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patho II > Msck - disease of joints > Flashcards

Msck - disease of joints Flashcards

1
Q

epi of Rheumatoid arthritis

A

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

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2
Q

Rheumatoid arthritis most often presents in ———- individuals

A

HLA-D4 (+)

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3
Q

Cause of Rheumatoid arthritis

A

Autoimmune origin

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4
Q

Lab findings of Rheumatoid arthritis

A

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

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5
Q

Stages of of Rheumatoid arthritis?

A

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

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6
Q

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

A
  • 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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7
Q

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?

A

Rheumatoid arthritis

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8
Q

CM of Rheumatoid arthritis

A

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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9
Q

Which joints are the most commonly affected by Rheumatoid arthritis?

A

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

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10
Q

Chracteristic Chronic joint changes in Rheumatoid arthritis

A

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

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11
Q

Extra-Articular manifestations of Rheumatoid arthritis

A

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

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12
Q

3 varients of Rheumatoid arthritis

A
  1. Sjögren Syndrome
  2. Felty Syndrome
  3. Still disease
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13
Q

* Varient of Rheumatoid Arthritis

CF of Felty Syndrome

A

Splenomegaly, neutropenia and RA

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14
Q

* Varient of Rheumatoid arthritis

Still disease is aka?

A

Juvenile Rheumatoid Arthritis

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15
Q

Still disease is associated w/?

A

generalised lymphadenopathy and
hepatosplenomegaly

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16
Q

Seronegative Arthritis is aka?

A

Spondylo-Arthropathies

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17
Q

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

A

HLA-27(+)

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18
Q

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

A

Absence

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19
Q

CM of Seronegative arthritis

A

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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20
Q

Types of Seronegative Arthritis

A

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

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21
Q

Akylosing Spondylitis is ass w/?

A

HLA-27 (+) patients (90%)

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22
Q

CM of Ankylosing Spondylitis

A

Involvement of the spine: Bone fusion “Bamboo spine”

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23
Q

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

A

Ankylosing Spondylitis

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24
Q

* Type of Seronegative arthritis

causes/association of Reiter’s syndrome

A

Venereal or intestinal infection

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25
Q

CM of Reiter’s Syndrome

A

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

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26
Q

type of Seonegative Arthritis

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

A

Peripheral Arthritis or
Ankylosing Spondylitis

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27
Q

Type of Seronegtaive arthrits

CM of Psoriatic Arthritis

A

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

28
Q

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?

A

Psoriatic Arthritis

29
Q

——— : degenerative joint disease

A

Osteoarthritis

30
Q

Epi of Osteoartheritis

A

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

31
Q

cause of Osteoarthritis

A

Mechanical taruma
“Wear-and-tear” arthritis

32
Q

Which syndrome is charcaterise by t “Wear-and-tear” arthritis?

A

Osteoarthritis

33
Q

Patho of Osteoarthritis

A

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

34
Q

* 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?

A
  • 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
35
Q

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?

A

Osteoarthritis

36
Q

Where Are Heberden nodes located?

A

Osteophytes (bony projections) at the distal inter-phalangeal joints of the fingers

37
Q

Where are Bouchard nodes located?

A

Osteophytes at the proximal inter-phalangeal joints of the fingers

38
Q

Morphological feature of?

A

Osteoarthritis

39
Q

cause of Primary Osteoarthritis

A

unknown

40
Q

Cause of Secondary Osteoarthritis

A

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

41
Q

Examples of Arthritides of Metabolic origin

A
  1. Gout
  2. Chondro-Calcinosis (Pseudo-Gout)
42
Q

causes of Gout

A

Hyperuricaemia

43
Q

———- →
Exacerbation of Gout

A

Large meal or alcohol intake

44
Q

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

A

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

45
Q

lab findings in Gout

A

▪ Hyperuricaemia
▪ Urate crystals and neutrophils in synovial fluid

46
Q

CM of Gout

A

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

47
Q

What is Urate Nephropathy

A

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

48
Q

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?

A

Gout

49
Q

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

A

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

50
Q

causes of Chondro-Calcinosis (Pseudo-gout)

A

Calcium pyrophosphate dihydrate crystal
deposition

* Clinical resemblance to Gout

51
Q

charcateristics of Chondro-calcinosis (Pseudo-Gout) Crystals

A

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

52
Q

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

A

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

53
Q

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?

A

Chondro-Calcinosis (pseudo-Gout)

54
Q

Most common form of bacterial arthritis

A

Neisseria gonorrheae arthritis (Gonococcal Arthritis)

55
Q

CM+ Loc of Gonococcal Arthritis

A

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

56
Q

cause of Lyme disease

A

Borrelia burgdorferi

57
Q

CM of Lyme disease

A
  • 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)
58
Q

Diagnosis of Lyme disease

A

Serum IgM Abs to Borrelia burgdorferi

59
Q

cause of Hypertrophic Osteo-artheropathy

A

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

60
Q

CM of Hypertrophic Osteo-Arthopathy

A

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

61
Q

DIAGNOSIS?

A

Hypertrophic Osteo-Arthropathy

62
Q

patho of Ganglion cyst:
————–of connective tissue → Development of a ———-

A

Myxoid degeneration of connective tissue
→ Development of a cystic space

63
Q

CF of Ganglion Cyst

A

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

64
Q

Macroscopic findings:
- Small cystic nodule

Microscopic findings:
- Wall of cyst: Dense fibrous tissue. No synovial lining.
- Content of cyst: Mucoid fluid

features of?

A

Ganglion cyst

65
Q

Location of Ganglion cysts

A

In the tendon sheath or the joint capsule of the wrist

patho II (29 decks)

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