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64 Cards in this Set

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what is a synarthoses?
solid or nonsynovial joints poriving structural integrity and minial movment
what is a synovial joints
cavitated with joint space allowing for moement situated btw bones and strengthened by capsule, ligaments, and muscles, lined by synovium and filled with clear, viscous plasma filtrate providing lubrication and nutrition for articular hyline cartilage
why do joints rarely get tumors?
no blood supply or lymph or nerve supply nutrients provided by synovial fluid
what is the collogen type in joint cartilage?
type II
what cells produce cytokines that can lead to joint destuction/
chondrocytes, synociocytes, fibroblasts, and inflammatory cells
what is the most common type of arthritis?
osteoarthritis(DJD)
what is the pathology of osteoarthiritis?
progressive erosion of articular cartilage in weight bearign joints(HIPs, Knees, vertebrae)

related to age wear and tear , decreased capacity of chondrocytes to maintina cartilage matrix. Alterations in proteoglycans and collagen decreases cartilage resilience
what is the presentation of osteoarthirits?
slow onset pain in hips knees and vertebrae

morning stiffness made worse by use, crepitus, limiation in movement

bakers cysts
what is the problem with joint replacement metal joints
metal joints leak toxins and cause inflamation that can speed up arititic processes
what is a baker cyst
leaking of synovial fluid out of joint space
what are some assoicated findings with osteoarthritis?
bone spurs
jointing narrowing on Xray
Heberden nodes(women) osteophytes at disatl interphalangeal joints
what is the treatment for arthritis
pain control till it progresses far enough to perform joint replacement
what is found grossly in a joint with osteoarthritis?
early granulartiy and softening of join cartilage surface leads to break down of cartilage that creates fissuring and flaking of cartilage until exposed bone on bone within the joint

this leads to an ivory or eburnation of appearance of the joint

small fractures break off and float in the synovial fluid

osteophytes form a margin of articular surface, synovium only minimally altered
what is the cause of subchondral cysts in osteoarthiritis?
bone on bone leads to flaking and break down of bone to create cavities which will house the excess synovial fluid
what is the gene associated with rheumatoid aritirs?
HLA-DRBI create altered area that acts as a binding site for athritogens

PTPN22 -creates abnormal T cell response
what is the pathology of rheumatoid arthiris?
systemic autoimmune process causing sever chronic synovitis leadin gto destruction adn ankylosis of affected joints

can be caused by initial infection
what is presentation of rheumatoid arthritis?
joints are red, painful, warm, and over time less mobile
what is a pannus formation?
mass of synovium and stroma with marked inflammation

after destroying cartilage, bridge of fibrous tissue forms btw bones, leain to immobility of joint(ankylosis)

seen in RA
what is a test of RA?
rheumatoid factor
what is rheumatoid factor?
IgM antibody against Fc portion of patients own IgG circulatinog complexes of IgM/IgG contribute to process but is not he sole factor in causatino
what is CCP
anticyclic citrullinated peptide
what is the best indicator for RA?
postiive test of both anti-CCP and rheumatoid factor

presence of only anti-CCP may indicate early RA

rheumatoid factor alone is not really specific for RA, but can be useful if clear history is suggestive
what are some systemic findings in RA?
Rheumatoid nodules
vasculitis-of the medium and small arteries
what are the characteristics of the rheumatoid nodules?
usually cutaneous, can occur in viscera.

central fibrinoid necrosis surrounded by histiocytes and chronic inflammatory cells

often develop in area of trauma, often seen on back if you sleep on ur back
what is the characteristic RA joint?
radial deviation of wrists and ulnar deviation of fingers

articular erosions, subchondral cysts, osteoporosis, and fibrous ankylosis are results of inflammation.
what is the histology of rheumatoid nodules?
fibrinoid necrosis and peripheral palisading of histiocytes
what areas often are sites of rheumatoid nodules?
usually aries in the skin of the ulnar area, elbows, occiput, and lumbosacral area. Soft tiusse locations include the lungs, spleen, pericardium, myocardium, heart valves, aorta
what is the diagnostic presentation of RA?
morning stiffness
arthritis in three or more joints areas
arthritis of hand joints
symmetric arthritis
rheumatoid nodules
serum rheumatoid factor
typical radiographic changes(osteoporosis/subchondral cyst)

any four of the above
what is a good radiographic finding that helps differentiate RA from lupus?
bone erosion is found in RA but not in lupus
what are some differences btw juvenile onst RA and normal RA?
occurs before age 16,
larger joints
absent rheumatoid nodules and factor, commonly positive ANA(antinuclear antibody)
what is felty syndrome?
RA with splenomegaly, and neutropenia due to sequesters neutrophils in the spleen
what is RA associated with?
ulcerative colitis
Sjogren syndrome(autoimmune disorder in which the glands that produce tears and saliva are destroyed, causing dry mouth and dry eyes)
What is the definition of arthritis in SLE?
nonerosive arthritis which involves two or more peripheral joints, and tenderness, swelling, or effusion
what occurs in the acute phase of SLE artithritis?
neutrophils and fibrin enter the synovium, with perivascular mononuclear cell infiltrate in subsynovial tissue

