Msck - disease of joints Flashcards by Elyaa Saleh

epi of Rheumatoid arthritis

▪ Female > Male
▪ Peak incidence: 20-50 years of age

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Rheumatoid arthritis most often presents in ———- individuals

HLA-D4 (+)

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Cause of Rheumatoid arthritis

Autoimmune origin

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Lab findings of Rheumatoid arthritis

Serum rheumatoid factor (most often IgM); (highly characteristic but not specific for Rheumatoid Arthritis)

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Stages of of Rheumatoid arthritis?

1) Synovitis
2) Pannus
3) Fibrous ankylosis
4) Bony ankylosis

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Rheumatoid arthrtis

Morphological feature:
- ———- w/ Lympho-plasmacytic infiltrates and oedema
- Hyperplasia and hypertrophy of the synovial lining cells → ———-
- Granulation tissue (——–) over articular cartilage
- Extension of pannus to sub-chondral bone → gradual ——- of bones and cartilage
- Subcutaneous nodules
- Cystic change sof the ’—————’ centre
- Palisading epitheliod (histocytes) macrophages

Synovitis w/ Lymph-plasmacytic infiltrates and oedema
Hyperplasia and hypertrophy of the synovial lining cells → finger-like villi
Granulation tissue (pannus) over articular cartilage
Extension of pannus to sub-chondral bone → gradual erosions of bones and cartilage
Subcutaneous nodules
Cystic change sof the ‘nercrobiotic’ centre
fibrinoid necrosis
palisading epithelioid macrophages

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Microscopic featuers:
- Synovitis w/ Lymph-plasmacytic infiltrates and oedema
- Hyperplasia and hypertrophy of the synovial lining cells → finger-like villi
- Granulation tissue (pannus) over articular cartilage
- Extension of pannus to sub-chondral bone → gradual erosions of bones and cartilage
- Subcutaneous nodules
- Cystic change sof the ‘nercrobiotic’ centre
- fibrinoid necrosis
- palisading epithelioid macrophages

features of?

Rheumatoid arthritis

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CM of Rheumatoid arthritis

1) Morning joint stiffness
2) Joint swelling
3) fever, fatigue, weight loss (systemic symptoms)
4) Symmetrical joint involvement
5) Ulnar deviation of fingers
6) PIP and MCP joints of the hand (75% involved)
7) minimal radial deviation of teh wrist

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Which joints are the most commonly affected by Rheumatoid arthritis?

1) Wrists (minimal radial deviation)
2) MCP and PIP joints of the hand

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Chracteristic Chronic joint changes in Rheumatoid arthritis

1) “Swan neck” deformity of the fingers
2) Botuonniere deformity of the thumb
3) Ulnar deviation of the MCP joints

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Extra-Articular manifestations of Rheumatoid arthritis

▪ Pleural and pericardial effusions
▪ Pulmonary involvement (pleuritis)
▪ Secondary reactive amyloidosis
▪ Vasculitis
▪ Anaemia of chronic disease

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3 varients of Rheumatoid arthritis

Sjögren Syndrome
Felty Syndrome
Still disease

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* Varient of Rheumatoid Arthritis

CF of Felty Syndrome

Splenomegaly, neutropenia and RA

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* Varient of Rheumatoid arthritis

Still disease is aka?

Juvenile Rheumatoid Arthritis

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Still disease is associated w/?

generalised lymphadenopathy and
hepatosplenomegaly

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Seronegative Arthritis is aka?

Spondylo-Arthropathies

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———- Individals have high incidence of developing Seronegative arthritis

HLA-27(+)

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In Seronegative Arthritis there is [Presence/Absence] of Rheumatoid factor (RF)

Absence

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CM of Seronegative arthritis

1) Peripheral arthritis (inflammation of the large joints e.g., elbow, wrist, knee, ankles)
2)Sacroiliitis (inflammation of the sacroiliac joint)

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Types of Seronegative Arthritis

1) Ankylosing Spondylitis
2) Reiter’s syndrome
3) Psoriatic Arthritis
4) Arthritis in assc. w/ IBD

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Akylosing Spondylitis is ass w/?

HLA-27 (+) patients (90%)

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CM of Ankylosing Spondylitis

Involvement of the spine: Bone fusion “Bamboo spine”

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Which disorder is has the following manifestaiton?
fusion of spinal bones “Bamboo spine”

Ankylosing Spondylitis

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* Type of Seronegative arthritis

causes/association of Reiter’s syndrome

Venereal or intestinal infection

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CM of Reiter's Syndrome

Traide of: 1) Assymetrical arthritis 2) Conjuctivites 3) Urethritis/Cervicitis or Diarrhoea

# type of Seonegative Arthritis CM of Arthritis in assc. w/ IBD (Crohns and ulcerative colitis)

Peripheral Arthritis or Ankylosing Spondylitis

# Type of Seronegtaive arthrits CM of Psoriatic Arthritis

1) **"Pencil-in-cup** deformity of the joints (seen on Radiograph) 2) Nail pitting 3) skin and nail lesions 4) sausage-shaped DIP joints

A patient comes in with the follwing CM: 1) Nail lesions 2) **"Pencil-in-cup"** deformities of the joints (Seen on Radiograph) 3) Nail pitting and 4) Sausage-shaped DIP joints Diagnosis?

Psoriatic Arthritis

**---------** : degenerative joint disease

Osteoarthritis

Epi of Osteoartheritis

▪ Most common form of arthritis ▪ Females, >50 years of age

cause of Osteoarthritis

Mechanical taruma **"Wear-and-tear" arthritis**

Which syndrome is charcaterise by t **"Wear-and-tear"** arthritis?

