Pathology and Disease Flashcards
bone enlargement, thickened cortices, thickened trabeculae with mixed areas of lysis and sclerosis
Paget’s Disease
Signs of Osteoarthritis
Crepitus Restricted movement Bony enlargement Joint effusion Bony instability
Symptoms of Osteoarthritis
Short lived morning joint stiffness
Joint pain with movement and weight bearing
May have inflammatory flare ups
Joints Affected:
Hands
Knee
Spine
Hands = DIP, PIP, 1st CMC
Knee = may see Baker’s cyst in the popliteal fossa
Spine =
Cervical region - pain and reduced ROM
Lumbar - osteophytes may produce spinal stenosis
Pathophysiology of Osteoarthritis (Key Cell)
Osteophytes
Attempt to repair the damage to the bone surface
Investigations for Osteoarthritis (2)
Bloods - inflammatory markers NORMAL
X-ray - classic signs
X-ray features of Osteoarthritis
Loss of joint space
Osteophytes
Subchondral sclerosis
Formation of cysts
Management
Physical
Pharmacological
Physical = weight loss, low impact exercise Pharmacological = pain control, NSAIDs
Seronegative Inflammatory Arthritis (4)
Ankylosing Spondylitis
Reactive Arthritis
Enteropathic Arthritis
Psoriatic Arthritis
HLA type in Rheumatoid Arthritis
HLA-DR4
Pathophysiology of Rheumatoid Arthritis
Autoimmune response to the synovium
Inflammatory layer forms which attacks and degrades the cartilage
TNF-a is produced and contributes to joint destruction
Complications of Rheumatoid Arthritis
Atlanto-axis subluxation
Cervical cord compression
Clinical Presentation of Rheumatoid Arthritis
Prolonged morning stiffness
Usually starts in the small joints of the hand
Boggy swelling
DIP joint usually spared
Affected: elbows, shoulders, knees, ankles
Autoantibodies present in RA
Anti-CCP - more specific, present before disease onset
- Also have rheumatoid factor, used less now
Investigations in RA
Bloods - inflammatory markers RAISED
Autoantibodies - anti-CCP, rheumatoid factor
X-ray - won’t show any joint abnormality until later
Polymyalgia Rheumatica
- Presentation
Presentation:
- Reduced movement
- Aching joints (not from weakness of muscles)
- Usually shoulder and hip girdle
- Accompanied by morning stiffness >1 hour - General symptoms
e. g. fatigue, anorexia, fever, weight loss
Polymyalgia Rheumatica
- Investigations
No specific test
Inflammatory markers are raised
Polymyalgia Rheumatica
- Management
Prednisolone 15mg
See dramatic improvement in symptoms
Polymyalgia Rheumatica
- Associations
= giant cell arteritis
- Temporal artery biopsy
- Increase prednisolone to 40mg (don’t wait for biopsy)
Inflammatory Myopathies (2)
Dermatomyositis
Polymyositis
Difference between dermatomyositis and polymyositis
Clinically similar EXCEPT
- Dermatomyositis is just the skin and muscles
- Dermatomyositis has an increased risk of malignancy
Aetiology of Inflammatory Myopathies
Idiopathic
More likely to occur in females
Dermatomyositis
- Skin Features
Heliotrope Rash = purplish colours around the eyes
Gottron’s Sign = red/purplish papules on finger joint area
Shawl Sign = rash where a shawl would have traditionally sat
Dermatomyositis and Polymyositis
- Muscle Features
- Antibodies
- Muscle weakness (hip and shoulders)
- Insidious onset
- Usually symmetrical
- Worsens over a few months
- Proximal weakness - struggle washing/brushing hair, climbing stairs
Antibody: anti-Jo-1
Polymyositis
- Histology
= muscle biopsy
- Muscle fibre necrosis, degeneration, inflammatory cell infiltrate
Polymyositis
- Other Clinical Features
Generalised = fever, weight loss, Raynaud’s
Lung = ILD
Oesophageal = dysphagia, oesophageal muscle weakness
Poor prognostic sign
Cardiac = myocarditis
Polymyositis
- Investigations
- Antibodies
Raised inflammatory markers
Increased CK levels (often extreme increase)
Electromyography = almost always abnormal in polymyositis
Muscle Biopsy = DEFINITIVE
(MRI)
Antibodies: anti-Jo-1
Polymyositis and Dermatomyositis
- Management
Prednisolone 40mg
Combined with immunosuppressive drugs e.g. methotrexate, azathioprine
How: add in steroid initially as immunosupressant takes 4-6 weeks to be effective
Giant Cell Arteritis
- Management
Prednisolone
- 40mg
- 60mg if visual impairment
- Start as soon as diagnosis is suspected
Kawasaki Disease
= medium vessel vasculitis
- Usually seen in children
WARY: coronary artery affected > aneurysm
Small Vessel Vasculitis
- General Features
Fever, weight loss, arthralgia/arthritis
Rash = raised, non-blanching, purpuric
pANCA
- Vasculitis which are +VE
MPA
EGPA
cANCA
- Vasculitis which are +VE
GPA
Investigations for Small Vessel Vasculitis
U&E to check renal involvement
Inflammatory markers raised
Urinalysis
Chest x-ray
EGPA
- Other features
Asthma, rhinitis, high peripheral blood eosinophils
MPA
- Complications
= necrotising vasculitis
Complication: glomerulonephritis
GPA
- Aetiology
- Presentation
- Associations
- More common in those of N European descent, typically 35-55
ENT: deafness, nosebleeds, recurrent sinusitis, nasal crusting
Associations: cANCA
HSP
- Aetiology
- Pathogenesis
- Presentation
- Disease Course
Aetiology: usually occurs in children
Pathogenesis: IgA mediated
1. Purpuric rash - buttocks and the lower limbs
2. Abdominal pain, joint pain, vomiting
- Usually a preceding illness e.g. URTI, pharyngeal, GI
