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Systemic Pathology I > Pathology of Joints > Flashcards

Pathology of Joints Flashcards

1
Q

How are joints formed?

A

Articulations or joints are formed when two or more bones are united by fibrous, elastic or cartilaginous tissues or by a combination of these tissue

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2
Q

What are the types of joints?

A
  • Fibrous Joints (synarthroses)
  • Cartilaginous Joints (amphiarthroses)
  • Synovial Joints (true joints or diarthroses)
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3
Q

What is a Fibrous joint? Where can they be found?

A

Fibrous joints (synarthroses): Bones are united by fibrous tissue.
Ex: Joints between cranial bones; joints between the teeth and alveolar bone

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4
Q

What is a Cartilaginous joint? Where can they be found?

A

Bones are united by hyaline cartilage (e.g., costochondral joints) or fibrocartilage (pelvic and mandibular symphyses, intervertebral joints).

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5
Q

What is a synovial joint? Where can they be found?

A

Synovial Joints (True joints or Diarthroses): Unite
two bone ends covered by hyaline articular cartilage. An articular capsule surrounds a cavity filled with synovial fluid.

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6
Q

What joint type is known for having the most pathology?

A

Synovial Joints

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7
Q

What is the age of this animal likely? Why? What is the synovial membrane/ what is its job?

A

Older animal, no physis present/ minimal
-Synovial membrane -> makes synovial fluid (lubricant material)
-This provides nutrition to articular cartilage.
- Joint also has ligaments made of fibrocartilage.

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8
Q

Name the parts of this joint ? What kind of joint is it?

A

A.) Bone
B.) Articular Cartilage
C.) Bone
D.) Synovial Membrane
E.) Articular Capsule
F.) Joint containing Synovial Fluid
Synovial Joint

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9
Q

What is the common Joint reaction to injury? What is the joint that you most commonly see joint lesions in domestic animals?

A
  • Most common joint lesions in domestic animals involve
    synovial (diarthrodial) joints * Injury to articular cartilage results in fibrillation (fraying),
    eburnation or “Joint mice” formation
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10
Q

What can be seen in fibrillation? What is eburnation? What is a consequence of these?

A
  • Fibrillation -> Color of cartilage (usually blue/ white), erosion of articular cartilage, causes fraying, since loss of proteoglycan, and exposure of the . yellowish in color, dull , more granular/ fibular. This indicates damage of the cartilage. If it severe enough it will cause ulceration of the cartilage -> called eburnation.
  • Increased density of subchondrial bone/ osteosclerosis when their is ulceration of the cartilage/ bone.
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11
Q

What is the reason for increased density of subchondrial bone when their is joint degeneration / injury?

A
  • No nerve endings in articular cartilage, when their is proper coverage of cartilage, there is no pain, when their is ulceration, bone on bone is rubbing together, so there is pain. Bone and bone rubbing together will cause scar tissue and dense tissue accumulation.
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12
Q

What is seen in this image? What does each arrow indicate?

A

Teal: Fibrillation
Blue: Ulceration
Purple: Increase subchondrial bone density

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13
Q

What is indicated by the white/ teal arrows in this image? What is the cause?

A

Osteophyte formation. Stimulation of chondrosseus junction , causing osteophytes, areas of bone deposition.

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14
Q

What can you see in the joint of patients with chronic arthritis? What is a cause of osteoarthritis (general terms)

A
  • Any issue with ligament/ joint laxity, you can see osteoarthritis, ect.
  • You can see areas of fibrillation, ulceration, and you can see yellowing of The cartilage. Stimulation of chondrialosseus junction , causing osteophytes, areas of bone deposition.
  • Chronic arthritis: you can see thickening of joint capsule. Usually more membranous, due to position of cartilage, ect.
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15
Q

What is seen in this image indicated by the teal line? What else can be seen in this image? What is the cause?

A
  • Villous hypertrophy/ hyperplasia of the synovial membrane is other manifestation of chronic joint injury
    ◦ Synovial membrane, in cases of chronic damage, they have villous hypertrophic from chronic inflammation. Hyperplasia.
    ◦ There is also loss of articular cartilage on the head of the femur.
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16
Q

What is pannus formation? What is the cause ?

