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Pathology 1 > Week 12 - Arthritis > Flashcards

Week 12 - Arthritis Flashcards

1
Q

What are a group of long-term conditions marked by widespread inflammation in blood vessels and damage to connective tissue?

A

Systemic Autoimmune Rheumatic

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2
Q

What (3) things have a shared immune-mediated pathogenesis?

A
  • Rheumatoid arthritis
  • systemic lupus erythematosus
  • systemic sclerosis
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3
Q

Is rheumatoid arthritis (RA) acute or chronic autoimmune disease?

A

Chronic autoimmune disease

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4
Q

Does RA affect women or men more?

A

women by 2.5x higher

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5
Q

What is the Peak incidence age of RA?

A

40-50 years

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6
Q

What is the etiology of RA?

A

Genetic predisposition initiated by an immunologic trigger

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7
Q

In RA, the immune response in leads to what (2) things?

A
  • Synovial inflammation
  • Destruction of the joint architecture
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8
Q

RA is initiated by what type of cells?

A

Helper T-cells

  • local release of inflammatory mediators and cytokines that destroy the joint.
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9
Q

What (3) things are attracted to the area to initiate damage to joint cartilage in RA?

A
  • Neutrophils
  • Macrophages
  • Lymphocytes
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10
Q

What are the (3) stages of pathogenesis for RA?

A

1) Initiated by helper T cells, local
release of inflammatory mediators
and cytokines that destroy the joint

2) Formation of antibodies

3) Anticyclic citrullinated peptide
(anti-CCP) antibodies

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11
Q

70-80% of people with RA have?

A

rheumatoid factor (RF)

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12
Q

Why do synovial cells & sub synovial tissues in RA undergo reactive hyperplasia? (Enlargement)

A

Occurs due to increased blood flow and
capillary permeability caused by inflammation

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13
Q

What occurs in the synovial membrane after reactive hyperplasia happens?

A

Angiogenesis

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14
Q

Angiogenesis in the synovial membrane leads to?

A

Formation of pannus, a type of tissue that forms in the joint and can damage the bone

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15
Q

The pannus spreads from?

A

The joint lining to the exposed bone area

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16
Q

Pannus contains what kind of cells
that destroy adjacent cartilage and
bone?

A

Inflammatory cells

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17
Q

Eventually, the Pannus develops
where and leads to decreased joint motion and possible ankylosis?

A

between the joint margins

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18
Q

As RA progresses, structural
changes lead to what (4) changes?

A
  • joint instability
  • muscle atrophy from disuse
  • stretching of the ligaments
  • involvement of tendons &
    muscle
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19
Q

Articular (Joint) Manifestations of RA include? (3)

A
  • Affects joints symmetrically
  • Joint pain and stiffness
  • Limited joint movement
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20
Q

Extra-articular (Systemic) manifestations of RA include?

A
  • Rheumatic nodules
  • Vasculitis – uncommon
  • Dryness of eyes, mouth, mucous membranes (advanced)
  • Eye changes due to scleral nodes
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21
Q

What are Early symptoms of extra-articular (systemic) RA? (3)

A

fatigue, weakness, anorexia and
weight loss due to systemic
inflammation

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22
Q

What is elevated and correlate with amount of RA disease activity?

A

ESR (Erythrocyte Sedimentation Rate) and CRP (C-reactive protein)

both tests used to measure inflammation in the body.

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23
Q

Rheumatic nodules form over where?

A

Pressure points

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24
Q

In physical exam for RA, what are (4) signs of RA?

A
  • Joint- swelling tenderness
  • Warmth
  • Reduced motion
  • Soft spongy feel
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25
Q

What would you see on the lab tests for RA?

A
  • Positive RF & anti-CCP antibodies in lab tests
  • ESR, CRP elevated
26
Q

What are (4) Treatment plans for RA?

A
  • Education about the disease and treatment
  • Physical rest
  • Therapeutic exercises , splints
  • Medications
27
Q

What is AKA degenerative joint disease?

A

Osteoarthritis

28
Q

What is the most prevalent type of joint disease?

