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66 Cards in this Set
- Front
- Back
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What is in articular cartilage?
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chondrocytes embedded in hydrated gel of proteoglycans in fibrous netowrk of Type II collagen
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What does the collagen network do for the cartilage?
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structure, stress resistance, limits hydration of proteoglycans
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What creates resistance in cartilage?
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polyanionic proteoglycans, hold on to water, let go of it when loading
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What happens in primary osteoarthritis?
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central degeneration of cartilage, compensatory peripheral bone formation, no demonstrable cause, can be general or local
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What are the clinical features of generalized primary osteoarthritis?
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osteophytes are the chief manifestation, Heberden nodes, mild disease, does not progress to eburnation
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Where does generalized primary osteoarthritis affect?
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hands and spine
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Where does localized primary osteoarthritis usually affect?
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knee and hip
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How does localized primary osteoarthritis manifest itself clinically?
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severe, with eburnation, limitation of function, pain, deformity
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What are Heberden nodes?
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osteophytes of DIP joints of hands
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Which joints are affected in primary osteoarthritis in old women?
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knees and hands
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Which joints are affected in primary osteoarthritis in old men?
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hips
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What are Bouchard's nodes?
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osteophytes at PIP joint in the hands
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What mutation can cause familial early severe osteoarthritis?
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point mutation in type II collagen
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What is secondary osteoarthritis?
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results from degeneration of joint function caused by antecedent disease
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What is post-traumatic osteoarthritis?
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secondary to malalignment following fractures or direct injury of joint or joint support, preventalbe and common
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What diseases can cause osteoarthritis?
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rheumatoid, infections, metabolic disorderes, necrosis, congenital anomalies
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What is the histopathology of osteoarthritis?
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loss of proteoglycan matrix around chondrocytes, fibrillation of cartilage, chondrocytic proliferation progresses to chondrocyte apoptosis, cartilage erosion
eburnation, pseudocyts in bone underlying fractured cartilage, osteophytes, detritic synovitis |
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What is eburnation?
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ivory like dense reactive bone in central areas of cartilage loss
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What is detritic synovitis?
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synovial inflammation around detached fragments of cartilage
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How do bacteria cause arthritis?
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reach joint from blood or bone infection
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Who gets bacterial arthritis?
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patients with frequent bacteremia, immunocompromised, severe underlying joint disease
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Which bacteria cause bacterial arthritis?
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Staph Aureus, H flu, Pseudomonas, Salmonella, gonococci
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Who gets infected with H flu in joints?
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kids
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Who gets infected with pseudomonas in joints?
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drug addicts
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Who gets Salmonella in joints?
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sickle cell disease
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Who gets gonococci in joints?
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sexually active young adults
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When do you get TB arthritis?
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40s and 50s, secondary to involvement of adjacent bone
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What is Pott's Disease?
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TB in the spine joints
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How do you diagnose TB arthritis?
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destructive lesions on x-ray
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How does TB arthritis present in the 3rd world?
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children affected, produces kyphosis of the spine
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Which joints are most affected by TB arthritis?
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spine, hip, knee
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What causes Lyme disease?
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Borelia Burgdoferi and transmitted by ticks
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How does Lyme disease cause arthritis?
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develop destructive chronic arthritis of single joints, Borelia in synovial tissue
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How does Hep B cause arthritis?
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immune complexes of Hep B surface antigen and antibody settles in joints, activates complement
arthritis leaves as surface antigen disappears from joint |
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During which phase do you get Hep B arthritis?
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prodromal
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When do you get autoimmune arthritis?
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following group A beta hemolytic strep infection, rheumatic fever
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How does autoimmune arthritis present?
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transitory, affects large joints asymmetrically
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What is reactive arthritis?
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acute sterile inflammatory arthritis afeter an infection, at site remote from primary infection
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What HLA type are most people with reactive arthritis?
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HLA-B27
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What is the most frequent pediatric autoimmune disease?
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juvenile rheumatoid arthritis
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How is juvenile rheumatoid arthritis different from rheumatoid arthritis?
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large joints involved more than small ones, few with rheumatoid factors or subcu nodules
more pericarditis, hepatitis, uveitis |
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How does polyarticular juvenile rheumatoid arthritis present?
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5+ joints, usually mild, can distort bone growth and lead to micrognathia
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How does oligoarticular juvenile rheumatoid arthritis present?
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4 or fewer joints, often with uveitis
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How does systemic juvenile rheumatoid arthritis present?
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high spiking fevers, skin rash, prominent visceral involvement, lymphadenoapthy, hepatosplenomegaly, pericarditis
arthritis is rarely chronic and destructive |
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What is Still's Disease?
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systemic juvenile rhemuatoid arthritis
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What is the most common presentation of juvenile rheumatoid arthritis?
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systemic
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What is Sero-negative spondyloarthropathy?
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chronic remittent arthritic disease, tend to have inflammation, bony ankylosis in spine and sacro-iliac joints, no rheumatic fever
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Who gets sero-negative spondyloarthropathy?
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HLA-B27
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What is the pathology of ankylosing spondylitis?
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fibrosis and ossification at site of insertion of ligaments and joint capsule into bone
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Which joints are involved in ankylosing spondylitis?
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sacroiliac bilaterally and ascending spine
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Who gets ankylosing spondylitis?
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HLA-B27, familial
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Who gets worse ankylosing spondylitis?
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males
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With what clinical features is ankylosing spondylitis associated?
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few have rheumatoid factor, 25% iritis, 10% aortic insufficiency
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What is Reiters syndrome?
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arthritis, non-gonococcal arthritis, conjunctivitis
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What causes Reiters syndrome?
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chlamydia urethritis, shigella dysentery
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Who gets Reiters syndrome?
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males, HLA-B27
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What is enteropathic arthritis?
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arthritis in Crohns disease or UC
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What is gout?
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hyperuricemai, recurrent acute monarticular arthritis often involves metatarsal phalangeal joint of big toe, crystals of monosodium urate in leukocytes of syndovial fluid, periarticular deposits of uric acid, renal disease with kidney stones
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What defines hyperuricemia?
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serum urate > 7 mg/dl
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What causes gout?
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polygenic inheritance, underexcretion or overproduction of uric acid
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What is pseudogout?
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acute attacks of arthritis, due to rupture of preformed clusters of calcium pyrophosphate crystals from local avascular cartilage into adjacent synovial cavity
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What are the symptoms of pseudogout?
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pain, stiffness, local heat over joint
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What can precipitate pseudogout?
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surgery, stroke, MI
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How do you diagnose pseudogout?
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calcification of articular cartilage on x-ray, finding crystals of calcium pyrophosphate in synovial fluid
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What do you see with urate crystals?
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many needle shaped not birefringent particles
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What do you see with calcium pyrophosphate?
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few rhomboid weakly positive birefringent particles
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