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Exam 2 Skin block > Joints > Flashcards

Joints Flashcards

1
Q

Osteoarthritis: primary and secondary causes

A

degenrative joint disease DJD

idopathic (primary) with aging

men: hips predominate
women: knee and hands predominate
secondary: repeated injuries to a joint, hemochroatosis, obesity

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2
Q

Osteoarthritis: etiology

A

Degeneration of cartilage outpaces repair. 80-90% by age 65. Mechanical defects due to muscle strength or obesity.

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3
Q

Osteoarthritis phases

A

chondrocyte injury

chondrocyte proliferate

chondrocyte drop out with a loss of cartilage

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4
Q

Osteoarthritis presentation on the bone

A

superficial roughened and cracked cartilage.

bone eburnation (exposed bone on surface0 looks like polished ivory and underlying bone sclerosis

joint mice (loose bodies of cartilage)

subchondral cysts of synovial fluid

ostephytes (bone spur): extra bone at joint edge

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5
Q

osteoarthritis presentation

A

insidious typically involving one or a few joints. Deep achy pain. morning stiffness. worse with use. creptius of joint. limited range of motion. vertebral osteophytes impinge on nerve root.

herberden nodes: osteophytes at DIP in women.

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6
Q

Osteoarthritis areas of risk

A

hips

knees

lower lumbar

cervical

dip

pip

first carpmetacarpal

spares: wrists, elbows, shoulders

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7
Q

Rheumatoid arthritis. etiology, gender, and age risk factor

A

systemic autoimmune inflammatory disease

nonsuppurative proliferative inflammatory synovitis often destroying cartilage with later ankylosis of the joint

female > male

age: any but most often 40-70

some genetic susceptibility

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8
Q

Rheumatoid arthritis: pannus

A

exuberant inflamed synovium

chronic inflammation with T cells 9mostly CD4), B cells, plasma cells, macrophages

granulation tissue with hemosiderin

erodes articular cartilage

erodes bone: juxtarticular cysts, subchondral cysts, osteoporosis

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9
Q

Rheumatoid arthritis pathogenesis

A

AG exposure in a susceptible host creating an ongoing autoimmune process. 80% have rheumatoid factor (autoAB against Fc portion or IgG) but is not specific. AB to citrullin modified peptides (anticyclic citrullinated peptide or CCP Ab) more specific

TNF major role

Synovial fluid: high protein content, low mucin content, inflammation

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10
Q

Rheumatoid arthritis: clinical presentation joints and spread

A

clinical course variable: can have periods of remission

10% acute onset but most insidious. May be preceded by malaise, fatigue, myalgia

symmetric with small joints before large. PIP MCP, MTP (note OA is DIP). Later writs, ankles, elbow, knees (spares hips)

joints: swollen, warm painful and stiff with inactivity

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11
Q

Rheumatoid arthritis diagnosis X ray and other features

A

X ray: juxta articular osteopenia. Bone erosions with narrowing of joint space from loss of articular cartilage. Joint effusions.

Radial deviation of wrist

ulnar deviation of fingers

flexion hyperextension of fingers (swan neck; boutonniere)

synovial cysts: Baker cyst (back of knee)

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12
Q

Rheumatoid arhtritis: clinical features: rheumatoid nodules

A

most common cutaneous manifestation (25%)

areas subject to pressure: ulnar aspect of forearm, elbow, occiput, lumbrosacral

fibrinoid necrosis surrounded by macrophages

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13
Q

Rheumatoid arthritis: clinical features: blood vessels

A

vasculitis: does not involve kidneys.

Can be obliterative endarteritis of vasa nervorum and digital arteries (neuropathies, ulcers, and gangrene).

Leukocytoclastic venulitis (purapura, skin ulcers, and nail bed infarction)

may be adjacent tendonitis, myositis

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14
Q

Rheumatoid arthritis critera

A

four of the following

AM stiffness

> 2 joints arthritis

typically and joint involvement

symmetric arthritis

rheumatoid nodules

serum rheumatoid factor

typically radiologic changes

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15
Q

Juvenile idiopathic arthritis: overview. Joint targets and other manifestations

A

Heterogeneous group by definition before age 16 and presents 6 weeks of oligoarticular < 5 joints, polyarticular, systemic

knees, writs, elbows, ankles (large joints)

extra articular manifestations: pericarditis, myocarditis, pulmonary fibrosis, uveitis, glomerulonephritis, growth retardation

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16
Q

Juvenile idiopathic arthritis vs Rheumatoid arhtritis

A

differs: oligoarthritis is more common. systemic onset more common. large joints. absence of rheumatoid factor, absence of rheumatoid nodules, may be ANA positive.
similiar: Pannus formation. Morphology of involved joints.

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17
Q

seronegative spondyloarthropathies

A

pathology in ligamentous attachment

immune mediated; no specific autoantibody. Many are +HLA B27. Rheumatoid factor negative.

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18
Q

seronegative spondyloarthropathies triggers and the types (4)

A

often triggered for example infection

  1. ankylosing spondyloarthritis
  2. enteritis associated arthritis
  3. reactive arhtritis
  4. psoriatic arthritis
19
Q

Ankylosing spondyloarhtritis: risk factors gender, age, genetics, and affected area.

A

“rheumatoid spondylitis”

young adults; M>F

HLA B27 (90%)

axial joints: sacroiliac joint and apophyseal joints of vertebrae

20
Q

Ankylosing spondyloarhtritis: onset, clinical presentation, complications

A

ONset 2-3 decade with low back pain

inflammation of tendon/ligament insertion: ossification of inflammation. Fibrous and boney ankylosis

complication: 1/3 hip, knee, shoulder arthritis. Uveitis, aortitis, amyloidosis, spine fractures

21
Q

reactive arthritis (reiter syndrome) caused by and triad

A

appendicular noninfectious arthritis

< 1 month after primary infection. Genitourinary chlamydia or GI: shigella, salmonella (diarrhea)

triad: arthritis, urethritis or cervicitis (nongonococcal), and conjunctivitis

22
Q

Reiter syndrome risk factors age and genetics. Areas of damage and clinical features.

