Joints Flashcards
What joints predominate in osteoarthritis in men and women?
Men - hips
Women - Knees and hand
What is bone eburnation?
Exposed bone on surface, cartilage is bone
Underlying bone sclerosis
What are joint mice?
Loose bodies of cartilage
What are osteophytes?
Extra bone at joint edge
Bone spurs
How does osteoarthritis present?
Achy pain
Morning stiffness, gets worse with use
Crepitus of joint
Limited RoM
What are Heberden nodes?
Osteophytes at DIP in women
What is Rheumatoid arthritis?
Systemic autoimmune inflammatory disease
Synovitis often destroying carilage with later ankylosis of the joint
What is a pannus?
Exuberant inflamed synovium
Chronic inflammatory cells (Mostly CD4+ T cells)
Granulation tissue
What is the pathogenesis of RA?
Ag exposure in a susceptible host creating an ongoing autimmune process
80% have Rheumatoid Factor
Ab to Citrullin-modified peptides
Describe the synovial fluid in RA?
High protein content
Low mucin content
What joints does RA typically affect?
PIP, MCP, MTP (more proximal than OA)
Wrists, ankles, elbow, knees
What is a major presentation difference between RA and OA with regards to movement?
RA - feels better with movement
OA - gets worse
Describe hand deviation in RA.
Radial deviation of the wrist
Ulnar deviation of the fingers
Swan neck deformity
What do you see on an xray of RA?
Juxta-articular osteopenia
Bone erosions with narrowing of joint space
Joint effusions
What are Rheumatoid nodules?
Most common cutaneous manifestation of RA
Fibrinoid necrosis surrounded by macrophages
What is Juvenile idiopathic arthritis?
Heterogeneous group by definition before age 16 and present 6 weeks
Oligoarticular, Polyarticular, Systemic
What are seronegative spondyloarhtropathies?
Immune mediated pathology in ligamentous attachments
Many are HLA B27 +
RF negative
What joints are common in ankylosing spondyloarthritis?
Sacroiliac joints
Apophyseal joints of the spine
What is Ankylosing spondyloarthritis?
Inflammation of tendon/ligament insertion
Ossification of inflammation
Fibrous and boney ankylosis
What do you see on an xray of ankylosing spondylitis?
Bamboo spine
Ossification of the SI joint
What is reiter syndrome?
Reactive arthritis
Appendicular noninfectious arthritis
Occurs after a primary infection
HLA B27 +
What is the classic triad associated with reiter syndrome?
Arthritis
Urethritis or cervicitis
Conjunctivitis
What is enteritis-associated arthritis?
GI infection: Salmonella, shigella, campylobacter
Most often abrupt in knees and ankles
Generally clears in < 1 year
What is psoratic arthritis?
Insidious
Involves the DIP joint
Pencil cup deformity
How is infectious arthritis acquired?
Hematogenous spread
What is the most common pathogen that causes infectious arthritis in <2 year old patients?
H. influenzae
What is the most common pathogen that causes infectious arthritis in Adolescent/young adults?
Gonococcus
What is the most common pathogen that causes infectious arthritis in Elderly and children > 2 years?
S. aureus
What is the most common pathogen that causes infectious arthritis in sickle cell disease?
Salmonella
How does infectious arthritis present?
Predisposing conditions: ID, drug abuse
Swollen hot joint
How does infectious arthritis from lyme disease present?
Remitting/migratory arthritis in large joints knees>shoulders?elbows?ankles
What is gout?
Uric acid from purine metabolism
Crystals are negative birefringent
End point of hyperuricemia
What are the causes of primary gout?
Uknown
HGPRT defect
What are the causes of secondary gout?
Increased nucleic acid turnover from AML treatment
Chronic renal disease
What is the pathogeneis of gout?
Monosodium urate precepitates out from supersaturated synovial fluid
Negative birefringence
Low temperatures
Crystals initiate inflammation
What are the phases of gout?
Asymptomatic
Acute arthritis
Intercritical gout
Chronic tophaceous gout
What are tophi?
Large deposits of urate that are pathognomic of gout
What are the risk factors for gout?
Age
Genetics
Heavy drinking
Obesity
Thiazides
Lead toxicity
What is calcium pyrophosphate crystal deposition disease (CPPD)?
Pseuodgout
Crustals first seen in articular matrix, menisci, and intervertebral disc
Positive birefringent
What is a ganglion cyst?
Cyst near joint or tendon sheath
Wrist is most common
No communication with joint space
What is a synovial cyst?
Connected to joint capsule or bursa
What is a baker cyst?
Politeal synovial cyst often in setting of RA
What is a tenosynovial giant-cell tumor?
Macrophages and giant cells with hemosiderin and lipid vacuoles
What is diffuse tenosynovial giant cell tumor?
Pigmented Villonodular Synovitis
Red/brown to yellow from hemosiderin
Mostly knee
Locking or swelling
What is a localized tenosynovial giant-cell tumor?
Well circumscribed
Slow growing, painless
Fingers and wrists
Most common soft tissue tumor of the fingers
