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MSK II Midterm > Joint pathology > Flashcards

Joint pathology Flashcards

1
Q

Osteoarthritis (degenerative joint disease)

A
  • progressive degeneration of articular cartilage, most common type of arthitis
  • most often due to wear and tear
  • major risk factor is age
  • hips, lower lumar spine, knees, DIPs, and PIPs are common sites
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2
Q

presentatio of OA

A

-joint stiffness in the morning that worsens during the day

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3
Q

pathologic features of OA

A
  • disruption of cartilage that lines the articular surface; fragments of cartilage floating in the joint space (joint mice)
  • eburnation of the subchondral bone
  • osteophyte formation
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4
Q

what are heberden nodes?

A

-osteophyte formation in DIP

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5
Q

bouchard nodes

A

-osteophytes in PIP

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6
Q

What type of collagen is degraded by matrix metalloproteinases?

A

-type 2

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7
Q

Rheumatoid arthritis

A
  • chronic, systemic autoimmune disease
  • women of late childbearing age
  • associated with HLA DR4
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8
Q

what is hallmark of RA

A
  • synovitis leading to formation of a pannus

- leads to destruction of cartilage and ankylosis (fusion) of the joint

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9
Q

What is a pannus?

A

-inflammed granulation tissue

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10
Q

clinical features of RA

A
  • arthiritis with morning stiffness that improves with activity*
  • symmetric involvement of PIP joints (swan neck deformity)
  • small joints are affected before large ones
  • DIP are usually spared
  • fever, malaise, weight loss, and myalgia
  • Rhematoid nodules
  • Vasculitis
  • Baker cysts
  • pleural effusions
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11
Q

What is a baker cyst?

A
  • swelling of bursa behind the knee

- think of RA when you see this

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12
Q

lab findings for RA

A
  • IgM autoantibody against Fc portion of IgG (rheumatoid factor), marker of tissue damage and disease activity
  • neutrophils and high protein in synovial fluid
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13
Q

Complications of RA

A
  • anemia of chronic disease

- secondary amyloidosis

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14
Q

What is the other thing that we have autoantibodies to in RA?

A

-citrullinated peptides (CCPs)

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15
Q

What is the characteristic finding on the patient’s wrist for RA?

A
  • radial deviation of wrist

- ulnar deviation of the fingers

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16
Q

What can we give RA patients to help with the pain?

A

-TNF antagonists

17
Q

Juvenile Idiopathic Arthritis (JIA)

A

-heterogeneous group of disorders of unkown cause that present with arthritis before age 16 and persist for at least 6 weeks

18
Q

Seronegative spondyloarthropathies

A
  • group of joint disorders characterized by:
  • lack of rheumatoid factor
  • axial skeleton involvement
  • HLA-B27 association
19
Q

What does ankylosing spondyloarthritis involve?

A
  • SI joints and spine
  • young male adults
  • low back pain… bamboo spine
  • uveitis and aortitis (leads to aortic regurg)
20
Q

What is Reiter syndrome?

A
  • triad of arthritis, urethritis, and conjunctivitis

- “can’t see, cant’ pee, can’t climb a tree”

21
Q

when do we see Reiter syndrome(reactive arthritis)?

A

-young male adults weeks after a GI or chlamydia infection

22
Q

What is seen in 10% of cases of psoriasis and involves the axial, and peripheral joints?

A
  • psoriatic arthritis

- gives us sausage fingers or toes

23
Q

What do 90% of ankylosing spondylitis have?

A
  • HLA-B27

- also HLA-Cw6 alleles

24
Q

What is reiter syndrome referred to in robbins?

A

-Reactive Arthritis**

25
Q

Enteritis associated arthritis

A
  • caused by GI infection
  • knees and ankles, abrupt onset
  • lasts for about a year, then generally clears up (unlike reactive arthritis)
26
Q

infectious arthritis

A
  • usually bacterial
  • N gonorrhoae most common cause
  • S aureus older children and adults
  • single joint…. knee
  • presents as a warm joint with limited ROM, fever, increased white count and elevated ESR are often present
27
Q

What kind of suppurative arthritis predominates in children younger than 2?

A

-H influenza

28
Q

If someone has sickle cell disease, what infection are they prone to?

A

-Salmonella

29
Q

Mycobacterial arthritis

A
  • weight bearing joints

- central caseous necrosis

30
Q

Lyme Arthritis

A
  • Borrelia burgdorferi
  • deer ticks
  • arthritis in late stage
  • 1 or 2 joints affected at a time
  • look for anti-borrelia antibodies
31
Q

Gout

A
  • monosodium urate
  • hyperuricemia
  • purine metabolism… excreted by kidney usually excretes uric acid
  • prime gout is most common form… etiology of hyperuricemia unkown
32
Q

secondary gout

A
  • leukemia and myeloproliferative disorders… increased cell turnover
  • lesch-Nyhan syndrome: deficiency in HGPRT.. mental retardation and self mutilation
  • renal insufficiency: decreased renal excretion of uric acid
33
Q

How does acute gout present?

A
  • painful arthritis of the great toe
  • inflammatory rxn initiated
  • alcohol and consumption of meat may precipitate arthritis
34
Q

What does chronic gout lead to?

A
  • development of tophi- white chalky aggregates of uric acid crystals with fibrosis and giant cell reaction in the soft tissue and joints
  • renal failure- urate crystals may deposit in kidney tubules (urate nephropathy)
35
Q

what will we see in the synovial fluid with gout?

A

-needle shaped crystals with negative birefringence under polarized light

36
Q

What is pseudogout?

A
  • resembles gout clinically
  • but is due to deposition of calcium pyrophosphate dihydrate (CPPD)
  • synovial fluid shows RHOMBOID-SHAPED crystals with weakly positive birefringence under polarized light
37
Q

what are tophi again?

A
  • pathognomonic hallmark of gout

- large aggregations of urate crystals surrounded by an intense inflammatory rxn of foreign body giant cells

38
Q

What is a ganglion

A
  • small cyst that is almost always located near a joint capsule or tendon sheath
  • no communication with joint space
  • popliteal space in the setting of rheumatoid arthritis (Baker cyst)
39
Q

Tenosynovial giant cell tumor

A
  • term for several closely related benign neoplasms that develop in the synovial lining of joints, tendon sheaths, and bursae
  • knee in 80% of cases
  • localized variant is the most common mesenchymal neoplasm of the hand

MSK II Midterm (15 decks)

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