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MSS 2 > Pathology of Joint Disease > Flashcards

Pathology of Joint Disease Flashcards

1
Q

What is a joint?

A
  • connection between 2 bones
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2
Q

What are solid joints?

A
  • tightly connected to provide structural strength.
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3
Q

What are SYNOVIAL joints?

A
  • have a joint space to allow for motion.
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4
Q

** Of what is the articular surface of adjoining bones is made?

A
  • hyaline cartilage (type II collagen) that is surrounded by a joint capsule.
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5
Q

What is the synovium that lines synovial joints?

A
  • lines the joint capsule and secretes fluid rich in HYALURONIC ACID to lubricate the joint and facilitate smooth motion.
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6
Q

** What is degenerative joint disease; DJD (OSTEOARTHRITIS)? (PICMONIC)

A
  • progressive degeneration of ARTICULAR CARTILAGE due to “WEAR and TEAR.”
  • MOST COMMON type of arthritis.
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7
Q

What is a major risk factor for degenerative joint disease (osteoarthritis)?

A
  • age over 60.

* also obesity and trauma.

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8
Q

What are the clinical features of degenerative joint disease (osteoarthritis)?

A
  • joint stiffness of the hip, lower lumbar spine, knees, DIP and PIP joints of fingers, in the morning that worsens during the day.
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9
Q

*** What are the 3 pathological features of degenerative joint disease (osteoarthritis)?

A
  1. disruption of the cartilage that lines the articular surface. This leads to fragments of cartilage floating in the joint space (called ‘joint mice’).
  2. eburnation (polishing) of the subchondral bone due to bone on bone rubbing.
  3. osteophyte formation (reactive bony outgrowths); classically in the DIP (Heberden nodes) and PIP (Bouchard nodes) joints of the fingers.
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10
Q

** What is RHEUMATOID ARTHRITIS (RA)? (PICMONIC)

A
  • chronic, systemic autoimmune disease characterized by SYNOVITIS (“RICE BODIES”) leading to formation of a PANNUS (inflamed granulation tissue; contains blood vessels, fibroblasts, and myofibroblasts) in the joint.
  • classically arises in women of late childbearing age
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11
Q

** With what is RA associated?

A
  • HLA-DR4

- RANKL= osteoclastic activity (breaks down bone).

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12
Q

To what does RA lead?

A
  • The contractile properties of the granulation tissue (pannus) leads to destruction of the cartilage, fusion of the joint (ankylosis), and/or dragging of the joint in a different direction.
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13
Q

** What are the 7 clinical features of RA?

A
  1. arthritis with morning stiffness that IMPROVES with ACTIVITY.
  2. join-space narrowing, loss of cartilage, and osteopenia are seen on x-ray.
  3. fever, malaise, weight loss, and myalgias (symptoms of systemic autoimmune disease).
  4. RHEUMATOID NODULES= central zone of necrosis surrounded by epithelioid histiocytes seen in skin and visceral organs.
  5. vasculitis= multiple organs.
  6. baker cyst= swelling of bursa behind the knee.
  7. pleural effusions, lymphadenopathy, and interstitial lung fibrosis.
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14
Q

Will the involvement of joints in RA by symmetric or asymmetric?

A
  • SYMMETRIC involvement of PIP joints of the fingers (SWAN-NECK deformity), wrists (radial deviation), elbows, ankles, and knees.
  • DIP is usually spared (unlike osteoarthritis).
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15
Q

** What laboratory findings will you see in RA?

A
  • IgM autoantibody against the Fc portion of IgG (RHEUMATOID FACTOR); marker of tissue damage and disease activity.
  • neutrophils and high protein in synovial fluid.
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16
Q

** What complications will you see with RA?

A
  • ANEMIA of CHRONIC DISEASE due to chronic inflammatory state resulting in production of acute phase reactants, such as hepcidin, which will block the ability to use iron that is stored in the macrophages.
  • SECONDARY AMYLOIDOSIS due to acute phase reactant production, such as SAA produced by the liver, which gets converted to AA and deposited in various tissues.
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17
Q

** What are SERONEGATIVE SPONDYLOARTHROPATHIES?

A
  • group of joint disorders that LACK rheumatoid factor, involve the AXIAL skeleton, and have HLA-B27 association.
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18
Q

*** What are the 3 seronegative spondyloarthropathies?

A
  1. ankylosing spondyloarthritis
  2. reiter syndrome (reactive arthritis)
  3. psoriatic arthritis
19
Q

** What is AKYLOSING SPONDYLOARTHRITIS? (PICMONIC)

A
  • seronegative spondyloarthropathy involving the SACROILIAC JOINTS and SPINE.
  • arises in YOUNG ADULTS.
  • HLA-B27 positive
20
Q

*** How does akylosing spondyloarthritis present?

A
  • low back pain (involvement of vertebral bodies eventually arises, leading to fusion of the vertebrae (‘BAMBOO SPINE’).
  • UVEITIS and AORTITIS (leading to aneurysm and aortic regurgitation).
21
Q

** What is REITER SYNDROME (Reactive Arthritis)?

A
  • seronegative spondyloarthropathy causing ARTHRITIS, URETHRITIS, and CONJUNCTIVITIS.
  • arises in young male adults weeks after a GI or Chlamydia trachomatis infection.
  • HLA-B27 positive
  • remember: can’t see, can’t pee, and can’t climb a tree.
22
Q

** What is PSORIATIC ARTHRITIS?

A
  • seronegative spondyloarthropathy seen in 10% of cases of psoriasis.
  • involves the AXIAL and PERIPHERAL JOINTS (DIP joints of the hands and feet are most commonly affected leading to “SAUSAGE” fingers or toes.
  • HLA-B27 positive
23
Q

*** What is INFECTIOUS ARTHRITIS?

A
  • arthritis due to an infectious agent, usually bacterial.
  • causes include Neiserria gonorrhoeae (young adults; MOST COMMON), or Staph aureus (older children and adults).
  • classically involves a SINGLE JOINT (usually the KNEE).
24
Q

How does infectious arthritis present?

