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MOD 2 Quiz 1 > Joint pathology > Flashcards

Joint pathology Flashcards

1
Q

Primary/ idipathic osteoarthritis?

A

aging phenomenon
appears insidiously without cause
oligoartiuclar (few joints affected)

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2
Q

Secondary osteoarthritis?

A

younger individuals
history of predisposing conditions
-previous injury, congenital deformity, systemic disease
usually affect the predisposed joint

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3
Q

Clinical course osteoarthritis?

A 
insidious
deep, achy pain
morning stiff
crepitus
limit ROM
impingment on spinal foramina causing radiular pina, muscle spasm, muscle atrophy, and neuro deficits
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4
Q

Commonly seen with/ joints of osteoarthritis?

A

hips, knees, cervical and lumbar vertebrae, PIP, DIP
herberden nodes common in women
no preventive treatment, cannot halt progression

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5
Q

Genetic factors osteoarthritis?

A

genes involved with prostaglandin metabolism and WNT signaling

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6
Q

Environmental factors osteoarthritis?

A 
Aging, 80-90% have evidence of OA by 65 yo
Biochemical stress (joint stability, muscle strength)
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7
Q

Path mechanism of OA?

A

chondrocyte injury cause proliferation and form clusters
water content increases and concentration of proteoglycans decreases
Cracking of the matrix occurs as the supporing catilage and type II collage are degraded

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8
Q

Gross morphology of OA?

A

exposed subchonral surface
subchondral cyst
residual cartilage (destruction of)

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9
Q

Eburnation?

A

dectructive process of cartialge that exposes the bone

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10
Q

Rheumatoid arthritis?

A

chronic, systemic, inflammatory disorder
affects many tissues and organs
women more than men
nonsuppurative, profilerative and inflammatory synovitis

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11
Q

clinical course Rheumatoid arthritis?

A

slow and insidious
maliase, fatigue, generalized MSK pain
joint involvement ensuses after several weeks to months, small before large/symmetrical

(joints swollen, warm, painful, stiff from inactivity)

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12
Q

Lab indicators of Rheumatoid arthritis?

A

Rheumatoid factor- may appear in other conditions

Anti-CCP antibody (both tests together are sensitive)

synovial fluid shows:
neutrophils, high protein content, low mucin content

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13
Q

Diagnose Rheumatoid arthritis? (four of following)

A 
morning stiffness
arthritis in 3 or more joints
arthritis of hang joints
symmetric arthritis
rheumatoid nodules
serum rheumatoid factor
typical radiographic changes
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14
Q

Pathogenesis Rheumatoid arthritis?

A

genetic susceptibilty associated with HLA-DRB1
Environment arthritogen microbial agents: EBV, retrovirus, mycobaterium citrullinated proteins
autoimmunity

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15
Q

What causes bone/cartilage destruction?

A 
antigen is picked up by MHC class II, present to CD4+ T cell, release cytokines
activate macrophages, B cells, and recruit leukocytes

leads to pannus formation, destroy bone, catilage
fibrosis, ankylosis

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16
Q

Histology of Rheumatoid arthritis?

A

formaiton of villi
proliferative synovium
dense lymphoid aggregate

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17
Q

Rheumatoid nodule?

A

most common cutaneous lesion
usually in areas subjected to pressure (elbows, forearm)
less common in lungs, spleen, heart

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18
Q

What is a Rheumatoid nodule?

A

central zone of fibrinoid necrosis surrounded by palisading granuloma and numerous lymphocytes and plasma cells

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19
Q

Herberden’s nodes?

A

at the DIP

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20
Q

Bouchard’s node?

A

at the PIP

21
Q

Boutonniere deformity?

A

hyperflexion of the PIP, hyperexternsion of DIP

22
Q

Swan neck deformity?

A

hyperflexion of DIP, hyperextension of PIP

23
Q

Juvenile idiopathic arthritis?

A

before 16 yo, persist for min 6 wks

no nodules

24
Q

JIA from RA?

A

oilgoarthritis is more common
systemic disease more frequent
large joints affected more often than small joints
rhuematoid nodules and RF are usually absent
ANA seropositivity is common

25
Q

Crystal induced arthritis?

A

gout, pseudogout

26
Q

Gout?

A

monosodium urate crystals accumulate in the joint, due to overproduction or underexcretion of uric acid
hyperuricemia

27
Q

clin course gout?

