Pankratz DSA: MSK Joint Pathology

Question 1

Osteoarthritis

Answer 1

• Herbeden nodes
• Bouchard nodes
• Osteophytes

Question 2

ORheumatoid arthritis

Answer 2

• rheumatoid factor
• rheumatoid nodules
• pannus
• swan-neck deformity
• boutoneeire’s deformity

Question 3

Osteoarthritis

Answer 3

• 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

Question 4

Herbeden node

Answer 4

-in DIP joint

Question 5

Bouchard node

Answer 5

-in PIP joint

Question 6

Rheumatoid arthritis

Answer 6

• autoimmune
• CD4 T cells
• HLA-DRB1 allele
• PTPN22 gene
• improves with use
• symmetric
• systemic symptoms

Question 7

What are the long-term complications for RA?

Answer 7

• systemic amyloidosis
• Caplan syndrome
• Anemia of chronic disease
• Felty syndrome

Question 8

Clinical findings for RA

Answer 8

• pannus
• fibrinoid necrosis with palisaing histiocytes
• radial deviation or wrist, ulnar deviation of fingers
• swan neck deformity
• boutonneire defomty (opp of swan)

Question 9

What was the bolded thing under RA that wasn’t rheumatoid factor?

Answer 9

-Antibodies against citrullinated peptides

Question 10

What is Rheumatoid factor?

Answer 10

-serum IgM or IgA autoantibodies that bind to Fc portion of their own IgG

Question 11

Juvenile idiopathic arthritis

Answer 11

• arthritis b4 age of 16 and persists for at least 6 weeks
• more common in large joints
• absent rf and rheumatoid nodules
• positive ANA

Question 12

Seronefative spondyloarthropathies

Answer 12

• immune mediated disease triggered by T-cell response to unidentified antigen
• Ankylosing spondylitis
• reactive arthritis
• enteritis associated arthritis
• psoriatic arthritis

Question 13

Immune mediated disease triggered by t cell response to unidentified antigen

Answer 13

• pathologic change in ligamentous attachments not synovium
• involvement of SI joints
• Absence of RF
• HLA-B27 association

Question 14

Ankylosing spondylitis

Answer 14

• destrution of articular cartilage and bony ankylosis
• SI and pophyseal joints
• 20-30’s
• low back pain with spinal immobility

Question 15

Reactive arthritis

Answer 15

• Arthritis and non-gonoccocal urethritis or cervicitis and conjunctivitis
• HLA-B27
• Autoimmune rxn initiated by prior infection

Question 16

clinical manifestations of reactive arthritis

Answer 16

• develops within weeks of urethritis or diarrhea
• asymmetric pattern involving knees, ankles, feet
• may wax and wane for weeks to 6 months

Question 17

Enteritis associated arthitis

Answer 17

• 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

Question 18

Psoriatic arthritis

Answer 18

• 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

Question 19

What are the kinds of infectious arthritis

Answer 19

• Suppurative arthritis
• Mycobacterial arthritis
• Lyme arthritis
• Viral arthritis

Question 20

Suppurative arthritis

Answer 20

• 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

Question 21

most common causal agent for Children suppurative arthritis

Answer 21

-H influenza: gram negative coccobacillus

Question 22

Adult suppurative arthritis

Answer 22

-S. Aureus: gram + cocci

Question 23

Suppurative arthritis from sickle cell disease

Answer 23

-salmonella: gram - rod

Question 24

suppurative arthritis from sexually active individuals

Answer 24

-N. gonorrhea: gram negative diplococcus

Question 25

Mycobacterial arthritis

Answer 25

- 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

Question 26

Lyme arthritis

Answer 26

- Borrelia burgdorferi: spirochete - Late stage; untreated individuals - large joints - diagnosis made by ID of spirochete and anti borrelia antibodies

Question 27

Gout

Answer 27

- hyperuricemia - synovium, neutrophilic infiltrate, edematous - needle shaped negative birefringence

Question 28

What is Tophaceous gout?

Answer 28

- 12 yrs after initial acute attack - synovium: hyperplastic, fibrotic, thickened, which leads to pannus formation and bone erosions - development of tophi

Question 29

What are tophi

Answer 29

large aggregations of urate crystals surrounded by inflammatory rxn of foreign body giant cells

Question 30

Complications (gouty nephropathy)

Answer 30

- uric acid nephrolithiasis | - pyelonephritis

Question 31

What does radiology look like in gout?

Answer 31

-justa-articular bone erosion caused by osteoclastic bone resorption and loss of joint space

Question 32

Calcium pyrophosphate deposition disease (pseudo-gout; chondrocalcinosis)

Answer 32

- 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

Question 33

hereditary psuedogout

Answer 33

- auto dominant; germline mutation in pyrophosphate channel | - delvelopment of crystals at an early age with severe steoarthritis

Question 34

-secondary pseudogout

Answer 34

-associated with previous joint damage, hyperparathyroidism, hemochromatosis, hypomagnesemia, hypothyroidism, ochronosis, diabetes