A
  • as a SINGLE WARM joint with limited range of motion, fever, increased white count, and elevated ESR.
25
Q

*** What is GOUT? (PICMONIC)

A
  • deposition of MONOSODIUM URATE (MSU) crystals in tissues, especially the joints.
  • due to HYPERURICEMIA, related to overporduction or decreased excretion of uric acid.
26
Q

From where is uric acid derived?

A
  • PURINE metabolism and is excreted by the kidney.
27
Q

*** What is PRIMARY gout?

A
  • MOST COMMON form; etiology of hyperuricemia is unknown (aka either overproduction or decreased excretion of uric acid).
28
Q

*** What is SECONDARY gout

A
  • hyperuricemia due to a known cause:
  • LEUKEMIA and MYELOPROLIFERATIVE disorders (increased cell turnover leads to hyperuricemia).
  • LESCH-NYHAN syndrome (x-linked deficiency of hypoxanthine-guanine phosphoribosyltransferase (HGPRT); presents with mental retardation and self mutilation.
  • RENAL INSUFFICIENCY= decreased renal excretion of uric acid.
29
Q

What is acute gout?

A
  • exquisitely painful arthritis of the great toe (PODAGRA).
  • MSU crystals deposit in the joint, triggering an acute inflammatory reaction from the macrophages. ALCOHOL or consumption of MEAT may precipitate arthritis.
30
Q

What is chronic gout?

A
  • development of TOPHI (white, chalky aggregates of uric acid crystals with fibrosis and giant cell reaction in the soft tissue and joints).
31
Q

What else can pts develop with chronic gout?

A
  • renal failure due to uric acid deposition in tubules (URATE NEPHROPATHY).
32
Q

** What are the laboratory findings of pts with gout?

A
  • hyperuricemia
  • synovial fluid shows NEEDLE-SHAPED CRYSTALS with NEGATIVE BIREFRINGENCE under polarized light.
  • remember: when crystals lay flat (low), they are yellow.
  • also yellow under parallel light.
33
Q

** What is PSEUDOGOUT? (PICMONIC)

A
  • clinically resembles gout, but due to deposition of calcium pyrophosphate dihydrate (CPPD).
  • first develop in menisci and intervertebral discs.
34
Q

** What will you see in the synovial fluid of a pt with pseudogout?

A
  • RHOMBOID-SHAPED, MAGENTA CRYSTALS with weakly POSITIVE BIREFRINGENCE under polarized light.
35
Q

What is Morton’s neuroma?

A
  • benign neuroma of an interdigital plantar nerve,(most commonly of the 2nd and 3rd intermetatarsal spaces; between 2nd−3rd and 3rd−4th metatarsal heads), which results in the entrapment of the affected nerve causing shooting pains that are made worse with standing.
  • often in women due to poorly fitting shoes.
  • thickening of digital artery, Schwann cell and fibroblast proliferation, and loss of myelinated nerve fibers.
36
Q

What is osteochondritis dissecans?

A
  • noninflammatory condition in young adults causing necrosis of the articular cartilage and underlying subchondral bone, resulting of separation of structures.
  • causes pain and swelling of the affected joint which catches and locks during movement.
37
Q

What does osteochondritis dissecans typically occur?

A
  • lateral aspect of the medial femoral condyle
38
Q

What are some other entities that can cause infectious arthritis?

A
  • lyme disease (Borrelia burgdorferi)
  • spondylodiskitis
  • suppurative arthritis
  • tuberculous arthritis
39
Q

What is suppurative arthritis?

A
  • seeding of joint during bacteremia, usually due to Staph or Strep.
  • also seen due to post-surgical infections.
40
Q

What associations should you make with certain pathogens for suppurative arthritis?

A
  • children under age of 2= H. influenza.
  • older children and adults= Staph aureus.
  • young women= gonorrhea
  • sickle cell disease= salmonella.
41
Q

What is Erythema chronicum migrans?

A
  • ‘bullseye-like’ skin lesion at site of tick bite (from Borrelia burgdorferi), which disappears in a few weeks.
  • associated with fever lymphadenopathy
42
Q

What is spondylodiskitis?

A
  • inflammation of intervertebral disk and vertebrae, causing lower back pain.
  • mostly due to infections with Staph or strep
  • necrosis of disk, chronic osteomyelitis, vascularization
43
Q

What is important to know about tuberculosis arthritis?

A
  • usually develops from osteoarthritis or hematogenous spread from pulmonary TB.
  • chronic progressive arthritis.
  • monoarticular in knee and hip.
  • causes fibrous ankylosis of joint with obliteration of joint space.
  • GRANULMOAS and CASEOUS NECROSIS.
44
Q

What is TB that spreads to the vertebrae called?

A
  • Pott’s disease

MSS 2 (15 decks)

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