A 
asymptomatic hyperuricemia
acute gouty arthritis (hyperemic, warm, painful joint)
   (rule out septic arthritis)
intercritical gout
chronic tophasceous gout
28
Q

Classify gout?

A

primary or idiopathic (usually)
secondary (increased nucleic acid turnover) (leukemia, cancer) Metabolic disease (Lesch-Nyhan deficient HGPRT)
renal disease

29
Q

Uric acid crystals?

A

need shaped, negatively birefirngent, water soluble crystals

30
Q

Path of Gout?

A

crystals phagocytized by macrophage, release IL-1beta other cytokines to cause release of proteases, to cause tissue injury and inflammation

crystals also activate complement, neutrophil chemotaxis, phagocytosize crystals by neutrophils,lysis of neutrophils, release of lysosomal enzymes, tissue injury and inflammation

31
Q

Gross morph gout?

A

synovium is endematous and congested

32
Q

Histo of gout?

A

dense neutrophilic infiltrate with uric acid crystals in synovium
scattedered lymphocytes, plasma cell and macrophages

33
Q

Thophus?

A

pathognomonic lesion of gout
gross- urates from visible depositis in the synovium, Hyperplastic and fibrotic synovieum

Histo- large aggregates of urate crystals
intense inflammatory reaction

34
Q

Pseudogout (chondrocalcinosis)?

A

calcium pyrophosphate crystals accumulate and deposit in the joint, can be seen on xray

over 50, common knee
weakly bifringent, rhomboid/geometric shaped crystals

35
Q

Pseudogout assoc with?

A

diabetes, hypothyroidism, hyperparathyroidism, hemochromatosis

36
Q

Infectious arthritis?

A

potential serious, can cause deformatities
routes of infection
-hematogenous dissemination (via blood)
-direct inocculation
-contiguous spread from soft tissue abcess or focuse of osteomyeltitis

37
Q

Etiologic agents for infectious arthritis?

A

Bacteria
Mycobacterium TB
sprichete: Borrelia burgdorferi
virus

38
Q

bacterial arthritis?

A

suppurative arthritis, cloudy synovial fluid
acute onset on painful and swollen infected joint
systemic symptoms, fever, leukocytosis, increased ESR
etiologic agents by group

39
Q

etiologic agents of bacterial arthritis?

A

<2 yo— H. influenza
older children and adults— S.aureus
Sex active women– Gonococcus
all ages with sickle cell disease— salmonella

40
Q

Lyme disease?

A 
Tick borne (Ixodes dammini) disease
Borrelia burgdroferi
skin rash
migratory arthritis involving the knees, shoulder and elbows
CNS and cardiac involvement
41
Q

Erythema Chronicum Migrans?

A

target lesion from lyme disease

not allergy but actual infection

42
Q

Seronegative Spondyloarthropathies?

A

develop in genetically predisposed individuals

HLA-B27 (prevalent in caucasians)

43
Q

immuno Seronegative Spondyloarthropathies?

A

immune mediated manifestations triggered by a T cell response towards an antigen that cross=reacts with native molecules of MSK system
peripheral or azial inflammatory oligoarthritis

44
Q

Seronegative Spondyloarthropathies? (ex)

A

Anklyosing spondyloarthritis
Reiter syndrome
Enteritis-Associated Arthritis (GI infection)
Psoriatic arthritis (chronic inflammatory arthropathy develeops in more than 10% of this pop)

45
Q

Anklyosing spondyloarthritis?

A

rehuamtoid spondylitis
destruction of articular cartilage and resultant bony ankylosis esp sacroiliac joint (LBP)
men are affected more than women
HLA-B27
(complications) fracture spine, uveitis, aortitis, and amyloidosis

46
Q

Reiter Syndrome?

A

Form of reactive arthritis
waxes/wanes over period wks-months
caused by autoimmune rxn by previous infection
HLA-B27 pos

47
Q

Reiter Syndrome previous intiated by?

A 
GI infection (Shigella, Salmonella, Campylobacter)
GU (Chlamydia)
48
Q

Reiter Syndrome triad of?

A

nongonoccocal urethritis or cervititis

conjunctivitis

49
Q

Extra-articular symptoms of Reiter Syndrome?

A

inflammatory balanitis, cardiac conduction abnormalities and aortic reguritation

MOD 2 Quiz 1 (9 decks)

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