A

Osteoarthritis

29
Q

(2) types of osteoarthritis?

A
  • Primary (idiopathic) disorder - Unknown cause
  • Secondary OA due to known underlying cause
30
Q

Is osteoarthritis a single factored or multifactorial disease?

A

Multifactorial disease

31
Q

(5) risk factors for OA?

A
  • Family history
  • Age
  • Ethnicity
  • Gender- female > male
  • Obesity
32
Q

What is the role of cartilage in joints?

A

Cartilage acts as a smooth weight-bearing surface, helping the joint move easily

33
Q

How does cartilage, combined with synovial fluid, affect joint movement?

A

When combined with synovial fluid, cartilage provides very low friction, allowing smooth movement of the joint.

34
Q

How does cartilage help in distributing mechanical stress in joints?

A

Cartilage transmits mechanical load down to the bone, helping to disperse the mechanical stress

35
Q

What is a joint change related to articular cartilage in OA?

A

There is a gradual loss of articular cartilage.

36
Q

What happens to the subchondral bone in joints in OA?

A

The subchondral bone becomes thicker.

37
Q

What are bony outgrowths that form at the joint margins?

A

Osteophytes

38
Q

What type of inflammation occurs in the synovial membrane from OA?

A

Mild synovial inflammation occurs

39
Q

OA results in (4)?

A
  • Joint pain
  • Stiffness
  • Limitation of motion
  • Possible joint instability & deformity
40
Q

What is the main cause of osteoarthritis (OA)?

A

“wear and tear” on the joints.

41
Q

What changes occur in the cartilage during OA?

A

There are significant changes in both the composition and mechanical properties of cartilage.

42
Q

What happens to chondrocytes in OA?

A

Chondrocyte injury occurs, leading to the release of cytokines.

43
Q

How does chondrocyte injury affect cartilage?

A

It predisposes chondrocytes to additional injury and impairs their ability to maintain cartilage production and repair damage.

44
Q

What early structural change occurs in chondrocytes in OA?

A

Chondrocytes enlarge and reorganize.

45
Q

What happens to the cartilage surface in OA?

A

The cartilage loses its smooth surface, and cracks or micro-fractures occur.

46
Q

What happens to the articular cartilage in OA?

A

Portions of the articular cartilage become eroded, and the exposed subchondral bone becomes thickened and polished (eburnation).

47
Q

What are “joint mice” in OA?

A

Fragments of cartilage and bone become dislodged, creating free-floating osseocartilaginous bodies that enter the joint cavity.

48
Q

What can happen to synovial fluid in OA?

A

Synovial fluid may leak through defects in cartilage, forming cysts.

49
Q

What happens to the subchondral bone in OA?

A

The subchondral bone becomes sclerotic due to increased pressure on the joint surface.

50
Q

What are osteophytes in OA?

A

Osteophytes, also known as spurs, are abnormal bony outgrowths that occur at the joint margins.

51
Q

What effect does trauma to the synovial membrane have in OA?

A

Trauma to the synovial membrane results in nonspecific inflammation.

52
Q

What are the most frequently affected joints? (2)

A

Hands- proximal (Bouchard’s node) and distal joints (Heberden’s node)

53
Q

Heberden’s and Bouchard’s nodes are often described as? (3)

A

red, swollen, and tender

54
Q

Does cause Heberden’s and Bouchard’s nodes cause significant loss of function?

A

No, but distress because of the visible disfigurement

55
Q

What deformity is commonly seen in knee OA?

A

Joint malalignment, causing a bow-legged appearance and gait due to cartilage loss in the medial compartment.

56
Q

How is OA diagnosed? (3)

A

history and physical exams, x-ray studies, and lab findings that exclude other diseases.

57
Q

Is there a cure for OA?

A

No

58
Q

What is the treatment for OA based on?

A

Symptoms presenting

59
Q

Is physical rehab is part of the treatment plan for OA?

A

Yes

60
Q

What surgical treatments might be considered for OA?

A

may include arthroscopy, joint replacement, osteotomies, and spinal decompression.

Pathology 1 (14 decks)

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