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Msk > Joints > Flashcards

Joints Flashcards

0
Q

What other risk factors for osteoarthritis

A

Obesity
Age
Trauma

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1
Q

What is degenerative joint disease/osteoarthritis ?

A

Progressive degeneration of articular cartilage Due to mechanical wear and tear

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2
Q

How does an osteoarthritis patients present?

A

Go to sleep – > joint gets rest – >

Wake up Joint stiffness @ morning – >

use joints = increase wear+tear (cartilage loss start medially = bowlegged) ->

Increase pain during day

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3
Q

What are the pathologic features of osteoarthritis

A

Destruction of cartilage lining the articular surface –>

Joint mice – cartilage fragments fall into joint space

Eburnation of subchondral bone – bone rubbing against bone = polish

SUbchondral cysts
Sclerosis+Synovitis

Heberden’s nodes (DIP)
Osteophytes
Bouchard nodes (PIP)

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4
Q

Treatment of osteoarthritis?

A

Paracetamol NSAIDs intra-articular glucocorticoids

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5
Q

What is rheumatoid arthritis?

A

Autoimmune inflammatory destruction

of synovial joints

mediated by cytokines & HSR 3 + 4

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6
Q

What is the aetiology + risk factors for rheumatoid arthritis ?

A 
HLA-DR4
Autoimmune = middle-aged woman
Rheumatoid factor positive = anti-IgG
Anti-cyclic citrullinated peptide AB = more specific
Mediated by cytokines + HSR3+4
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7
Q

What joints are involved in osteoarthritis is

A

Lower lumbar

Knee

Elbow

Distal + proximal interphalangeal joint

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8
Q

What is the hallmark of rheumatoid arthritis?

A

Synovitis inflammation of the Synovium

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9
Q

Explain how synovitis can lead to clinical features

A

Synovitis – >produce thick pannus granulation tissue = BV, fibroblasts, myofibroblasts = contract – >

– ankylosis = fusion of joint -> joint space narrowing
– Deviation of joints diff direction eg. ulnar deviation
– Destroy articular cartilage due to pannus taking over

Synovitis – >
inflammatory process wear away @bone – > osteopenia

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10
Q

What is the clinical hallmark Of rheumatoid arthritis

A

Morning stiffness improves with activity

Patient sleep – >joints rest – >
inflammatory process occurs @joints – >
damage joints – > wake-up + move joints – >
squeeze joints free of him inflammatory debris – > improvement

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11
Q

Which joints are involved in rheumatoid arthritis?

A

SYMMETRIC

Proximal interphalangeal joint

Elbow + Wrists (metacarpophalangeal joint )

Knee + ankle

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12
Q

Patient presents with

  • fever weight loss myalgia
  • Rheumatoid nodules, vasculitis, Baker’s cyst,
  • lymphadenopathy, interstitial fibrosis, pleural effusion, pleuritis

Explain the fever weight loss and myalgia
Explain rheumatoid nodules and Baker’s cyst

A

Fever weight loss and myalgia due to inflammatory process i.e. systemic autoimmune disease

Rheumatoid nodules @skin + visceral organs with central area of necrosis surrounded by epithelioid histiocytes

Baker’s cyst = swelling of bursa behind knee

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13
Q

What would you find in the labs with rheumatoid arthritis?

A

Auto IgM against FC portion of IgG Ie rheumatoid factor

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14
Q

What would we find inside the synovial fluid in rheumatoid arthritis

A

Neutrophils + high-protein

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15
Q

What are the complications of rheumatoid arthritis

A

Chronic inflammatory state – >produce acute-phase reactant e.g.

