Unit 3 - CVD Pt 1 Flashcards
Common features of Collagen Vascular Disease
- all affect blood vessels via collagen
- all chronic diseases
- all autoimmune diseases caused by formation of autoantibodies
- affect more females than males (except CVD polyarteritis nodosa)
common s/s of CVD
- weight loss
- anemia
- fatigue, fever, malaise
- joint and musculoskeletal pain
- joint deformities (swan neck and boutonniere)
- elevated ESR
- raynaud’s
- rash
rheumatoid arthritis facts
Inflammatory Joint Disease
Likely has Systemic Effects
Female: Male = 5:2
Peak 40-60 years of age
RA info
Affects Joints Inflammation: Joint Capsule Synovium Destroys Articular Cartilage Bone Destruction (Erosion) with pannus formation Nodules/granulomas Extra-artocular manifestations
juvenile RA and 2 types
RA in Children
Joint swelling and pain
Polyarticular: 4 or more joints*** - small joints
Pauciarticular: less than 4 joints - large joints
JRA clinical feutres and prognosis
Asymmetrical Pattern of joint involvement
Some children “age out” and go into remission
Others do not “age out”
More joints affected, the more likely the disease will be chronic in nature
systemic JRA (still’s disease) triad
- Joint swelling and pain
- Spiking fever (>102 degrees F)
- Rash (Salmond colored, bumpy)
adult onset still’s disease
(rare) Systemic Inflammation: Joint swelling and pain Spiking fever Rash (Salmond colored, bumpy) Pericarditis Pleuritis Gastroenteritis and Nausea Pharyngitis Enlarged Lymph Nodes
rheumatoid pannus
inflammatory exudate which collects around and over the synovial lining of affected joints
Highly vascularized granulation tissue
Derived from the synovial membrane
extra-articular manifestations of RA - skin
subcutaneous nodules
vasculitis - brown spots
ecchymosis - bruising
extra-articular manifestations of RA - heart
Myocarditis Valvulitis Pericarditis tamponade (rare) all can lead to CHF
extra-articular manifestations of RA - lungs
Pleuritis with/out pleural effusion (fluid in pleural space)
pulmonary inflammatory lesions - causing interstitial lung disease
extra-articular manifestations of RA - eyes
Scleritis or Conjunctivitis
extra-articular manifestations of RA - nervous system
Peripheral neuropathy
Sensory nerves: Stinging and burning
peripheral compression syndromes (carpal tunnel, ulnar nerve, peroneal palsy, cervical spine)
Mx weakness and decreased DTRs
extra-articular manifestations of RA -systemic
anemia (60% - common) osteoporosis Felty's syndrome Sjogren's syndrome Amyloidosis (rare)
felty’s syndrome
RA, splenomegaly, leukocytopenia (dec WBCs)
Sjogren’s syndrome and blood marker
Dryness of Mucous Membranes
Mouth, Skin, Vagina
Parotid and Lacrimal gland Enlargement
Telangiectasias-small dilated capillary spots
*Anti Ro/SS-A is a blood marker present in about 70% cases
Amyloidosis
Accumulation of proteins in the form of abnormal, insoluble fibers
Known as Amyloid fibrils
Accumulate within the extracellular space in the tissues of the body
RA assessment criteria
- 3+ joints in adults
- usually in a symmetrical pattern (monoarthropathies in kids)
- subcutaneous nodules
- morning stiffness and pain for 1+ hour
- ulnar drift and other deformities
- bony erosion and loss of joint space shown on xray
most specific criteria suggesting presence of RA
Rheumatoid factor measured in blood (IgM and IgG)
80-90%
another blood marker associated with RA
Anti-CCP
acts as an autoantibody
blood test measures levels of antibodies that bind citrulline and CCP
inflammatory indicators will also be elevated - CRP and ESR
Is OA a CVD
No!
it is a degenerative joint disease (DJD)
OA etiology
- genetic: 12th chromosome mutation
- trauma to a joint
- 45+ yrs
- females more
OA info
Progressive Joint Disease Chronic Non-inflammatory joint disease** OA is not a systemic disease Destruction of articular cartilage Formation of osteophytes (bone spurs) Articular cartilage worn away and loses compressibility, decrease bone space
OA mainly affects which joints
weight bearing joints
- hips, knees, ankles, feet, spine
Nodes and finger joints RA vs OA
OA - DIPs affected - Heberden’s nodes
RA - PIPs affected - Bouchard’s nodes when OA
Dx of OA
- morning stiffness shorter duration than RA, but pain progresses throughout the day
- no diagnostic markers in the blood
- possible C-telopeptid marker
composition of normal articular cartilage
Chondrocytes-cells that make cartilage
Collagen fibers-most abundant substance
Proteoglycans-macromolecules with high water content
Normal cartilage composed of Type II collagen
Coded by the COL2A1 Gene
Located on the long term of chromosome 12
Type II collagen traits
Normal remodeling
Normal compressibility
Mutation in the COL2A1 Gene
Increased degradation of proteoglycans and Type II collagen-net loss over time –> Type I collagen replaces Type II
Proteoglycan loss
Loss of compressibility causes cartilage to wear down
other types of OA
Erosive inflammatory osteoarthritis
Ankylosing hyperostosis
Secondary osteoarthritis
Erosive inflammatory osteoarthritis
- Affects MCP/IP joints of the hand
- Cartilage particles cause inflammation
Ankylosing hyperostosis
Affects the lumbar spine
Elderly patients
Note the osteophytes (bone spurs)
Note loss of the intervertebral joint spaces (vertebral bodies)
Secondary osteoarthritis
interarticular fracture, trauma
sports injury
