Msck - disease of joints Flashcards
epi of Rheumatoid arthritis
▪ Female > Male
▪ Peak incidence: 20-50 years of age
Rheumatoid arthritis most often presents in ———- individuals
HLA-D4 (+)
Cause of Rheumatoid arthritis
Autoimmune origin
Lab findings of Rheumatoid arthritis
Serum rheumatoid factor (most often IgM); (highly characteristic but not specific for Rheumatoid Arthritis)
Stages of of Rheumatoid arthritis?
1) Synovitis
2) Pannus
3) Fibrous ankylosis
4) Bony ankylosis
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
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
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
Which joints are the most commonly affected by Rheumatoid arthritis?
1) Wrists (minimal radial deviation)
2) MCP and PIP joints of the hand
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
Extra-Articular manifestations of Rheumatoid arthritis
▪ Pleural and pericardial effusions
▪ Pulmonary involvement (pleuritis)
▪ Secondary reactive amyloidosis
▪ Vasculitis
▪ Anaemia of chronic disease
3 varients of Rheumatoid arthritis
- Sjögren Syndrome
- Felty Syndrome
- Still disease
* Varient of Rheumatoid Arthritis
CF of Felty Syndrome
Splenomegaly, neutropenia and RA
* Varient of Rheumatoid arthritis
Still disease is aka?
Juvenile Rheumatoid Arthritis
Still disease is associated w/?
generalised lymphadenopathy and
hepatosplenomegaly
Seronegative Arthritis is aka?
Spondylo-Arthropathies
———- Individals have high incidence of developing Seronegative arthritis
HLA-27(+)
In Seronegative Arthritis there is [Presence/Absence] of Rheumatoid factor (RF)
Absence
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)
Types of Seronegative Arthritis
1) Ankylosing Spondylitis
2) Reiter’s syndrome
3) Psoriatic Arthritis
4) Arthritis in assc. w/ IBD
Akylosing Spondylitis is ass w/?
HLA-27 (+) patients (90%)
CM of Ankylosing Spondylitis
Involvement of the spine: Bone fusion “Bamboo spine”
Which disorder is has the following manifestaiton?
fusion of spinal bones “Bamboo spine”
Ankylosing Spondylitis
* Type of Seronegative arthritis
causes/association of Reiter’s syndrome
Venereal or intestinal infection
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 Heberden nodes located?
Osteophytes (bony projections) at the distal inter-phalangeal joints of the fingers
Where are Bouchard nodes located?
Osteophytes at the proximal 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
- Gout
- 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
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
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 involvement
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