A
  • Pannus formation – another possible sequel to chronic joint injury
  • Pannus is a fibrovascular (granulation) and histiocytic tissue that develops within the synovial membrane at its junction with the periosteum and cartilage margins (transitional zone) and can spread over the articular surfaces as a velvety membrane. You will also have neovascularizartion

Pannus is granulation tissue developing within the Synovial membrane. The pannus formation is trying to repair.

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17
Q

What is a complication of pannus formation?

A

Inflammatory cells within the pannus along with collagenases from synovial fibroblasts may further damage the articular cartilage and lead to ankylosis (fixation) of the joint.
Complications: Can unite and cause ankylosis of joint in chronic joint injury -> inability/ difficulty flexing joint.

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18
Q

What is an end stage joint? What can you see with these?

A

Generic term to describe a joint with severe chronic injury.
* Affected joints exhibit variable degrees of damage to the articular cartilage, deformation, osteophyte and pannus formation, capsular fibrosis, synovial villous hypertrophy/ hyperplasia and occasional ankylosis (fixation, stiffness. Immobility of a joint).

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19
Q

What is a well known developmental joint disease?

A

Osteochondrosis (Dyschondroplasia)

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20
Q

What is Osteochondrosis (Dyschondroplasia)?

A

Characterized by abnormal growth and maturation of the
articular cartilage
➢Severe degenerative joint disease is a common sequel
➢It is the most common cause of lameness in domestic animals,
especially swine, horses, poultry and large breed dogs
➢Pathogenesis is multifactorial but poorly understood ➢Whatever the underlying causes ischemic damage to the growing cartilage seems to play a significant role ( this damages hyaline cartilage which doesn’t have great regenerative capacity.)
➢In rapidly growing pigs the incidence may reach close to 100%
* Ischemic damage is main change, nutritional issues can be a part of pathogenesis.
* Any case of lameness ( young pigs, multiple pigs) consider this. Only 30% are usually showing signs.

Common in young animals, large breed dogs, pigs, horses ect.

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21
Q

What joint condition can be seen almost 100% of the time with rapidly growing pigs?

A

Osteochondrosis (Dyschondroplasia)

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22
Q

What is Osteochondrosis/ Osteochondritis Dissecans (OCD)?

A

➢ Specific form of osteochondrosis characterized by the separation of a piece (flap) of articular cartilage from the subchondral bone.
➢ In dogs lesions are more common in young fast- growing males of large and giant breeds and affect primarily the shoulder and elbow joints. Lesions in the elbow joint form part of the “elbow dysplasia syndrome” which also includes ununited anconeal process and fragmented (or ununited) medial coronoid process of the ulna; important
orthopedic conditions in young dogs.

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22
Q

What is Osteochondrosis/ Osteochondritis Dissecans (OCD)?

A

➢ Specific form of osteochondrosis characterized by the separation of a piece (flap) of articular cartilage from the subchondral bone.
➢ In dogs lesions are more common in young fast- growing males of large and giant breeds and affect primarily the shoulder and elbow joints. Lesions in the elbow joint form part of the “elbow dysplasia syndrome” which also includes ununited anconeal process and fragmented (or ununited) medial coronoid process of the ulna; important
orthopedic conditions in young dogs.

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23
Q

Is there alot of inflammation with OCD lesions? What are they similar to? What is the difference between those two? Where are differences seen?

A
  • Differences in species, mostly found in shoulder/ elbow region of large dogs.
  • Not a lot of inflammation associated with this lesion. Same pathological condition as dyschondroplasia.
  • Separation of cartilage with flap in it.
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24
Q

Where are OCD lesions commonly seen in large dogs?

A

mostly found in shoulder/ elbow region of large dogs.

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25
Q

What is a common cause of lameness in young animals? What animals is this an important disease for?

A

➢OCD is an important disease of horses and a common cause of lameness in young animals.

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26
Q

Where are OCD lesions typically seen in horses?

