MSK path X Flashcards
What is enteritis assoc arthritis
GI infection causes it
yersinia salmonella shigella, campylobacter
presentation enteritis assoc arthritis
knees and ankles
somtimes wrists fingers and toes
lasts for about a year then generally clears
kid has new murmur and puffy face
recently had infeciton, not compliant to antibiotics
post strep glomerulonephritis
What is Psoriatic arthritis
chronic inflammatory arthropathy assoc with psoriasis that affects peripheral and axial joints and entheses
what are entheses
ligaments and tendons
Sx psoriatic arthritis
30-50 years old following onset of skin disease peripheral joints of hands and feet asymmetric distribution "pencil in cup"
pencil in cup
psoriatic arthritis
what is atypical psoriatic lesion
not on elbow or knee at first presentation but on wrist
what infections are asplenic patients at risk for
H influenza
pneumococcal
because these are encapsulated
how do bacterial infections enter joints to cause infectious arthritis
hematogenous spread
presentation infectious arthritis
sudden acute paingul and swollen joint with dec ROM
fever, leukocytosis and increase sed rate
nongonococcal infecitous arthritis
single joint, usually knee
then hip shoulder elbow wrist and sternoclavicular joint
axial joint involvement in infectious arthritis tells you what about patient
drug user
Dx infectious arthritis
joint aspiration yielding purulent fluid
lyme arthritis
caused by borrelia burgdorferi
what stage do lymes unTx patients develop arthritis and in what joints
late stage
knees, shoulders elbows ankles
how long does lymes arthritis last
one or 2 joints for few weeks- months then moves to new sites
Dx of lymes arthritis
anti-Borrelia Ab
Tx lymes arthritis
antibiotics
early stage lymes presentation
erythema multiforme
targetoids
what is crystal induced arthritis
acute and chronic joint disorders like gout and pseudogout
what is psuedogout composed of
Ca pyrophosphate dehydrate
what is gout made of
monoNa urate from broken down DNA
majority gout
idiopathic
secondary gout causes
increased nucleic acid turnover from leukemia
chronic renal disease
congenital
what can cause primary gout
idiopathic and known enzyme defects like HGPRT
what is hyperuricemia
plasma urate >6.8
what can lead to hyperuricemia
increased production or decreased excretion
inflammation in gout triggered by
precipitation of monoNa urate crystals into joints
recruits lymphocytes
when does gout appear
after 20-30 years of hyperuricemia
genetic predisposition to gout
male beause X linked abnormalities of HGPRT
what polymorphisms can lead to gout
URAT1 and GLUT9
what lifestyle factors contribute to gout
alcohol
obesity
drugs (thiazides)
lead toxicity
what are the distinctive morphologic features of gout
acute arthritis
chronic tophaceous arthritis
tophi in various states
gouty nephropathy
acute arthritis in gout
dense neutrophilic infiltrate
need shaped crystals
chronic trophaceous arthritis in gout
repetitive precipitation of urate crystals during acute attacks
hyperplastic synovium with fibrosis and thickening by inflammatory cells and forms pannus that destroys cartilage
what will gout look like grossly
white and chalky
ASx hyperuricemia in males and females
males around puberty
females postmenopause
locations for acture arthritic attacks from gout
insteps, ankles, heels, knees, wrists, fingers, elbows
how long till get chronic trophaceous gout
12 years after initial attack
see juxtaarticular bone erosion from osteoclastic bone resorption and loss of joint space
progression of chornic trophaceous gout can lead to
crippling disease
pseudogout presentation
50+ years old
some swelling and redness, not as much
crystal morph in pseudogout
oval blue purple aggregates
rhomboid crystals
inflammation
how long does pseudogout last
several days to weeks
where does pseudogout appear
monoarticular or poly
knees, wrists elbow, shoulders, ankles
Tx for pseudogout
supportive
if yellow crystals are parallel to axis then what
gout
if yellow not parallel to axis then what
pseudogout
what immune response is in RA
humoral and cellular
