Infectious Arthritis, Seronegative Spondyloarthropathies, Tumor Like Lesions - Jones

Front 1

Suppurative Arthritis:

Etiological factors

Back 1

-most often caused by bacterial infections: gonococcus, staph, strep, gram (-) bacilli
-bacteria can seed a joint during bacteremia
-contiguous spread from underlying epiphyseal osteopmyelitis

Front 2

Suppurative Arthritis:

Important Points

Back 2

-S. aureus is the main agent, gono is prevalent during late adolescence
-individuals w/ sickle cell are prone to infx with Salmonella at any age
-gono arthritis is mainly seen in sexually active women**

Front 3

Suppurative Arthritis:

Clinical Presentation

Back 3

-sudden development of acutely painful, hot, and swollen joint
-restricted ROM of joint
-fever
-leukocytosis and eleveated SED

Front 4

Disseminated Gonococcal Infx

Back 4

-symptoms are subacute
-infx involves only a single joint
-usually knee followed in frequency by the hip, shoulder, elbow, wrist, and sternoclavicular joints

Front 5

IV drug abuse

Back 5

-axial articulations are involved

Front 6

Tuberculous Arthritis:

Important Clinicopathological Characteristics

Back 6

-chronic progressive monoarticular disease occurring in all age groups
-devels as a comp of adjoining osteomyelitis
-devels from hematogenous dissem from a visceral (usually pulmonary) site of infection
-onset insidious, progressive pain

Front 7

Tuberculous Arthritis:

Mycobacterial Seeding of Joints

Back 7

-formation of confluent granulomas w/ central caseous necrosis
-affected synovium may grow as a pannus over the articular cartilage and erode into bone along the joint margins

Front 8

Tuberculous Arthritis:

Joints most often affected

Back 8

-severe destruction w/ fibrous ankylosis and obliteration of the joint space
-weight-bearing joints, especially the hips, knees and ankles in descending order of frequency

Front 9

Tuberculous Arthritis:

Aids in diagnosis and identifying inciting microbe or agent

Back 9

-gram stain, blood cultures, synovial
-synovial is best: 75-95% sens for non-gonococcal joint infx
-protein, LDH elevated, glucose low
-cultures are + >90% of cases

Front 10

Tuberculous Arthritis:

Non-inflammatory Effusions

Back 10

-group 1
-leukocyte <3000, few neutrophils
-OA, traumatic arthritis, PVNS

Front 11

Tuberculous Arthritis:

Inflammatory Effusions

Back 11

-group II
-leukocyte 3000-75000, 50% neutros
-RA, SLE, Reiter Syndrome, Rheumatic fever, acute crystal induced arthritis

Front 12

Tuberculous Arthritis:

Purulent (infectious) effusions

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-group III
-leukocyte >50000, >90% neutros
-bacterial, fungal, TB joints

Front 13

Tuberculous Arthritis:

Hemorrhagic Effusions

Back 13

-Group IV
-traumatic, PVNS, synovial hemangiomas, hematologic disorders, thrombocytopenia, anticoagulant therapy

Front 14

Tuberculous Arthritis:

Treatment

Back 14

-prompt drainage and abx administration (IV) after blood and synovial cultures are collected
-initial tx: usualy 3rd gen cephalosporin
-definitive tx based upon ID of culture

Front 15

Seronegative Spondyloarthropathies:

Important Points

Back 15

-group of diseases in genetically predisposed individuals
-immune mediated diseases, trig by T-cell response to unknown Ags
-produce inflam peripheral or axial arthritis and inflam of tendinous attachements

Front 16

Seronegative Spondyloarthropathies:

Diseases

Back 16

1. Ankylosing spondylitis
2. Reactive Arthritis (Reiter and enteritis-associated arthritis)
3. Psoriatic arthritis and arthritis assoc w/ IBS (ulc colitis, Crohn's)
-* share overlapping clinical features and assoc w/ HLA-B27

Front 17

Ankylosing Spondyloarthritis

(Rheumatoid Sponylitis and Marie-Strumpell Disease)

Back 17

-chronic inflam jt dx of axial jts, especially the sacroiliac jt
-20-30 y/o, M 66% more than F
-90% are HLA-B27 positive
-SI jts infilt w/ CD4 and CD8 T cells, macros and high [TNFa]