A

➢In horses OCD lesions can be widespread but the stifle, hock and fetlock joints are commonly affected sites. Primarily hind limb

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27
Q

What pathology can be seen in this image/ What is circled?

A

Focal area of cartilage ulceration.

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28
Q

What is seen in this image/ What is circled?

A

Area of cartilage ulceration at later stage ( beginning of joint mice)

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29
Q

What are joint mice? How can they be caused?

A
  • Joint mice, can be formed. Pieces of cartilage that can sit inside the joint and even increase in size.
    Can be formed by trauma, OCD lesions, joint degeneration, ect.
  • You can have iatrogenic formation of damage, causing a similar Symptom.
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30
Q

What is seen circled in purple? What about in teal?

A

Purple: Normal Bone
Teal: Changes in subchondrial bone, increased density.
* Cartilage should be uniform, you can see uneven thickness of cartilage in affected bones.

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31
Q

What can cause flaps?

A

*Damage in subchondrial bone can cause changes that lead to OCD/ flaps.

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32
Q

What is seen in this image? Is this uncomfortable? Why does it look nodular?

A
  • Chronic lameness, animal was given things to try to reduce inflammation/ pain, but in the end had to be euthanized. Stifle joint was the most affected joint, You can see the femoral trochlear, is abnormal, flap eventually broke off, and there is cartilage attempts at regenerations. Articular cartilage, does not regenerate properly, which is why its coming out nodular. This is very painful
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33
Q

What is seen in this image?

A

Normal Lateral Ridge if a femur

34
Q

What is seen in this image?

A

OCD lesion on the lateral ridge of a femur, You can note abnormal growth of the articular cartilage and subchondral bone resulting in deformation of the trochlear groove and ridges.

35
Q

What is articular collapse? What should you be concerned with if this is seen?

A
  • Articular collapse: folding of the subchondrial bone
    ◦ Some cases you can see articular collapse with metabolic bone disease.
  • Concern for Metabolic bone diseases in this animal. Think their could be fibrous osteodystrophy/ bone softening which led to collapse.
36
Q

What is seen in this image?

A

Normal Femoral Head

37
Q

What is seen in this image?

A

Collapse of articular surface in pig with osteochondrosis.

38
Q

What can be seen in this image? What is circled in purple? Blue?

A

Purple: * Not normal, caving in, nodular appearance, separation of pieces of cartilage of bone underneath.
- The many small Cartilage nodules represent regenerative attempts at repair.

Blue: Areas of Villious Hypertrophy

39
Q

What is another developmental joint disease seen in large dogs?

A

Hip Dysplasia

40
Q

What is hip dysplasia? What is it characterized by? Can it be seen in other species?

A

➢Very important orthopedic disease in large breed dogs –occasionally seen in other species
➢Characterized by a lack of conformity between the
femoral head and the acetabulum -> subluxation -> DJD.

41
Q

What is the cause of hip dysplasia? Is there any genetic predisposition? Any specific breed? Why?

A

➢ Polygenic mode of inheritance has been postulated in
dogs but environmental factors as nutrition and rapid
growth plays a significant role
➢ Joint laxity (instability) is an early finding leads to these degenerative changes.
* Sometimes acetabulum is too narrow ti fit femur.

  • German Shepard is predisposed ( not a lot of muscle in rump, genetic predisposition)
42
Q

What is seen in this image?

A
  • Macerated/ bleached femur of dog. Femur head is flat, so there Is a lack of conformity of this bone. Their was erosion of this cartilage
43
Q

What is seen in this image?

A
  • Few areas where cartilage is normal, area is yellowish in color, areas a rough not smooth and shiny. Soft tissue around joint is thickened, synovial membrane is very prominent.
44
Q

What is seen in this image?

A

Patient died of hepatic carcinoma. You can see chronic osteoarthritis. Rim of acetabulum is thick, and you can see loss of cartilage.
— Chronic joint injury

45
Q

What is Intervertebral Disk disease? What is the joint disease category it falls under? Where are the differences ?

