Joint Pathology Flashcards
Normal Joint
Architecture
Components of Cartilage:
- Chondrocytes
- Water
- Collagen
- Proteoglycans

Osteoarthritis
Overview
“Degenerative Joint Disease”
- See deterioration and loss of articular cartilage
- Takes place over the course of many years
- Affects weight bearing joints
- Pathogenesis: biomechanical and biochemical theories
-
Clinical course: insidious with progressive pain and disability
- No constitutional signs, differential from RA
- No specific preventative or maintenance therapy (as of now)

Osteoarthritis
Morphology
- Loss of cartilage
- Exposure and eburnation of subchondral bone
- ± Subchondral cyst formation
- Osteophytes aka “Joint mice”
- Heberden’s nodes

Osteoarthritis
Symptoms
- Joint pain associated with movement
- Limitation of motion
- Stiffness after periods of rest
- Referred pain

Osteoarthritis
Clinical Manifestations
- Changes in shape of the joint
- Malalignment
- Limitation of motion
- Instability
- Spasm or atrophy of surrounding muscles
- Fine crepitation on joint motion

Rheumatoid Arthritis (RA)
Overview
Systemic, relapsing, chronic destructive synovitis
- Etiology unknown, course unpredictable
- Women affected 3x more than men
- Diagnosis by physical exam and lab studies
- Shortened life expectancy, often due to complications of therapy
- Variants: juvenile RA, Felty’s syndrome, ankylosing spondylitis
Rheumatoid Arthritis (RA)
Morphology
-
Irregular, hypertrophied synovial membrane
- ‘Villiform’ structure
- Lymphoid inflammation
- Can contain lymphoid follicles
- Chronic inflammation
- Pannus formation (scarring @ edges of joint space)
- Fibrous and bony ankylosis (bone fusion)

Felty’s Syndrome
Constellation of sx:
- Rheumatoid arthritis
- Splenomegaly
- Neutropenia
Rheumatoid Arthritis (RA)
Pathogenesis
Believed to be autoimmune disease.
(Theory that process can be initiated by a virus)

Rheumatoid Arthritis (RA)
Course
Disease can follow various courses:
- Single episode followed by sustained remission
- Initial episode followed by complete remissions and exacerbations
- Acute illness with intercurrent milder disease activity
- Sustained disease activity
Rheumatoid Arthritis (RA)
Intra-articular Manifestation
- Joints inflamed
- Progressive stiffness and ankylosis (fusion of the bones)
- Hand becomes claw-like with ulnar deviation

Rheumatoid Arthritis (RA)
Extra-articular Manifestations
-
Subcutaneous and subperiosteal nodules
- Fibrin core surrounded by palisading histiocytes
- Constitutional sx (malaise, fatigue, diffuse pain, fever)
-
Organs and Tissue involvement:
- Pulmonary
- Cardiac
- Ocular
- Neurological
- Vascular
- RA pts often have Sjogren’s syndrome

Rheumatoid Arthritis (RA)
Pulmonary Involvement
- Pleuritis
- Pleural effusion
- Pulmonary fibrosis
- Parenchymal rheumatoid nodules
Caplan’s Syndrome
Peumoconiosis and rheumatoid arthritis
Rheumatoid Arthritis (RA)
Vascular Involvement
-
Digital Arteritis
- Focal ischemic areas with pitting
- Digital gangrene
- Raynaud’s phenomenon
- Leg ulcers
-
Necrotizing systemic vasculitis
- Mesenteric
- Renal
- Coronary