A

20-30s

HLA b27 (80%)

ankles, knees feet (lower extremity) in asymmetric pattern

sausage toe or finger from digital tendon sheath synovitis

23
Q

Reiter syndrome: other clinical features and SX patterns

A

extra articular: balantitis, conjunctivitis, heart conduction defects, aortic regurgitation

SX wax and wane with 50% recurrence

24
Q

Enteritis assoiciated arthritis

A

GI infection by yersinia, salmonella, shigella, campylobacter. Liposaccharide stimulate immune repsonse.

most often abrupt in knees and ankles

generally clears in < 1 year

25
Q

Psoratic arthritis: overview. Genetic risk factors, age, presentation, area affected

A

10% of psoriasis patients (HLA b27 and HLA Cw6)

onset 30-50

insidious > acute onset; peripheral and axial

50% asymmetric in DIP of hands/feet. Pencil in cup deformity

can affect large joints

can cause sacriliac and spine disease

26
Q

Psoratic arthrtitis histology

A

histologically simlar to RA

less severe than other seronegative arthropathies

limited extra articular complications: conjunctivitis. Iritis.

27
Q

infectious arhtritis: bacterial infection age related or disease associated.

A

bacterial almost always suppurative

hematogenous spread is most common

<2 years: H flu.

adolescentyoung adult: gonococcus (F>M)

elderly and children > 2 years: S. A.

Sickle cell disease: salmonella

28
Q

Infectious arthritis predisposing conditions. Area affected.

A

predisposing conditions: immunodeficiency, abnormal joint, debilitation, iv drug abuse, arthritis

swollen hot joint

GC: often subacute. One joint: KNee > hip > shoulder > elbow

drug abuse axial joints

29
Q

Infectious arthritis: tuberculosis

A

monoarticular typically from adjacent osteomyelitis or hematogenous spread

vertebrae, hips, knees ankles

30
Q

infectious arthritis: viral

A

parvovirus B19

HCV, HBV

HIV

31
Q

infectious arthritis lyme disease

A

2 weeks- 2 years after bite from ixodes

60-80% of untreated; prominent in late disease

remitting/migratory arthritis in large joints knees > shoulders > elbows > ankles

chronic synovitis with organisms near vessels

borrellia burgdofreri

32
Q

gout: etiology

A

uric acid from purine metabolism: crystal are negative birefringent

end point of hyperuricemia

acute arrthritis from monosodium urate precipitation in joint, can become chronic

tophi: mass deposits of urates

urate nephorpathy common if chronic

33
Q

Gout primary and secondary causes

A

10% population has hyperuricemia. gout in 0.5% of this population.

Primary gout (90%): unknown cause or known enzyme defects (partial HGPRT)

secondary gout: increased nucleic acid turnover (AML) or chronic renal disease

34
Q

gout

A

monosodium urate precipitates from supersaturated synovial fluid. negative birefringence. precipitates better at lower temperatures. Crystal initiate acute and chronic inflammation. Dissolve over time and symptoms abate.

acute arthritis joint aspirate samples need to be polarized for crystals and cultured.

35
Q

gout phases

A

asymptomatic hyperuricemia

acute arthritis: 50% first MTP joint foot. Instep > ankles > heels > knees > wrists

intercritical gout: no sx

chronic tophaceous gout

36
Q

gout tophi

A

pathogenomonic of gout: large deposits of urate. macrophages, lymphocytes and giant cells

location. Tophaceous arthritis: joints and periarticular tissue. Inflammation destroys synovium, joint and adjacent bone.

SKin, soft tissues and organs

37
Q

gout risk factors

A

> 30 years (ie duration of hyperuricemia)

genetic predisposition

heavy drinking

obesity

drugs (thiazides)

PB toxicity

38
Q

calcium prophosphate crystal deposition disease overview and age risk factor

A

pseudo gout or chondrocalcinosis

> 50 years; increases to 50% at 85 years

usually asymptomatic. mimic other forms of arthritis. acute, subacute, or chronic

knee > wrist

39
Q

CPPD primary and secondary disease

A

heriditary or idopathic

secondary; prior joint damage, hyperparathyrodism, hypothyrodism, hemochromatosis, diabetes

40
Q

ganglion cyst

A

< 2cm cyst near joint or tendon sheath

wrist is most common

cystic or myxoid degeneration of tissue

no communication with joint space

41
Q

synovial cyst

A

connected to a joint capsule or bursa

baker cyst: popliteal synovial cyst often seeting of rheumatoid arthritis

42
Q

tenosynovial giant cell tumor

A

T (1;2): express CSF-1, attract macrophages

classification: diffuse (pigmented villonodular synovitis) and localized (giant cell tumor of tendon sheath)

macrophages and giant (macrophage) cells: hemosiderin and lipid vacuoles

43
Q

diffuse tenosynovial giant cell tumor

A

pigmented villonodular synovitis (PVNS)

joint synovium diffusely affected

red/brown to yellow from hemosiderin

lush villous surface

80% knee

locking or swelling; later decrease range of motion

can erode bone and create a mass

often recurs after excision

44
Q

localized tenosynovial giant cell tumor

A

well circumscribed

often attached to synovium or tendon

slow growing painless

fingers and wrists (most common soft tissue tumor of hand; especially fingers)

Exam 2 Skin block (22 decks)

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