A

Intervertebral Disk Disease (degenerative joint disease)
➢ Occurs in all dog breeds as part of the aging process
➢ There are differences between IDD in chondrodystrophic and non-chondrodystrophic breeds regarding the age of onset and the nature of the
degenerative changes

46
Q

What is the most common cause of paresis in dogs?

A

➢IDD is one of the most common causes of paresis in the dog

47
Q

What are the chondrodystrophic breeds? When can you see IVDD in them? When do you see IVDD in other dogs?

A

IVDD is one of most common causes of paresis in the dog.
Breeds: Daschund, French bulldogs, Chondodystrophic breeds, even at a young age.
Non chondrodystrophic breeds you wont see until later on in seniority.

48
Q

What is protrusion? Who is this seen more commonly in?

A

Protrusion: This is where their is breakdown of the outside cartilage, which allows the disc to bulge into vertebral canal but is still within the fibrosis anulus . More common in non chondrodystrophic breeds and can be related to age.

49
Q

What is extrusion? Who is this seen more commonly in?

A

Extrusion: More severe one, you can have this extrusion directly into the vertebral canal. More common in chondrodystrophic breeds. Can occur whern they are running around then just cant walk.

50
Q

What is Hansens type I? Who is it more common in?

A

Extrusion/ disc rupture- Chondrodystrophic breeds?

51
Q

What is Hansens type 2? Who is it more common in?

A

Protrusion - Older dogs

52
Q

What is the grey center of the vertebral disc called? What about the yellow outside layers?

A

Inner grey center: Nucleus Pulposus
Yellow outside layers: Annulus Fibrosis.

53
Q

What is seen in this image? What is circled in green? What is circled in purple? Is this a quick process? Are the clinical signs severe?

A

Green: Protrusion
Purple Degeneration
This is protrusion, this will cause changes in the spinal cord. It is usually progressive and slow, can develop ataxia, deficits ect. You can also see degeneration in these areas where the disc space is now uneven. This can be seen in purple in the image. you will also find some mineralization of the nucleus pulposus.
You can see narrowing/ softening of spinal cord/ malacia. Clinical signs can be mild, or can be more severe.

54
Q

What is spondylosis? What causes this? Where can you see the formation of this lesion?

A
  • The initial lesion appears to be degenerative changes in the ventral annulus fibrosus
  • Osteophytes form at lateral and ventral margins of vertebral bodies, adjacent to the vertebral spaces and bridge these areas. This causes reduction in mobility/ fixation of the vertebrae.
  • Lesions: Lateral and ventral margins of the vertebrae.
55
Q

What animals is spondylosis commonly seen in? What animals is it almost always seen in, and when? What clinical signs? Are they severe?

A
  • Seen commonly in old bulls, pigs, sows, boars and dogs.
  • Lesions are seen in almost every bull past the middle age and is especially common in those used for artificial insemination. Since they are being used every day they are more prone to vertebral trauma, and thus this degeneration and changes to vertebrae.
  • Usually an incidental finding but may cause mild to severe clinical signs (posterior weakness, ataxia or even paralysis).
  • If the bones are fixed together, they are more prone to pathologic fracture, so their is a chance of worsening clinical signs from this alone.
56
Q

What is seen in this image? What is seen in purple? Green? Dark Blue? Blue Pink?

A
  • Image: Loss of intervertebral disc space between vertebrae
    ◦ Purple: Area of degenerated intervertebral disc, very narrow
    ◦ Blue: Area of ankalyzing spondylosis (bone proliferation, fusing of 2 vertebral bodies)
    ◦ Green: Dorsal spinous processes fusion.
    ◦ Dark blue: Areas of osteosclerosis, compensatory mxn.
    ◦ Pink: Normal vertebral disc
    ‣ With these changes you can see the areas that have additional bone compressing spinal cord which shows increased deficits/ pain.
57
Q

Why does osteosclerosis occur with degenerative changes of the intervertebral spaces?

A

◦ There is also areas of with increased laxicity of the area due to degenerative changes in the intervertebral, also osteophyte formation. Osteosclerosis occurs as a compensatroy mechanism to decrease laxity, you will also have increased stress in this areas.

