MSK path IX Flashcards
what is OA
degeneration of cartilage causing structural and functional failure of synovial joints
failure/disordered repair
what occurs in early OA
chondrocytes proliferate and the collagent II fibers cleaved causes fissures and clefts
what are joint mice
parts of cartilage that slough into joint in OA
what cap the osteophytes in OA
fibrocartilage and hyaline
what is eburnated articular surface in OA
friction on bone causing smoothign surface
Sx OA
deep achy pain that worsens with use
morning stiffness, crepitus
limited ROM
impingement on spinal foramina by osteophytes
what occurs with radiculopathy from OA
muscle spasms, radicular pain, muscle atrophy and neurologic deficits
joints commonly involved in OA
hips knees, lower lumbar and cervical vertebrae, PIPs DIPs, first CMC and first TMT
heberden nodes
prominent osteophyes at DIP joints
common in women
Dx OA
radiographically because can see osteophytes
red ragged bloody clots in joint capsule
RA
RA
chronic inflammatory disorder of autoimmune origin
may affect many tissues and organs principally attacks joints producing nonsuppurative proliferatice and inflammatory synovitis
what do hands look like in RA
ulnar deviation
What is common genetically in RA
HLA susceptibility
what cells are involved in RA
T ell B cell and Macrophages
What cells initiate immune response in RA
CD4 T cells
reacti with arthritogenic agent
what specified Tx is helpful in RA and why
TNF antagonists because TNF somehow involved in RA
What is in the synovium of RA
germinal centers with secondary follicles and many plasma cells (autoAb)
synovium in RA
thick edema hyperplastic synovial cell hyperplasia, dense inflammatory infiltrates increased vasculaity fibrinopurulent exudate osteoclastic activity in underlying bone
what is pannus
mass of edematous synovium, inflammatory cells, granulation tissue and fibroblasts that grows over articular cartilage and causes its erosion
what is it called when pannus bridges opposing bones
fibrous anklyosis leads to boney ankylosis when it fuses
blue cells with hoff bodies
plasma cells
are plasma cells normal in synovium
no
what are RA subcutaneous nodules
parts of skin subject to pressure
firm nontender and round to oval
in subcutaneous tissue
what do RA subcutaneous nodules look like microscopically
necrotizing granulomas with central zone fibrinoid necrosis with rim of macrophages, lymphocytes and plasma cells
increased RF in RA patient
higher risk for vasculitis
acute necrotizing vasculitis with RA involves what and can lead to what
small and large aa
neuropathies, ulcers and gangrene
leukocytoclastic vasculitis can cause what
purpura, cutaneous ulcers, nail bed infarction
ocular changes like uveitis and keratoconjunctivitis
palisade necrozing granuloma need to test for?
TB
can be rheumatoid nodule in lung
Sx RA
slow malaise, fatigue, generalized MSK pain
what mediates pain in RA
IL1 and TNF
joint progression in RA
small joints first
symmetrically
what part of skeleton is usually spared in RA
lumbosacral and hips
Dx RA
characteristic radiographic finding
sterile turbid synovial fluid with poor mucin clot
combination of RF and anti CCP Ab
ehy does the synovial fluid of RA joint have poor mucin clot
all the inflammatory products break it downw
what are the inclusion breaing neutrophils in RA synovial fluid
tart cells
anti CCP Ab is best used for what
RA screening!!
What is Juvenile idiopathi arthritis
unknown cause arthritis before age 16 and persist for >6 weeks
differences of RA and JIA
JIA: oligoarthritis unilateral systemic disease more frequent large joints affected more RF and nodules usually absent ANA sero +
ANA + means what
autoimmune
seronegative spondylarthropathies have what
assoc with HLA B27
no RF
involve SI joints
anklyosing spondylitis
destruction of cartilage and bony anklyosis of SI and apophyseal joints
what are apophyseal joints
between tuberosities and processes
when does anklyosing spondylitis become Sx
20-30 years because of low back pain and spinal immobility
what peripheral joints are involved in anklyosing spondylitis sometimes
hips, knees, shoulders
HLA with anklyosing spondylitis
B27
What is reactive arthritis
reiter syndrome
arthritis, nongonococcal urethritis or cervicitis
conjunctivitis
HLA assoc with reactive arthritis
HLA B27 and HIV individuals
age of reactive arthritis
20s 30s
prior infection that can trigger reactive arthritis
chlamydia, shigella, salmonella, yersinia, campylobacter
