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MSK II > joints 1 > Flashcards

joints 1 Flashcards

1
Q

osteoarthritis

A

aka degenerative joint disease

characterized by degeneration of cartilage, failure of repair -> failure of synovial joints

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2
Q

osteoarthritis morphology

A

water content increases, proteoglycans decrease
granular soft articular surface
pieces break off- joint mice
bone eburnation

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3
Q

osteoarthritis clinical

A

usually doesn’t become symptomatic until >50
deep, achy pain, worsens with use, morning stiffness, crepitus, limited ROM
impingement of spinal foramina -> nn compression
usually only a few joints involved

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4
Q

heberden nodes

A

prominent osteophytes at distal interphalangeal joints common in women, not men

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5
Q

RA

A

chronic inflammatory disorder of autoimmune origin

principally attacks joints producing nonsuppurative proliferative and inflammatory synovitis

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6
Q

common hand presentation of RA

A

ulnar deviation and large knuckles

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7
Q

CD4 cells and RA

A

T helper cells may initiated autoimmune response in RA by reacting with an arthritogenic agent (microbial or selfAg?)

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8
Q

TNF and RA

A

most firmly implicated mediator of the disease

TNF antagonists very effective Tx

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9
Q

Germinal centers

A

found in synovium of RA pts with secondary follicles and abundant plasma cells producing Abs (some are against selfAgs)

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10
Q

pannus

A

mass of edematous synovium, inflammatory cells, granulation tissue, and fibroblasts that grow over articular cartilage and causes erosion -> fibrous ankylosis which eventually ossifies -> bony ankylosis
specific to RA

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11
Q

RA and skin

A

RA subQ nodules are most common cutaneous lesions
ulnar aspect of forearm, elbows, occiput, lumbosacral area,
can form in lungs, spleen, heart

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12
Q

Rheumatoid nodules

A

firm nontender, round-oval

microscopically resemble necrotizing granulomas with central zone of fibrinoid necrosis surrounded by macros, Ts, and Bs

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13
Q

RA and blood vessels

A

vasculitis

high rheumatoid factor correlates with risk of vasculitis

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14
Q

what should you check synovium sample for before Dx RA

A

acid fast stain for mycoplasm (both cause necrotizing granulomas)

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15
Q

RA clinical

A

50% have insidious onset with malaise, fever, fatigue, after several months joints involved
generally symmetrically and smaller joints first

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16
Q

Dx of RA

A

X-RAY
sterile, turbid, synovial fluid, decreased viscosity, poor mucin clot formation, inclusion bearing neutrophils
combination of Rheumatoid factor and anti-CCP Ab

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17
Q

juvenile idiopathic arthritis

A

presents <16 and persists for at least 6wks

18
Q

JIA vs RA

A

In JIA:
-oligoarthritis is more common
-systemic disease more frequent
-large joints are affected more then small
-rheumatoid nodules and rheumatoid factor are usually absent
ANA Ab is usually +

19
Q

spondyloarthropathies

A 
ankylosing spondyltis 
psoriatic arthropathy
juvenile anklosing spondylitis
sacroilitis 
intestinal arthropahty, UC, Chrons
reactive arthropathy, reiter syndrome
20
Q

spondyloarthropathies general characterisitics

A

pathologic changes in ligamentous attachments rather then synovium
involvement of SI w/or w/o other joints
absence of rheumatoid factor
HLA-B27

21
Q

Ankylosing spondyltis

A

destruction of articular cartilage and bony ankylosis especially at SI and apophyseal joints
symptomatic 2nd-3rd decade of life as lower back pain and spinal immobility
90% are HLA-B27+

22
Q

reactive arthritis

A

arthritis, nongonococcal urethritis/cervicitis and conjunctiviits
ususally men 20-30
80% HLA-B27+
also seen in HIV

23
Q

what organisms are linked to reactive arthritis

A 
chlamydia
shigella
salmonella
yersina
campylobacter
24
Q

enteritis associated arthritis

A

yersinia, salmonella, shigella, campylobacter
appears abruptly usually at knees and ankles, but sometimes also wrists, finger, toes
lasts for 1yr, generally clears rarely accompanied by ankylosing spondylitis

25
Q

psoriatic arthritis

A

chronic inflammatory arthropathy associated with psoriasis that affects peripheral and axial joints and entheses (ligs and tendons)
30-50
usually develops concurrently or after skin disease onset

26
Q

joints of psoriatic arthritis

A

SI 20%
usually hands and feet
distal interphalangeal joints are usually first affected with characteristic pencil in cup deformity

27
Q

psoriais of psoriatic arthritis

A

in unusual locations or not symmetrical

28
Q

infectious arthritis

A

aka suppurative arthritis

bacterial infections usually enter joints via hematogeneous spread

29
Q

classic presentation of infectious arthritis

A

sudden development of acutely painful and swollen joints with restricted ROM
fever, leukocytosis, elevated sed rate common
gonococcal infections are more subacute
usually only 1 joint (knee most common, axial joints in drug users)

30
Q

Dx infectious arthritis

A

joint aspiration

31
Q

crystal induced arthritis

A 
articular crystal deposits 
monosodium urate (gout)
calcium pyrophosphate dehydrate (pseudogout)
32
Q

gout

A

makred by transient attacks of acute arthritis
monosodium urate w/in and around joints
90% are primary causes

33
Q

what can cause secondary gout

A

increased nucelic acid turnover
chronic renal disease
congenital (lesch-nyhans, HGPRT deficiency)

34
Q

hyperuricemia

A

necessary, but not sufficient cause of gout

plasma must be >6.8

35
Q

gout risk factors

A 
age
genetics (x-linked HGPRT abnormalities)
alcohol
obesity
drugs (thiazides)
lead toxicity
36
Q

asymptomatic hyperuricemia phase of gout

A

appears around puberty in males and after menopause in females

37
Q

acute arthritis phase of gout

A

sudden onset of excruciating joint pain, with hyperemia, warmth
usually 1 joint, most common 1st metatarsophylangeal joint

38
Q

asymptomatic intercritical period

A

resolution of acute arthritis leads to symptom free interval

39
Q

chornic tophaceous gout

A

12 years after initalacute attack
x-ray showscharacteristic juxta-articular bone erosion caused by osteoclastic bone resorption and loss of joint space
progression leads to severe crippling disease

40
Q

pseudogout

A

calcium pyrophosphate crystal deposistion disease (CPCD)

50+

41
Q

histo gout vs pseudogout

A

gout- needles (yellow must be parallel)

pseudogout- coffin lids

MSK II (19 decks)

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