Arthritis

Front 1

what is a synarthoses?

Back 1

solid or nonsynovial joints poriving structural integrity and minial movment

Front 2

what is a synovial joints

Back 2

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

Front 3

why do joints rarely get tumors?

Back 3

no blood supply or lymph or nerve supply nutrients provided by synovial fluid

Front 4

what is the collogen type in joint cartilage?

Back 4

type II

Front 5

what cells produce cytokines that can lead to joint destuction/

Back 5

chondrocytes, synociocytes, fibroblasts, and inflammatory cells

Front 6

what is the most common type of arthritis?

Back 6

osteoarthritis(DJD)

Front 7

what is the pathology of osteoarthiritis?

Back 7

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

Front 8

what is the presentation of osteoarthirits?

Back 8

slow onset pain in hips knees and vertebrae

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

bakers cysts

Front 9

what is the problem with joint replacement metal joints

Back 9

metal joints leak toxins and cause inflamation that can speed up arititic processes

Front 10

what is a baker cyst

Back 10

leaking of synovial fluid out of joint space

Front 11

what are some assoicated findings with osteoarthritis?

Back 11

bone spurs
jointing narrowing on Xray
Heberden nodes(women) osteophytes at disatl interphalangeal joints

Front 12

what is the treatment for arthritis

Back 12

pain control till it progresses far enough to perform joint replacement

Front 13

what is found grossly in a joint with osteoarthritis?

Back 13

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

Front 14

what is the cause of subchondral cysts in osteoarthiritis?

Back 14

bone on bone leads to flaking and break down of bone to create cavities which will house the excess synovial fluid

Front 15

what is the gene associated with rheumatoid aritirs?

Back 15

HLA-DRBI create altered area that acts as a binding site for athritogens

PTPN22 -creates abnormal T cell response

Front 16

what is the pathology of rheumatoid arthiris?

Back 16

systemic autoimmune process causing sever chronic synovitis leadin gto destruction adn ankylosis of affected joints

can be caused by initial infection

Front 17

what is presentation of rheumatoid arthritis?

Back 17

joints are red, painful, warm, and over time less mobile

Front 18

what is a pannus formation?

Back 18

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

Front 19

what is a test of RA?

Back 19

rheumatoid factor

Front 20

what is rheumatoid factor?

Back 20

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

Front 21

what is CCP

Back 21

anticyclic citrullinated peptide

Front 22

what is the best indicator for RA?

Back 22

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

Front 23

what are some systemic findings in RA?

Back 23

Rheumatoid nodules
vasculitis-of the medium and small arteries

Front 24

what are the characteristics of the rheumatoid nodules?

Back 24

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

Front 25

what is the characteristic RA joint?

Back 25

radial deviation of wrists and ulnar deviation of fingers

articular erosions, subchondral cysts, osteoporosis, and fibrous ankylosis are results of inflammation.

Front 26

what is the histology of rheumatoid nodules?

Back 26

fibrinoid necrosis and peripheral palisading of histiocytes

Front 27

what areas often are sites of rheumatoid nodules?

Back 27

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

Front 28

what is the diagnostic presentation of RA?

Back 28

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

Front 29

what is a good radiographic finding that helps differentiate RA from lupus?

Back 29

bone erosion is found in RA but not in lupus

Front 30

what are some differences btw juvenile onst RA and normal RA?

Back 30

occurs before age 16,
larger joints
absent rheumatoid nodules and factor, commonly positive ANA(antinuclear antibody)

Front 31

what is felty syndrome?

Back 31

RA with splenomegaly, and neutropenia due to sequesters neutrophils in the spleen

Front 32

what is RA associated with?

Back 32

ulcerative colitis
Sjogren syndrome(autoimmune disorder in which the glands that produce tears and saliva are destroyed, causing dry mouth and dry eyes)

Front 33

What is the definition of arthritis in SLE?

Back 33

nonerosive arthritis which involves two or more peripheral joints, and tenderness, swelling, or effusion

Front 34

what occurs in the acute phase of SLE artithritis?