HEPCIDIN– >Block ability to use Fe2+ stored in macrophages – > ANEMIA OF CHRONIC DISEASE

SAA – > Converted to AA – > deposit in tissues = SECONDARY AMYLOIDOSIS

16
Q

What is gout

A

Depositions/precipitation of mono sodium urate crystals in tissues e.g. joints leading to acute inflammatory monoarthritis

17
Q

What is the most common form of gout

What causes primary gout

A

Primary gout – 90% = under excretion of uric acid

Exacerbated by thiazides

Idiopathic

18
Q

What are the two main reasons of hyperuricaemia

A

Push too much uric acid into blood

Not filter enough from blood

19
Q

What are the three reasons of secondary gout

A

Leukaemia + myeloproliferative disorders e.g. tumour lysis syndrome:
increased cell turnover – > increased nuclei turnover – > increased breakdown of purines + pyrimidines –> increased uric acid @ joints

Lesch Nyhan syndrome = X-linked
Decreased HGPRT – >

Hyperuricaemia
Gout
Pissed off {Self-mutilation (bite lips + fingers)} Retardation
dysTonia

Renal insufficiency = can’t excreta uric acid

20
Q

How does a patient with acute gout present

A

Deposition of uric acid (MSU) + joints

Eat meat = XS DNA + RNA +
Alcohol = compete with uric acid to be excreted ->

XS uric acid MSU crystals – >
Acute inflammation - crystals activate neutrophils – >

Painful arthritis of great toe = PODAGRA @metatarsophalangeal (MTP) joint

21
Q

How does a patient with chronic gout present

A

Long-standing acute gout – >

1.developed TOPHI =
white chalky aggregates of URIC acid crystals
+ Fibrosis + giant cell rxn
@Soft tissue + joints
E.g. Achilles tendon, external ear, olecranon bursa

2.renal failure
Uric acid deposit @tubules of kidney -> damage

22
Q

What do we see in the labs for gout

A

Hyperuricaemia

Needle shaped crystals with
Negative birefringent under polarised light

yeLLow under paraLLel light / lay LOW = yelLOW
Blue under perpendicular

23
Q

What is pseudogout

A

Deposition of calcium pyrophosphate

24
Q

What do we see histologically in pseudogout

A

Rhomboid crystals

Weak positive birefringence @polarised light

25
Q

How does a patient presented with pseudogout

A

Pain + effusion in joint

26
Q

What joints are affected in pseudogout
What age does it affect
What gender does it affect

A

Knee

> 50 years

Affects male + females equally as

27
Q

What’s the diseases are pseudogout associated with

A

Haemochromatosis
osteoarthritis
hyperparathyroidism

28
Q

In a+c gout How does the patient present generically

A

A symmetric joint distribution

Swollen red painful joints

29
Q

Explain three things about seronegative spondyloarthropathies

A
  1. lack rheumatoid factor
  2. involve axial skeleton – spine + large joints of central skeleton
  3. Associated with HLA– B 27
30
Q

What’s joints does ankylosing spondylitis affect

A

Sacroiliac joints - lower back pain

Spine - fusion of vertebrate = bamboo spine – > morning stiffness

31
Q

Apart from joint issues what 2 other things occur in ankylosing spondylitis

A

Aortitis = inflammation – >aneurysm – >Pull on aortic valve – >aortic regurgitation

Uveitis

32
Q

Patient comes in to click and says he can’t see, can’t Pee, can’t climb a tree.

What the diagnosis and what symptoms does he have

A

Reactive/Reiter syndrome

Conjunctivitis urethra to this arthritis + periostitis of Achilles tendon with planter fascia

33
Q

When does reactive/reiter syndrome occurring?

A

Post G I infection e.g. shigella yersinia salmonella

Post chlamydia infection

34
Q

How is the patient with Psoriatic Arthiritis present

A

Joint pain + stiffness

Affect the axial + peripheral joints – DIP of hands + feet = dactylitis = sausage finger/toes

X-ray = pencil in cup deformity

35
Q

Patient presents with joint pain and stiffness on x-ray his fingers look like a pencil in a cup. His fingers or sausages like. What’s the diagnosis

A

Psoriatic arthritis

36
Q

Explain the Pathphys of rheumatoid arthritis

A

Look at pic on 05/03/15

Msk (10 decks)

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