Joint pathology

Question 1

Pathology of RA vs OA

Answer 1

RA: autoantibodies against antigens in synovium
OA: degeneration of auricular cartilage causing matrix breakdown

Question 2

Diagnostics of Rheumatoid Arthritis

Answer 2

Anti-CCP
Possible Rheumatoid factor
Increased ferritin
Anemia of chronic disease
cloudy yellow synovium with leukocytosis, increased proteins, and decreased viscosity

Question 3

Morphology of Rheumatoid Arthritis

Answer 3

Pannus formation
Joint effusion
Juxta auricular osteopenia with erosions and narrowing of the joint space
necrotizing granulomas with central zone of fibrinoid necrosis, surrounded by macrophages, numerous lymphocytes and plasma cells

Question 4

symmetric involvement of small joints before large joints
MCP and PIP joints
Swann Neck, Boutonniere, or Hitchhiker Deformity
ulnar deviation of the fingers
atlanto-axial subluxation

Answer 4

Clinical presentation of Rheumatoid Arthritis

Also includes fatigue, malaise, Decreased ROM, morning stiffness and respiratory symptoms

Question 5

Morphology of OA

Answer 5

irregular joint space narrowing
subchondral sclerosis
osteophytes/ bone spurs
subchondral cysts

Question 6

describe pannus formation

Answer 6

synovial cell hyperplasia
dense inflammatory infiltrates
increased vascularity
fibrinopurulent exudate on synovial joint space
osteoclastic activity in underlying bone, causing periauricular erosions and subchondral cysts

Question 7

deep pain and stiffness
crepitus
predominantly affects weight bearing joints 
pares wrists and MCP
Prominent Herberden nodes ar DIP
Bouchard Nodes at PIP

Answer 7

Clinical findings in OA

Question 8

PTPN22
infection
immunological disposition

Answer 8

association of Juveline Idiopathic arthritis

Question 9

Diagnostics of JIA

Answer 9

Onset <16 y/o
increased inflammatory markers
Increased ANA
Leukocytosis
Anemia
THrombocytosis
Anti-CCP

Question 10

fever
uveitis
rashes
nail changes
LAD
oligoarthritis

Answer 10

Clinical presentation of JIA

Question 11

symmetrical joint involvement
DIP, spine and large joints
dactilytis

Answer 11

clinical presentation of psoriatic arthritis

in addition to psoriasis of course*

Question 12

back pain with spinal immobility
mornin stiffness
pain independent of positioning
dactilytis
uveitis
kyphosis
Tenderness over sacroilliac joints

Answer 12

clinical manifestation of ankylosing spondylitis

Question 13

conjunctivits
arthritis
urethritis

Answer 13

Reactive arthritis

Question 14

Bamboo spine
Elevated inflammatory markers
HLA-B27

Answer 14

Anklylosing Spondylitis

Question 15

Pathology of gout

Answer 15

supersaturation of uric acid in extracellular fluid, creating uric acid crystals
Crystals become coated with IgG, causing the release of inflammatory markers when phagocytized by PMNs

Question 16

Associations of gout

Answer 16

DM
HTN
Hypercholesterolemia
Hypertriglyceridemia
Anemia
heavy alcohol consumption
HGPRT abnormalities
Hyperuricemia

Question 17

Morphology of gout

Answer 17

polarized negatively birefringent needle-shaped monosodium urate crystals

Question 18

radiopaque soft tissue with punched out bone lesions with spiky periosteal appositions

Answer 18

gout XR

Question 19

arthritis
tophi
nephrolithiasis

Answer 19

clinical presentation of gout

Question 20

What causes pseudogout

Answer 20

germline mutations in pyrophosphate transport channel, causing the precipitation of calcium pyrophosphate crystals

Question 21

what allows mineralization and crystallization around chondrocytes in pseudogout

Answer 21

inhibition of auricular cartilage proteoglycans

Question 22

Morphology of Pseudogout

Answer 22

positively birefringent rhomboid-shaped CPPD crystals