58
Q

What is seen in this image? What is circled in dark blue?
What can occur as a result?

A
  • Macerated bull specimen -> bleached bone, you can see fused vertebral bodies, and the bump (circled in dark blue) is the area where their is ankalyzing spondylosis and osteophyte degeneration.
  • Pathologic fractures can occur due to the decrease in mobility, you need a little bit of mobility,
59
Q

What is wrong with the horse in this image? What are other conditions noted?

A

Lordosis or swayback is clear common problem here.
* With time this horse became lame, thought age related arthritis. In the past couple years they noticed lordosis in the spine, this animal developed other problems, weight loss, attrition of teeth, diarrhea and eventually euthanized. Horse was also ataxic.

60
Q

What is seen in this image? What is indicated in green? What is seen in blue? Since this is the horse with severe lordosis, why isn’t that more evident in this image?

A
  • In post mortem you could not see too much of the lordosis, this is because the lack of the weight of the abdominal viscera would make the change not very prominent. But with the weight of the abdominal viscera it was alot more accentuated.
  • You can see the 3 circled disc spaces with varying degree of degeneration, and the spondylosis (ankylizing) in the center circled disc. The far Left disc is normal. This osteophyte proliferation is trying to compensate for the increased mobility in this area. Persiosteum is what is inducing the osteophyte proliferation.
  • Areas of osteosclerosis seen in green.
61
Q

What is the types of degenerative joint diseases for synovial joints? How many types? What are they?

A

osteoarthritis/ osteoarthrosis
- 2 kinds
- Primary and Secondary DJD

62
Q

What is primary DJD?

A

No apparent predisposing cause. Generally
observed in older animals (age-related DJD)

63
Q

What is secondary DJD?

A
  • Secondary DJD: Associated with underlying abnormality/ pathology. Seen in younger animals. Issues with joint/ supporting structure that leads to premature degeneration of articular cartilage ( ex: Hipdysplasia, trauma, ect.) (professional athletes is another example)
64
Q

What is ringbone? Where does it often occur?

A
  • ringbone: common in horses used in barrel racing or polo, this results in chronic trauma from abrupt movements.
  • Osteophyte formation that essentially wraps around the tendons. Occurs near the pastern/ coffin joint
  • Occurs in pasturn joint between P1 and P2
    ◦ Can see changes between p2 and p3 and see ostephytes in the coffin bone.
65
Q

What can be seen in this image indicated by the green circles?

A

Ringbone

66
Q

What kind of issue is ringbone? What animal is it seen in most commonly?

A

Degenerative disease in horses affecting the inter-phalangeal joints (2ry DJD)
Common in horses used in rodeo events (barrel racing) or Polo ! chronic trauma: the result of abrupt stops, turns and twists

67
Q

What is inflammatory joint disease? Who is it most common in and why?

A

Infection/ inflammation in a joint.
* You can see effects in multiple joints especially when hematogenous route is affected.
* Polyarthritis ( more than one joint affected)
* Farm animals most common. Sometimes originates from umbilical infection

68
Q

What is a common cause of inflammatory joint disease in young animals?

A

Umbillical infection.

69
Q

What are the clinical signs of inflammatory joint disease? How long can it last?

A
  • Clinical sings: pain, facial changes associated with pain, lameness, ect. Can last from birth till 4 months of age sometimes.
70
Q

What are causes of inflammatory joint disease? What is numbered in this image?

A

1.) Hematogenous Route
2.) From Bone
3.)Osteomyelitis, starting outside of joint capsule and working way in.
4.)Iatrogenic ( needles from joint taps)
5.) Trauma

71
Q

What is the cause of non infectious arthritis? Who does it primarily affect?

A

Non-infectious arthritis occur most often in dogs and cats and have an immune- mediated etiology.

72
Q

What is circled in blue in these images?

A

Animals with septic arthritis

73
Q

What are the common bacteria isolated from septic arthritis? What animal does each one commonly effect?