Front 18

Ankylosing Spondyloathritis:

Histology

Back 18

-chronic synovitis, destruction of articular cartilage, bony ankylosis (esp SI and apopyseal jts)
-inflam of teninoligamenous insertion sites and ossification
-eventually severe spinal immobility: Bamboo Spine*

Front 19

Ankylosing Spondyloathritis:

Clinicopathological Features

Back 19

-pts w/ low back pain
-involvement of periph joints
-complications include fracture of spine, uveitis, aortitis, and amyloidosis

Front 20

Reactive Arthritis

Back 20

-episode of noninfectious arthritis of the appendicular skeleton that occurs w/in one month of a primary infx localized elsewhere in the body

Front 21

Reactive Arthritis:

Important points

Back 21

*assoc w/ GU (chlamydia) and GI (Shig, Sal, Yers, Campy) tract infx
-TRIAD of arthritis: nongono urethritis or cervicitis, and conjunctivitis is called REITER SYNDROME (most pts do not have these symptoms)

Front 22

Reactive Arthritis:

Clinicopathologyical Conditions

Back 22

-arth sx develop w/in weeks of urethritis or diarrhea
-joint stiffness and low back pain
-ankles, knees, feet (asym pattern)
-sausage toe or finger
-ossification of tenodlig insert sites leads to calcaneal spurs

Front 23

For severe chronic reactive arthritis, involvement of the spine makes it indistinguishable from what disease?

Back 23

ankylosing spondylitis

Front 24

Reactive Arthritis:

Extraarticualr involvement

Back 24

1. Inflammatory balanitis
2. Conjunctivitis
3. Cardiac conduction abnormalities
4. Aortic regurg

Front 25

Reactive Arthritis:

Prognosis

Back 25

-arthritis waxes and wanes over a period of several seeks to months
-~50% of pts have recurrent arth, tendinitis, fasciitis, and lumbosacral back pain that cause signif functional disability

Front 26

Tumors and Tumor Like lesions

Back 26

-ganglions, synovial cysts, and osteochondral loose bodies commonly involve jts and tendon sheaths
-from trauma or degen processes
-more common than neoplasms

Front 27

Primary neoplasms

Back 27

-unusual and tend to recap the cells and tissue types (syn membrane, fat, blood vessels, fibrous tissue, and cartilage) native to jts and related structures

Front 28

Pigmented Villonodular Synovitis (PVNS)

General overview:

Back 28

-arise from a clonal prolif, neoplastic
-involves the synovium of a joint
-involves one or more joints diffusely
-arise in 20-40s, M=F

Front 29

Giant Cell Tumor of Tendon Sheath (GCT) [aka localized nodular tenosynovitis]

General overview:

Back 29

-arise from a clonal prolif, neoplastic
-usually occurs as a discrete nodule on a tendon sheath
-20-40s, M=F

Front 30

Pigmented Villonodular Synovitis (PVNS)

General characteristics:

Back 30

-red-brown to mottled orange-yellow
-knee is converted into a tangled mat by red-brown folds, finger like projections, and nodules
-cells spread along the surface and infil the subsynovial compartment

Front 31

Giant Cell Tumor of Tendon Sheath (GCT)

General overview:

Back 31

-red-brown to mottled orange-yellow
-localized and well circumscribed, resembles a small walnut
-cells grow in a solid nodular aggregate that may be attached to the synovium by a pedicle

Front 32

What are frequent findings in lesions of both PVNS and GCT?

Back 32

-hemosiderin deposits, foamy macros, multinucleated giant cells, zones of sclerosis

Front 33

Pigmented Villonodular Synovitis (PVNS)

Clinicopathological Conditions:

Back 33

-presents as monartic arth (knee 80% then hip, ankle, calcaneo)
-pain, locking, and recurr swelling
-tumor prog limits the ROM, causes to become stiff and firm
-agress tumors erode into adjacent bones and soft tissue
-signif recurrence rate, use surgery

Front 34

Giant Cell Tumor of Tendon Sheath (GCT)

Clinicopathological Conditions:

Back 34

-solitary, slow-growning, painless mass (freq the tendon sheaths along the wrists and fingers)
-most common mesenchymal neoplasm of the hand
-cortical erosion of adj bone 15%
-often recurs locally, use surgery