Osteoarthritis

Patho of Osteoarthritis

▪ Degeneration of articular cartilage ▪ New bone formation sub-chondrally and at the margins of the affected joint

# * Osteoarthritis Morphologic Features: - Fragments of **----------** into synovial fluid - **--------------**: Polished, **-----------** appearance of bone - Sub-chondrally located cystic changes - New bone **(---------------)** formation - charcteristic **"------------"** - **-----------** and **-------------** nodes features of?

- Fragments of **Cartilage** into synovial fluid - **Eburnation**: Polished, **ivory-like** appearance of bone - New bone **(Sub-chondrally)** and osteophyte (bony projections) formation - charcteristic **"Joint mice"** - **Heberden** and **Bouchard** nodes

Morphologic features: - Fragments of **Cartilage** into synovial fluid - **Eburnation**: Polished, **ivory-like** appearance of bone - New bone **(Sub-chondrally)** and osteophyte (bony projections) formation - charcteristic **"Joint mice"** - **Heberden** and **Bouchard** nodes features of?

Osteoarthritis

Where Are Heber**d**en nodes located?

Osteophytes (bony projections) at the **d**istal inter-phalangeal joints of the fingers

Where are B**o**uchard nodes located?

Osteophytes at the pr**o**ximal inter-phalangeal joints of the fingers

Morphological feature of?

Osteoarthritis

cause of Primary Osteoarthritis

unknown

Cause of Secondary Osteoarthritis

**Mechanical factors**, **Metabolic disroders** (e.g. Ochronosis [accumulation of homogentistic acid; most common associated with Alkaptonuria]) and **inflammatory disorders**

Examples of Arthritides of Metabolic origin

1. Gout 2. Chondro-Calcinosis (Pseudo-Gout)

causes of Gout

Hyperuricaemia

**----------** → Exacerbation of Gout

Large meal or alcohol intake

patho of Gout: Deposition of **----------** (mainly in joints ) → Opsonisation of crystals by **------** → Phagocytosis by neutrophils → Release of proteolytic enzymes and inflammatory mediators

Deposition of **urate crystals** (mainly in joints) → Opsonisation of crystals by **IgG** → Phagocytosis by neutrophils → Release of proteolytic enzymes and inflammatory mediators

lab findings in Gout

▪ Hyperuricaemia ▪ Urate crystals and neutrophils in synovial fluid

CM of Gout

1) **Podagra** (Acute Gouty Arthritis of the metatarsophalangeal joint of the great toe) 2) Painful Acute Arthritis and Bursitis 3) **nodular tophi**, located about joints, helix/anti-helix of the ear, Achilles tendon 4) **Urate Nephropathy**

What is Urate Nephropathy

✓ Interstitial deposition of urate crystals ✓ Obstruction of collecting tubules by urate crystals ✓ Formation of urate and calcium stones

Microscopic Findings: ▪ **Tophi** (or **tophaceous deposits**): Urate crystals in a protein matrix, surrounded by fibrous connective tissue ▪ Urate crystals: **Needle-shaped** and **negatively birefringent under polarised light** ▪ Foreign body giant cell reaction features of?

Gout

# Gout Microscopic Findings: ▪ **Tophi** (or **----------------**): Urate crystals in a protein matrix, surrounded by fibrous connective tissue ▪ Urate crystals: **-----------** and **[negatively/Positvely]** birefringent under polarised light ▪ Foreign body giant cell reaction

causes of Chondro-Calcinosis (Pseudo-gout)

Calcium pyrophosphate dihydrate crystal deposition | * Clinical resemblance to Gout

charcateristics of Chondro-calcinosis (Pseudo-Gout) Crystals

▪ Rhomboid in shape ▪ Positively bire-fringent (under polarised light)

how can Chondro-calcinosis (Pseudo-gout) be differentiated from Gout?

Gout negatively birefringent under polarised light wherease Pseudo-Gout Positively birefringent under polarised light

Microscopic features: - Depositions of **calcium pyrophosphate dihydrate crystals** in articular matrix (in knee) - Bluish-white, **rhomboid shaped crystal** - **positive birefringence, under polarised light** features of?

Chondro-Calcinosis (pseudo-Gout)

Most common form of bacterial arthritis

Neisseria gonorrheae arthritis **(Gonococcal Arthritis)**

CM+ Loc of Gonococcal Arthritis

**Mono-articular involvemen**t Localisation: **Knee** (most frequent), wrist, small joints of the hand

cause of Lyme disease

Borrelia burgdorferi

CM of Lyme disease

- **Erythema Chronicum Migrans** (slowly spreading skin lesion) - **Polyarticular Arthritis**, **involving knees** and other large joints (late sequela) - **Myocardial, pericardial or neurologic changes** (possible late sequela)

Diagnosis of Lyme disease

Serum IgM Abs to Borrelia burgdorferi

cause of Hypertrophic Osteo-artheropathy

Systemic disorders (e.g. chronic lung disease, congenital cyanotic heart disease, liver cirrhosis, IBD)

CM of Hypertrophic Osteo-Arthopathy

▪ Clubbing of the fingers ▪ Periostitis at the distal end of the radius and ulna ▪ Painful swelling and tenderness of the peripheral joints

DIAGNOSIS?

Hypertrophic Osteo-Arthropathy

patho of Ganglion cyst: **--------------**of connective tissue → Development of a **----------**

**Myxoid degeneration** of connective tissue → Development of a **cystic space**

CF of Ganglion Cyst

**Ganaglion cysts** on the wrist - Firm, fluctuant subcutaneous nodule; Painful on palpation and movement

Macroscopic findings: - Small cystic nodule Microscopic findings: - Wall of cyst: Dense fibrous tissue. No synovial lining. - Content of cyst: **Mucoid fluid** features of?

Ganglion cyst

Location of Ganglion cysts

In the tendon sheath or the joint capsule of the wrist