A

➢ Trueperella (Arcanobacterium) pyogenes – cattle and swine
➢ Erysipelothrix rhusiopathiae – swine, sheep, birds (diamond skin disease in pigs)
➢ E. coli – calves, piglets
➢ Streptococcus suis – pigs 2-10 weeks old
➢ Haemophilus suis and parasuis - 5-12 weeks old pigs
➢ Mycoplasma hyorrhinis –pigs 3-10 weeks old ➢ Mycoplasma hyosynoviae – pigs more than 10 weeks old
➢ Histophilus somni - cattle
➢ Mycoplasma bovis - cattle
➢ Borrelia burgdorferi (Lyme disease), humans and dogs
➢ Rhodococcus Equi -> Can cause septic arthritis due to hematogenous spread. (Foals)

74
Q

What is septic arthritis?

A

Infection in joints

75
Q

What can you see grossly when opening the joint capsule of a patient with septic arthritis?

A

Septic arthritis: If you open the joint you will see the presence of fibrin and pus.

76
Q

What is caprine arthritis- encephalitis (CAE)? What are the characterization of the joint lesions? What are hygromas? What can indicate CAE in a herd?

A

➢Caprine Arthritis-Encephalitis (CAE): is a slowly progressive disease of goats caused by a retrovirus. The virus also produces a respiratory and neurologic syndrome. Joint lesions are characterized by a lymphocytic hyperplastic synovitis with the formation of carpal hygromas (carpal bursitis).
➢The hygromas are chronic lesions that appear as flattened cystic fluid-filled subcutaneous distensions over the cranialcarpus. Usually there is no communication with the carpal joint
or tendon sheath.
➢A high prevalence of hygromas and lameness in a goat herd is a characteristic feature of CAE.

77
Q

Is septic arthritis usually from bacteria or virus?

A
  • Septic arthritis -> more commonly from bacteria but can be viral in origin.
78
Q

What is non infectious arthritis? Who is it most common in? What is usually the cause? What is this in response to? What are the forms that could be seen?

A
  • Non infectious arthritis
    ◦ Most common in dogs and cats, polyarthritis
    ◦ Immune mediated ( rheumatoid like)
    ◦ Inflammation in response to antigen in synovial fluid, and is likely from previous infection, or deposition in the synovium of immune complexes derived from some other inflammatory lesion.
  • Erosive, Non erosive
79
Q

What are clinical signs of non infectious joint disease? What should you rule out in these patients? What will you see on cytology/ what will this lead you to in terms of your diagnosis?

A

‣ Cant really move joints, painful, ect. R/o possibility of septic arthritis. You will see primarily lymphocytes/ plasma cells (in synovial membrane) and this will indicate a more immune mediated form of arthritis. Results in damage to the articular cartilage.

80
Q

What are the types of malignant neoplasms from joints? Is it common? Where do they arise from?

A
  • Synovial cell sarcoma
  • Histiocytic sarcoma
  • Uncommon in dogs and very rare in other species.
  • Arise from synovial membrane
81
Q

How will patients present when they have malignant joint neoplasms? What will you see in terms of the lesion? How will you know if it is one of these tumors or osteosarcoma since both have proliferative properties?

A
  • Relatively rare, uncommon in dogs, and even more rare in other species.
  • Animals will come to clinic lame. You will find they have a proliferative lesion confined to the synovial cavity, and can later spread to adjacent tissues.
  • Clinicians consider this when the tumor is invading the synovial cavity. Usually osteosarcomas will not cross over into the synovial cavity.
82
Q

What is a common sequale to neonatal bacteremia? When is more than one joint affected?

A

Most common in farm animals, specially the young where its a common sequel to neonatal bacteremia.
* You can see effects in multiple joints especially when hematogenous route is affected.
* Polyarthritis ( more than one joint affected)

83
Q

What is a common sequel to neonatal bacteremia? When is more than one joint affected?

A

Most common in farm animals, specially the young where its a common sequel to neonatal bacteremia.
* You can see effects in multiple joints especially when hematogenous route is affected.
* Polyarthritis ( more than one joint affected)

Systemic Pathology I (23 decks)

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