termed proliferative synovitis
what is seronegative spondyloarthopathies negative for? what is it positive for?
arithritis negative for RF, but it is HLA-B27 positive
What is ankylosing seronegative spondyloarthritis?
occurs in males in the vertebrae and sacroiliac joints, follows an infection of adolescence.
what is reiter syndrome?
triad of arthritis, nongonococcal urethritis or cervicitis, and conjunctivitis.
what is enteritis associated spondyloarthritis?
arthritis following GI infections

usually salmonella and shegella

antibodies against these infections become cross sensitive to antigen sources in the joinst
what is psoriatic arthritis?
seroneagtive spondyloarthritis that occurs mainly in the small joints of the hand and feet but may extend to larger joints

occurs in people with severe psoriasis rarely
what are the seronegative spondyloarthritises?
ankylosing
rieters
enteritis associated
psoriatic
what are the most common causes of infectious arthritis?
gonococcus, staph, strep, H influenza, gram neg coliforms.

tuberculous

lyme

viral
where does tuberculous spread from into the joint?
spread from nearby bone,
what is potts disease?
tuberculous infection arthritis with spinal invovlement
what are the characters of lyme disease arthritis?
follows skin infection, remitting and migratory, primarily occurs in the large joints
what is the usual caues of viral arthritis?
may be due to direct infection or triggered by immunodifficency process like HIV.
What is important about infectious arthritis?
no antibodies can make it into the synovial fluid so if an infection occurs there it will rapidly proliferate and destroy the joint, septic joint disease is considered a medical emergency
what is the pathogenesis in gout?
hyperuricemia leads to precipitation of urate cystals in the joints

this causes compliment activation and phaocytosis by moncytes which release IL-1, TNF alpha, IL-6 and IL-8

This causes inflammation and swelling

Also neutrophils phagocytize the crystals and lyse bc they are unable to break them down or fully absorb them this releases lysosomal enzymes which further increase swelling and inflammation and tissue damage
what is the main primary cause of gout?
idiopathic, alcohol and obesity enhances a genetic predisposition for hyperuricemia
what are the secondary causes of gout?
associated with increased nucleic acit turnover such as hematologic diseases, drugs or renal failure.

Uric acid is the end product of purine metabolism so any process which increases the amount of purines being broken down can lead to hyperuricemia.

such things like tumor lysis syndrome in chemo therapy
What is characteristically seen grossly and on histo left behind by gout?
tophi which are deposits of cystals in the tissue
What is required for gout diagnosis?
must see the crystals
what is a problem with finding crystals in gout?
sometimes all the crystals have been deposited in these gouty tophi so none can be seen in the fluid aspirated.

however if patient has hyperuicemia and you have a flare up that looks very much like gout you can make a diagnosis of "presumptive gout" and then next time they have a flare up you will try again to find the crystals.
Where else can you look for crystals in gout if none are seen in aspirate?
in the urine
what is psuedogout?
calcium pyrophosphate deposition in the joints

presents very similar to gout

is hereditary, sporadic of associated with trauma or surgyer, seen often in osteoarthritis
how can you differentiate btw gout and psuedogout?
crystals are rhomboid rather than needle shaped, and polarization is not the same.

knee most common site
what are the tumor like lesions of the joint?
ganglion lesion

baker cyst
what is a baker cyst
synovial cyst herniation of the knee usually associated with excess fluid
what is the ganglion lesion?
small multicystic lesion of joint capsule or tendon ssheaths, arising from myxoid defeneration fo connective tissue

usually palpable yeilding, subcutaneous nodule of the wrist easily surgically treated.
What is the only tumor of the joint?
tenosynovial giant cell tumor.
what is the tneosynovial giant cell tumor?
a neoplastic process with tumor expression of colony-stimulation factor I a chemoattractant for macrophages
what are the two types of tenosynovial giant cell tumor?
nodular-giant cell tumor of the tendon

diffuse- pigmented villonodularsynoviits

Diffuse leads to destruction of underlying bone
what is the appeance of synovium in pigmented villonodular synovitis (diffuse type tenosynovial giant cell tumor)
pigmented macrophages hemosiderin give synovium a characteristic red braown to orange yellow color, with finger like projections covering synovial surface.
what is the polarization of gout crystals?
negatively birefrigent

parralell and yellow
what is the polarization of psuedogout crystals?
positively birefringent

parrallel and blue