Random (Mostly Quizzes) Flashcards
septic arhtritis synovial fluid wbc
> 50,000 suggestive
> 100,000 septic until proven otherwise
low glucose in synovial fluid is most exaggerated in _____ and _____
rheumatoid arthritis and a septic joint
synovial membrane components
2 layers
1: myofibrils, proteoglycans, capillaries, lymphatics, nerve endings
2: synovial cells (macrophage-like, and fibroblast-like)
joint capsule components
Type I Collagen, Type III Collagen, mechanoreceptors, and free nerve terminals
articular cartilage
Type II Collagen, Proteoglycans, and Chondrocytes
path of nutrients –> articular cartilage
capillaries→ diffusion through FENESTRATED capillaries →synovial fluid → hyaline cartilage
healthy joint wbc
<2,000
RA joint protein levels
inc due to inc permeability of synovium
RA joint glucose level
dec due to impaired active transport into synovial fluid and inc consumption due to inflammation
bacterial arthritis protein levels
inc
bacterial arthritis glucose levels
dec
traumatic effusion joint wbc
non-inflammatory range (<2000)
penetrating path into knee joint
Muscle/tendon, joint capsule, synovial tissue (membrane), joint space and cartilage
joint capsule collagen
almost exclusively of densely packed type I collagen separated by thin sheets of fibrillar type III collagen.
RF
IgM Ab against the Fc portion of IgG
__ is more specific for RA than RF
CCP
major components of RA tx
- NSAIDs
- corticosteroids
- disease-modifying anti-rheumatics (methotrexate)
- biologics
Mycophenolate mofetil
SLE
HLA-DR4
RA
HLA-B27
spondyloarthropathies
ESR in RA
elevated
CRP in RA
elevated
A warm swollen knee or wrist are the most common presentations of
a pseudogout flare (calcium pyrophosphate crystal)
lyme wbc
tend to be in the typical inflammatory range of between 2,000 and 50,000
mean onset of lyme arthritis
6 mo after the initial infective transmission
post-tx lyme arthritis is thought to be a result of
an ongoing immune response against retained B burgdorgeri fragments in immunegenetically susceptible host
HLA-DRB1-0401
Associated with greater likelihood of post-tx Lyme arthritis
Great similarity to shared epitope of RA (but B burgdorfeti does NOT trigger RA)
Chondrocytes within the Hyaline Cartilage of an osteoarthritc joint become ________
hyperplastic
Chondrocytes ACTIVITY within the Hyaline Cartilage of an osteoarthritc joint
metabolically active in BOTH catabolic and anabolic functions
Normal cartilage chondrocytes
- terminally differentiated
- maintain steady state
- glucose main energy source
- cartilage turnover is slow
Synovitis in Osteoarthritis is ___ distributed
focally
T/F
The presence of synovitis in Osteoarthritic knee joints correlates with the degree of pain
T
synovial CK in OA
IL-1, IL-7, TNF-a
In OA, the extent of ___, measured histologically, correlates with the extent of cartilage damage, observed by arthroscopy
synovitis
____ is the most frequent reason for joint replacement.
Osteoarthritis
____ is the most common joint disease in the world
Osteoarthritis
OA
innate or systemic response?
innate
Duloxetine
SNRI
FDA indicated for fibromyalgia, generalized osteoarthritis and depression
Erosions are typical of ____ arthritis
inflammatory
T/F
Asymptomatic hyperuricemia should not be treated with antihyperuricemic agents
T
Uricosuric agents such as probenicid should not be used in anyone who
has had a uric acid kidney stone
Allopurinol is an effective therapy for the treatment of an ___ attack of gout
acute
NSAIDs use in gout
acute attack
uric acid overproduction
HGPRT deficiency (lesch-nyhan)
uric acid underexcretion
renal fialure
lead
drugs (diuretics, SA, TB, cyclosporin)
idiopathic
EtOH and gout
xs EtOH –> inc urate production –> dec urate excretion due to lactic acid
gout <30 y/o, suspect
enzyme defect in purine metab
Tophi
acid crystals that can be found in joints, bursae, tendons, and extensor surfaces of forearms, as well as in the pinna of the ear, and rarely other tissues such as cornea, sclera, and heart valves
all non-allergic pt w/ tophi should take an
XO inhibitor
pathogenesis of gout
phagocytosis of uric acid crystals by PMNs witin the synovial fluid
–> initiates inflammatory cascade
–> WBC recruitment and release of lysosomal enzymes, IL-1, and TNF
T/F
high dose aspirin contributes to gout occurrence
F
low dose aspirin = uric acid retaining in kidney
high dose aspirin ____ renal excretion of uric acid
promotes
lead and gout
lead poisoning
–> decreased renal excretion of uric acid
–> decrease the solubility of uric acid in the joint space, causing the precipitation of uric acid crystals
conditions w/ inc cell turnover leading to gout
leukemia
lymphoma
psoriasis
polycythemia
chondrocalcinosis
linear calcifications in the cartilage
seen in X-rays of affected joints with “pseudogout”
OA flare wbc
non-inflammatory
<2000
low joint glucose
septic arthritis
RA
moonshine
lead –> gout –> renal underexcretion of uric acid
uric acid exposure induces…
lysosomal enzymes TNF IL-1 mast cell activation complement PMN oxidative burst
CPPD associated conditions
hypERparathyroidism hemochromatosis hypOMg hypOphosph familial hypOcalciuric hypERcalcemia
CPPD - acquired or inherited?
usually sporadic, can be inherited AD
gout closely linked to
hypERtriglyceridemia low HDL-CHL insulin resistance obesity HTN
Hyperparathyroidism and hemochromatosis lead to
CPPD
T/F
TMJ is frequently experienced by patients with Fibromyalgia.
T
fibromyalgia abnormalities in central pain processing
dec NE
dec serotonin
inc substance P
MRI of Fibromylagia pts has shown increased BF to the __ and __, two pain-sensitive areas of the brain.
Amygdala and Anterior Insula
T/F
NSAIDS are helpful in fibromyalgia
F
shown to improve overall fibromyalgia outcome
exercise and tricyclics
T/F
The HLA-DR4 alleles are seen w inc freq in fibromyalgia
F
Polymorphisms seen with increased frequency in fibromyalgia
5HT
COMT
DA
An example of a chronic strain injury is
carpal tunnel syndrome
Chronic strain injuries are characterized by chronic degenerative changes in ____ structure reflecting failed healing resonses and scarring
cartilage
JIA has an onset before y/o
16 y/o
JIA peak onset
1-3 y/o
Overall, JIA is more common in M or F
F
exceptions: systemic, enthesitis-related
most frequent rheumatic disease of children
JIA
ANA in systemic onset JIA
negative
clinical labs for MAS
dec ESR
dec wbc
dec PLT
T/F
ibuprofen is a disease-modifying NSAID used in JIA
F
only relieves pain/inflamm
dx criteria SLE
molar rash
photo sensitivity
arthritis
cerebritis
The classification system for Lupus Nephritis is based upon…
histopathologic findings of renal glomeruli in SLE
NOT GFR
T/F
anti-smith correlates well with level of lupus activity
F
very specific but doesn’t correlate w/ activity
hormonal fx in lupus pathogenesis
higher estrogen, greater risk of developing SLE
*klinefelter’s males at risk (XXY)
C3 C4 levels in SLE
low, indicate complement consumption from active lupus
anti-scl-70
found in pt w diffuse disease and assoc w scleroderma renal crisis
+ ANAs
anti-centromere abs
CREST syndrome
anti-mitochondrial Abs
pillory primary cirrhosis
