Jt Path

Front 1

oa

Back 1

wt bearing jts (hips knees feet c/l spine, fingers)

djd, deteriorate/loss articular cartilage w/ exposure/eburnation (polished, like ivory) of subchondral bone, subchondral cyst formation, fusiform swelling of jts, osteophytes (bone growth to side), joint mice, heberden's nodes (pair over dip), insidious over yrs, no constitutional signs, no tx

sxs: jt pain w/ mov't, limit rom, stiffness after rest, referred pain

signs: change jt shape, malalignment, instability, spasm/atrophy of surrounding mm, fine crepitation

Front 2

ra

Back 2

women 3x>men, affects hands wrist elbow shoulder hips knees feet

systemic, relapsing, chronic destrictuve synovitis (papillary-like inflam/prolif, **lymphocytic infiltrate), *pannus, ankylosis (loss of jt fxn), destruction of cartilage, inflam jts, prog stiffness/ankylosis, hand claw-like, ulnar deviation mcp, *swan-neck fingers, *boutonniere tumb, short le (therapy ae immunosupp), variants (juvenile ra, felty's syndrome, as)

sc/subperiosteal nodules (necrotic center, pallisading fibroblasts/macrophage), pulm (pleuritis, pleural effusion, fibrosis, parenchymal rheumatoid nodules, caplan's - pneumoconiosis/ra), also card/ocular/neuro, vascular (digital aa focal ischemia w/ pitting, gangrene, raynaud's, leg ulcers, necrotizing systemic vasculitis - mesenteric/renal/coronary)

constitutional sxs (malaise, fatigue, diffuse pain, fever), ss, felty's (ra, splenomegaly, neutropenia)

Front 3

heberden's nodes

Back 3

oa, pair of soft tissue nodules over dip

Front 4

pannus

Back 4

ra

Front 5

osteophytes

Back 5

oa

Front 6

felty's syndrome

Back 6

ra, splenomegaly, neutropenia

Front 7

swan neck deformity

Back 7

ra, dip flexion, pip hyperextension

Front 8

boutonniere deformity

Back 8

ra, "button hole," dip hyperextension, pip flexion

Front 9

suppurative arthritis

Back 9

n. gonorrheae (sex active), h. flu (children), salmonella (sca), also e. coli, pseudomonas

hematogenous/direct spread to single large jts, destructive nonspecific acute inflamm rxn, gonococci, staph, strep, gram neg

Front 10

tuberculous arthritis

Back 10

insidious/chronic in children, affects spine/hip/etc., caseating granulomas, ankylosis, skin sinuses, spinal cord dmg, early dx essential

Front 11

lyme dz

Back 11

spirochete, deer tick

1st stage: skin lesion (erythematous papule, erythema chronicum migrans), lymphadenitis
2nd: cardio (heart block, pericarditis, myocarditis), neuro (meningoencephalitis, cranial neuritis)
3rd: chronic disabilitating arthritis 10%, acrodermatitis atrophicans, neuropathy

serologic dx, abx tx

Front 12

gout

Back 12

hyper uricemia, recurrent acute arthritis (precipitate ua) w/ asymptomatic intervals, deposit **tophi (inflam mass of ua, pathognomic), renal impairment (stones, ua dep), 95% adult males podagra

1ary, 2ary due to red excrete (glomerular, tubular, rx, pb), inc prod (chemo --> inc cell death)

birefringent crystals phag by pmn/macrophage (release harmful prod), attack ends when crystals dissolve, chronic arthritis --> ankylosis, destruction

Front 13

as

Back 13

si jts, adolescent males, 90% hla b27, rf neg

Front 14

rea

Back 14

reiter's, triad (arthritis, non-gonococcal urethritis/cervicitis, conjunctivitis), 80% hla b27, autoimmune to gi/gu inf, rf neg

Front 15

reiter's

Back 15

rea, triad (arthritis, non-gonococcal urethritis/cervicitis, conjunctivitis), 80% hla b27, autoimmune to gi/gu inf, rf neg

Front 16

enteropathic arthritis

Back 16

post gi inf w/ yersinia, salmonella, shigella, campylobacter, hla b27, rf neg

Front 17

psoriatic arthritis

Back 17

dip jts of hands/feet, large jts, rf neg

Front 18

pseudogout

Back 18

ca pyrophostphate crystals (rhomboid) dep in menisci, intervertebral discs, can enlarge/rupture into jt --> inflamm

Front 19

ganglion cyst

Back 19

most common mass in hand, fluid-filled sac from adj jt capsule/tendon sheath, benign, can pop but can recur

Front 20

nodular tenosynovitis

Back 20

f>m, hands/feet, usu prox/flexor tendons, may erode bone w/ pressure, reactive? benign neoplasm?, single mass 1-3 cm, well-defined capsule, can be lobulated, whitish gray-yellowish brown

Front 21

synovial sarcoma

Back 21

highly malignant, mid-life, leg, painful, deep, bulky tumor, biphasic pattern w/ hemorrhage, necrosis, calcification