. Drugs. Basically anything causing excessive uric acid levels.

22
Q

What diseases can predispose to gout?

A

Diabetes, obesity, sickle cell, kidney dz

23
Q

Which patient populations are at a higher risk for gout?

A

Men, postmenopausal women, and ppl who drink alcohol

24
Q

T or F. Monosodium urate crystals form at normal body temp when the concentration of uric acid in the blood reaches 7 mg/dL.

A

T

25
Q

Why does gout usually affect toes and fingers first?

A

Blood temperature falls in the periphery and monosodium urate crystals can form at lower concentrations of uric acid with decreased temp.

26
Q

What is a tophi?

A

Precipitated monosodium urate crystals. They are white and chalky.

27
Q

Under microscope, what do monosodium urate crystals look like?

A

Needle shaped crystals which are yellow under polarized light when the polarizer is parallel with the long axis of the crystal. *yellow=urate=parallel

28
Q

What causes pseudogout?

A

Deposition of calcium phosphates usually in the knees. Common in the elderly.

29
Q

Under microscope, what do calcium phosphate crystals look like?

A

Needle or oblong shaped crystals which polarize yellow when the polarizer is perpendicular

30
Q

Which patient populations are at greater risk for pseudogout?

A

Older obvi. Pts with hypercalcemia, hypophosphatemia, or hypomagnesemia.

31
Q

What are the most common agents of infectious arthritis?

A

Gonococcus, Gram + cocci (staph, strep), and Gram - rods (E. coli, H. flu, Pseudomonas, Salmonella in SS)

32
Q

How do the bacterial agents arrive at the joint in infectious arthritis?

A

Hematogenous spread

33
Q

T or F. Suppurative arthritis is uncommon in children where as osteomyelitis is.

A

T

34
Q

Bacterial arthritis usually involves how many joints?

A

One…monoarticular

35
Q

Gonococcal arthritis usually involves how many joints?

A

Many…typically a series of joints

36
Q

In infectious arthritis, what quickly ruins the cartilage?

A

Hydrolytic enzymes from polys. In severe cases, the joint may be ankylosed.

37
Q

What are ganglion/synovial cysts?

A

Mobile masses usually located on the hands or feet. Not true cysts bc lack epithelial lining.

38
Q

Under microscope, what do ganglion cysts look like?

A

Spaces lined by myxoid material

39
Q

What is the tx for ganglion cysts?

A

Smack it with a heavy book

40
Q

What are giant cell tumors of tendon sheaths?

A

Well circumscribed, non-aggressive tumor often located near joints and can interfere with function

41
Q

Why are giant cell tumors of tendon sheaths yellow?

A

They contain many lipid-laden macrophages

42
Q

Histology of giant cell tumor of tendon sheath?

A

Multinucleated giant cells with a background of histiocytes that resemble synoviocytes

43
Q

What is pigmented villonodular synovitis?

A

Localized, destructive lesion within a single joint (usually the knee) with proliferation of synovium, hemosiderin pigmentation, and destruction of the joint

44
Q

What is the tx for pigmented villonodular synovitis?

A

Excision: usually curative but it may recur

Rheum Lectures (7 decks)

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