Back 34

neutrophils and fibrin enter the synovium, with perivascular mononuclear cell infiltrate in subsynovial tissue

termed proliferative synovitis

Front 35

what is seronegative spondyloarthopathies negative for? what is it positive for?

Back 35

arithritis negative for RF, but it is HLA-B27 positive

Front 36

What is ankylosing seronegative spondyloarthritis?

Back 36

occurs in males in the vertebrae and sacroiliac joints, follows an infection of adolescence.

Front 37

what is reiter syndrome?

Back 37

triad of arthritis, nongonococcal urethritis or cervicitis, and conjunctivitis.

Front 38

what is enteritis associated spondyloarthritis?

Back 38

arthritis following GI infections

usually salmonella and shegella

antibodies against these infections become cross sensitive to antigen sources in the joinst

Front 39

what is psoriatic arthritis?

Back 39

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

Front 40

what are the seronegative spondyloarthritises?

Back 40

ankylosing
rieters
enteritis associated
psoriatic

Front 41

what are the most common causes of infectious arthritis?

Back 41

gonococcus, staph, strep, H influenza, gram neg coliforms.

tuberculous

lyme

viral

Front 42

where does tuberculous spread from into the joint?

Back 42

spread from nearby bone,

Front 43

what is potts disease?

Back 43

tuberculous infection arthritis with spinal invovlement

Front 44

what are the characters of lyme disease arthritis?

Back 44

follows skin infection, remitting and migratory, primarily occurs in the large joints

Front 45

what is the usual caues of viral arthritis?

Back 45

may be due to direct infection or triggered by immunodifficency process like HIV.

Front 46

What is important about infectious arthritis?

Back 46

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

Front 47

what is the pathogenesis in gout?

Back 47

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

Front 48

what is the main primary cause of gout?

Back 48

idiopathic, alcohol and obesity enhances a genetic predisposition for hyperuricemia

Front 49

what are the secondary causes of gout?

Back 49

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

Front 50

What is characteristically seen grossly and on histo left behind by gout?

Back 50

tophi which are deposits of cystals in the tissue

Front 51

What is required for gout diagnosis?

Back 51

must see the crystals

Front 52

what is a problem with finding crystals in gout?

Back 52

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.

Front 53

Where else can you look for crystals in gout if none are seen in aspirate?

Back 53

in the urine

Front 54

what is psuedogout?

Back 54

calcium pyrophosphate deposition in the joints

presents very similar to gout

is hereditary, sporadic of associated with trauma or surgyer, seen often in osteoarthritis

Front 55

how can you differentiate btw gout and psuedogout?

Back 55

crystals are rhomboid rather than needle shaped, and polarization is not the same.

knee most common site

Front 56

what are the tumor like lesions of the joint?

Back 56

ganglion lesion

baker cyst

Front 57

what is a baker cyst

Back 57

synovial cyst herniation of the knee usually associated with excess fluid

Front 58

what is the ganglion lesion?

Back 58

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.

Front 59

What is the only tumor of the joint?

Back 59

tenosynovial giant cell tumor.

Front 60

what is the tneosynovial giant cell tumor?

Back 60

a neoplastic process with tumor expression of colony-stimulation factor I a chemoattractant for macrophages

Front 61

what are the two types of tenosynovial giant cell tumor?

Back 61

nodular-giant cell tumor of the tendon

diffuse- pigmented villonodularsynoviits

Diffuse leads to destruction of underlying bone

Front 62

what is the appeance of synovium in pigmented villonodular synovitis (diffuse type tenosynovial giant cell tumor)

Back 62

pigmented macrophages hemosiderin give synovium a characteristic red braown to orange yellow color, with finger like projections covering synovial surface.

Front 63

what is the polarization of gout crystals?

Back 63

negatively birefrigent

parralell and yellow

Front 64

what is the polarization of psuedogout crystals?

Back 64

positively birefringent

parrallel and blue