Pankratz DSA: MSK Joint Pathology Flashcards
Osteoarthritis
- Herbeden nodes
- Bouchard nodes
- Osteophytes
ORheumatoid arthritis
- rheumatoid factor
- rheumatoid nodules
- pannus
- swan-neck deformity
- boutoneeire’s deformity
Osteoarthritis
- degeneration of cartilage that results in structural and functional failure of synovial joints
- chondrocyte injury
- weight bearing joints
- asymmetric
- loss of knee cartilage medially
- trauma
- joint space narrowing
- Herbeden nodes and Bouchard nodes
Herbeden node
-in DIP joint
Bouchard node
-in PIP joint
Rheumatoid arthritis
- autoimmune
- CD4 T cells
- HLA-DRB1 allele
- PTPN22 gene
- improves with use
- symmetric
- systemic symptoms
What are the long-term complications for RA?
- systemic amyloidosis
- Caplan syndrome
- Anemia of chronic disease
- Felty syndrome
Clinical findings for RA
- pannus
- fibrinoid necrosis with palisaing histiocytes
- radial deviation or wrist, ulnar deviation of fingers
- swan neck deformity
- boutonneire defomty (opp of swan)
What was the bolded thing under RA that wasn’t rheumatoid factor?
-Antibodies against citrullinated peptides
What is Rheumatoid factor?
-serum IgM or IgA autoantibodies that bind to Fc portion of their own IgG
Juvenile idiopathic arthritis
- arthritis b4 age of 16 and persists for at least 6 weeks
- more common in large joints
- absent rf and rheumatoid nodules
- positive ANA
Seronefative spondyloarthropathies
- immune mediated disease triggered by T-cell response to unidentified antigen
- Ankylosing spondylitis
- reactive arthritis
- enteritis associated arthritis
- psoriatic arthritis
Immune mediated disease triggered by t cell response to unidentified antigen
- pathologic change in ligamentous attachments not synovium
- involvement of SI joints
- Absence of RF
- HLA-B27 association
Ankylosing spondylitis
- destrution of articular cartilage and bony ankylosis
- SI and pophyseal joints
- 20-30’s
- low back pain with spinal immobility
Reactive arthritis
- Arthritis and non-gonoccocal urethritis or cervicitis and conjunctivitis
- HLA-B27
- Autoimmune rxn initiated by prior infection
clinical manifestations of reactive arthritis
- develops within weeks of urethritis or diarrhea
- asymmetric pattern involving knees, ankles, feet
- may wax and wane for weeks to 6 months
Enteritis associated arthitis
- cause by: yersinia, salmonella, shifella, camplyobacter
- lipopolysaccharides stimulate immunological response
- abrupt onset involving usually involving knees and ankles
- typically lasts about 1 year then resolves
Psoriatic arthritis
- chronic arthropathy that affects peripheral and axial joints and enthuses
- HLA-B27
- 30-50
- predominantly in hands and feet
- Asymmetric pattern that usually first involves DIPJ
- clinical findings: PENCIL IN A CUP DEFORMITY
What are the kinds of infectious arthritis
- Suppurative arthritis
- Mycobacterial arthritis
- Lyme arthritis
- Viral arthritis
Suppurative arthritis
- bacterial infection enters joint through hematological spread
- non gono…. single joint
- drug users: axial joints
- joint aspiration shows purulent fluid with ID of causal agent
- sudden onset fever, leukocytosis, elevated ESR
- painful swollen joints
most common causal agent for Children suppurative arthritis
-H influenza: gram negative coccobacillus
Adult suppurative arthritis
-S. Aureus: gram + cocci
Suppurative arthritis from sickle cell disease
-salmonella: gram - rod
suppurative arthritis from sexually active individuals
-N. gonorrhea: gram negative diplococcus
Mycobacterial arthritis
- M tuberculosis
- complication of osteomyelitis or hematogenous dissemination from a visceral (most commonly pulmonary)
- gradual progressive pain in weight bearing joints
- confluent granulomas with central caseous necrosis
Lyme arthritis
- Borrelia burgdorferi: spirochete
- Late stage; untreated individuals
- large joints
- diagnosis made by ID of spirochete and anti borrelia antibodies
Gout
- hyperuricemia
- synovium, neutrophilic infiltrate, edematous
- needle shaped negative birefringence
What is Tophaceous gout?
- 12 yrs after initial acute attack
- synovium: hyperplastic, fibrotic, thickened, which leads to pannus formation and bone erosions
- development of tophi
What are tophi
large aggregations of urate crystals surrounded by inflammatory rxn of foreign body giant cells
Complications (gouty nephropathy)
- uric acid nephrolithiasis
- pyelonephritis
What does radiology look like in gout?
-justa-articular bone erosion caused by osteoclastic bone resorption and loss of joint space
Calcium pyrophosphate deposition disease (pseudo-gout; chondrocalcinosis)
- articular cartilage proteglycans, which normally inhibiti mineralizatio, are degraded allowing crystallization around chondrocytes
- > 50 yo
- usually asymptomatic
- knees, wrists, elbows, shoulders, ankles
- rhomboid crystals
- postivie birefringence
- management: supportive
hereditary psuedogout
- auto dominant; germline mutation in pyrophosphate channel
- delvelopment of crystals at an early age with severe steoarthritis
-secondary pseudogout
-associated with previous joint damage, hyperparathyroidism, hemochromatosis, hypomagnesemia, hypothyroidism, ochronosis, diabetes
