Joints Flashcards

1
Q

What are the differences between noninflammatory and inflammatory joint diseases?

A

Noninflammatory Disease:
- No synovial membrane inflammation
- No systemic signs & symptoms
- Synovial fluid – Cartilage debris/%WBC/PMN
- < 25%, high viscosity
Inflammatory Disease:
- Synovial membrane inflammation caused by immune complexes (rheumatoid factor + antigen in membrane or blood) in the blood & synovial tissue. RF = autoantibodies in RA.
- Systemic signs & symptoms (fever, etc.)
- Synovial fluid contains rheumatoid factor/%PMNs 50%-80%, low viscosity

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2
Q

Neither the cause nor are the risk factors known, & thus is also referred to as idiopathic osteoarthritis

A

Primary osteoarthitis

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3
Q

Caused by chronic, excessive, or abnormal forces that damage the joint surfaces, underlying bone, & leads to joint instability. Also joint instability may cause the abnormal forces

A

Secondary osteoarthritis

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4
Q

Bone spurs

A

Osteophytes

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5
Q

Pathological traits include: Initial changes = joint Narrowing, thinning/softening cartilage; Erosion of the articular cartilage; Abnormal pressure produces sclerosis (thickening & hardening) of bone underneath the cartilage a.k.a. eburnation; Bone cysts filled with fluids, communicates with the joint; Formation of bone spurs or osteophytes; Soft tissue around joint swelling & inflammation

A

Primary and secondary osteoarthritis

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6
Q

Causes include joint trauma (strains, dislocations, fractures), long-term mechanical stress, joint inflammation, joint instability, neurologic disorders (decreased pain proprioceptive reflexes), and chronic joint bleeding due to excessive PTH (hemophilia and hyperparathyroidism)

A

Secondary osteoarthritis

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7
Q

What are some clinical features of patients with OA?

A
  1. Pain relieved by rest
  2. Joint stiffness lasting 15-20 minutes after immobility (RA lasts hours)
  3. Reduced ROM, crepitus, and deformities due to intra-articular changes and periarticular inflammation
  4. Muscle spasms, contractors and atrophy adjacent to joints
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8
Q

What are some symptoms of OA?

A
  1. Hip involvement: pain in butt upper/medial thigh
  2. Knee Joint involvement: pain, crepitus,, effusion during WB. Varus or valgus deformities
  3. Lumbar & Cervical Spine involvement: affects the facet joints. Radicular pain from compression of spinal nerves by osteophytes which form at the facet joint margins.
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9
Q

What are symptoms in hands and feet in OA?

A

Hands: Most often Heberden’s Nodes at the DIPs in OA

Feet: Hallux valgus and bunion deformities of the first metatarsophalangeal joint

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10
Q

Chronic systemic inflammatory disease of unknown etiology with features of:

  • Chronic inflammation of synovial joints
  • Significant but not diagnostic serologic data suggesting an immune disorder
  • Variable extra-articular signs and symptoms
A

Rheumatoid Arthritis

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11
Q

What is the pathophysiology or RA?

A
  1. Inflammation begins as a synovitis in which, the inflamed synovial membrane releases PMNs, lymphocytes, and plasma cells into the joint cavity/synovial fluid.
  2. Inflammation leads to tissue repair or the proliferation phase of new synovial cells and new blood vessels, changing the synovial tissue into a sheet like granulation tissue called joint pannus
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12
Q

contains inflammatory cells (PMN [neutrophils & macrophages) that secrete lytic enzymes and chemical mediators of inflammation which, destroys synovial tissue, hyaline cartilage, and erodes underlying bone

A

Joint pannus

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13
Q

As a joint becomes progressively immobile, and the joint space becomes completely obliterated with JP that transformed to a collagen scar causing

A

Ankylosis

-process can be slowed with AROM during inflammatory flares

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14
Q

What occurs during an RA “flare”

A
  1. increased pain
  2. swelling
  3. decreased ROM
  4. decreased function
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15
Q

What are signs of RA?

A
  1. Bouchard’s Nodes at the proximal interphalangeal joint (PIPs)
  2. Deformity and dislocation at the metacarpophalangeal joints.
  3. Ulnar deviation of the fingers with anterior slippage of PIPs
  4. Elbow: subcutaneous nodules, painless & small (< 2 cm in diameter)
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16
Q

What are extra-articular symptoms during a flare in RA?

A
  1. Low grade fever
  2. Loss of appetite
  3. Fatigue
  4. Anemia
17
Q

How is RA conservatively treated?

A
  1. Anti-inflammatory drugs slow the progression
  2. Rest is beneficial during a flare
  3. Gentle & regular AROM exercises
  4. Moist heat or ice during a flare
  5. Splinting may prevent or delay joint deformities
18
Q

What are the surgical treatments of RA?

A
  1. Synovectomy
  2. Soft-tissue releases
  3. Arthroplasty: reshaping the joint & implanting an artificial joint surface or prosthesis
  4. Arthrodesis: surgical immobilization or fusion of the joint causing artificial ankylosis – a last resort.
19
Q

A metabolic disease characterized by a disturbance in purine metabolism resulting in the formation of sodium urate crystals

A

Gouty arthritis

20
Q

What are found in the synovial fluid of joints and soft tissues affected with gouty arthritis?

A

Sodium urate crystals?

21
Q

What are sodium rate crystals due to?

A

an increase in the serum uric acid, a normal end product of purine metabolism

22
Q

What are the clinical features of gouty arthritis?

A
  1. More common in men 30-40 y/o
  2. Less common in females and especially rare in women before menopause.
  3. Initial acute attack usually occurs in a single joint – most common 1st metatarsophalangeal joint
23
Q

What are the symptoms of gouty arthritis?

A
  1. Pain is usually severe
  2. May be caused by exercise, physical, and emotional stress
  3. Swelling, heat, extreme pain on palpation
  4. Redness at the 1st MTP Joint
  5. Destruction of articular cartilage
  6. Systemic: fever, tachycardia
24
Q

How do you treat gouty arthritis?

A
  1. Specific medication for control of inflammation and uric acid metabolism
  2. Rest
  3. Elevation
  4. Ice or moist heat as tolerated