Msk Pathology Joints And Autoimmune

Front 1

Disease: pain in weight-bearing joints after use, improves with rest, subchondral cysts, sclerotic bone around joint, ulcerated and narrowed cartilage, slight synovial hypertrophy, thickened capsule, osteophytes, eburnation, Herberden's nodes (DIP), Bouchard's nodes (PIP)

Back 1

Osteoarthritis

Front 2

What are the risk factors of osteoarthritis?

Back 2

Age, obesity, joint deformity

Front 3

Disease: morning stiffness that improves with use, symmetric joint involvement, systemic symptoms (fever, fatique, pleuritis, percarditis), pannus formation in MCP and PIP joints, subcutaneous nodules, ulnar deviation, subluxation, increased synovial fluid, bone and cartilage erosion

Back 3

Rheumatoid arthritis

Front 4

What is the immunological basis of rheumatoid arthritis?

Back 4

HLA-DR4 association, positive rheumatoid factor (anti-IgG Ab)

Front 5

Disease: xeropthalmia (dry eyes and conjunctivitis), xerostomia (dry mouth, dysphagia), arthritis, female 40-60, parotid enlargement

Back 5

Sjogren's syndrome

Front 6

Disease: dry eyes, dry mouth, nasal and vaginal dryness, chronic bronchitis, reflux esophagitis

Back 6

Sicca syndrome

Front 7

Sjogren's syndrome increases risk of

Back 7

B-cell lymphoma and dental caries

Front 8

What antibodies are involved in Sjogren's syndrome?

Back 8

SS-A (Ro) and SS-B (La) - autoantibodies to ribonucleoprotein antigens

Front 9

Disease: asymetric joint distribution, joint is swollen red and painful, typically MTP of big toe, tophus formation on external ear or Achilles tendon, acute attack typically happens after alcohol consumption or a large meal, M > F

Back 9

Gout

Front 10

What are the crystals like in gout?

Back 10

Monosodium urate crystals - negatively birefringent and needle shaped, yellow when parallel to light

Front 11

What are the caues of gout?

Back 11

Lesch-Nyhan syndrome (hypoxanthine deficiency), PRPP excess, decreased excretion of uric acid (eg: thiazide diuretics), increased cell turnover, or von Gierke's disease

Front 12

What is the treatment for gout?

Back 12

Allopurinol, probenecid, cochicine, and NSAIDs

Front 13

Disease: typically affects large joints (typically the knee), > 50 yo, M = F

Back 13

Pseudogout

Front 14

What are the crystals like in pseudogout?

Back 14

Calcium pyrophosphate crystals, basophilic and rhomboid, weakly positively birefrigent, yellow when perpendicular to the light

Front 15

What is the treatment for pseudogout?

Back 15

None available

Front 16

What are some possible causes of septic arthritis?

Back 16

S. aureus, Streptococcus, Neisseria gonorrhoeae

Front 17

What are some possible causes of chronic infectious arthritis?

Back 17

Tuberculosis or Lyme disease

Front 18

What are seronegative spondyloarthropathies?

Back 18

Arthritis without rheumatoid factor, strong association with HLA-B27 and more often occuring in males; Anklyosing spondylitis, Reiter's syndrome, psoriatic arthritis

Front 19

Disease: chronic inflammatory disease of the spine and sacroiliac joints --> stiff spine, uveitis, and aortic regurgitation

Back 19

Ankylosing spondylitis

Front 20

Disease: conjunctivitis and anterior uveitis, urethritis, arthritis, post-GI or chlamydia infections

Back 20

Reiter's syndrome - can't see, can't pee, can't climb a tree

Front 21

Disease: dactylitis, 'pencil and cup' deformity on x-ray, joint pain and stiffness

Back 21

Psoriatic arthritis (occurs in 1/3 of patients with psoriasis)

Front 22

Disease: female 15-45 yo, black > white fever, fatigue weight loss, nonbacterial verrucous endocarditis, hilar adenopathy, Raynaud's phenomenon, wire-loop lesions in kidney with immune complex deposition (with nephrotic syndrome), malar rash, discoid rash, oropharyngeal ulcers, pleuritis, pericarditis, arthritis, photosensitivity,

Back 22

Systemic lupus erythematosus

Front 23

What do patients with SLE die of?

Back 23

Renal failure and infections

Front 24

What lab tests confirm SLE?

Back 24

Positive antinuclear antibodies (sensitive, but not specific), confirmed by positive anti-double stranded DNA antibodies (specific, poor prognosis) or anti-Smith antibodies (specific)

Front 25

Antihistone antibodies indicate

Back 25

Drug-induced lupus

Front 26

If you get a positive on the RPR/VDRL test and you don't have syphilis, you should be tested for

Back 26

SLE (due to antiphospholipid antibodies)

Front 27

Disease: black female, increased ACE, non-caseating granulomas, restrictive lung disease, bilateral hilar lymphadenopathy, erythema nodosum, Bell's palsy, epithelial granulomas with Schaumann and asteroid bodies, uveoparotitis, hypercalcemia, rheumatoid , gammaglobulinemia

Back 27

Sarcoidosis

Front 28

Why does hypercalcemia occur in sarcoidosis?

Back 28

Increased conversion of vitamin D to active form in epitheliod macrophages

Front 29

Disease: pain and stiffness in shoulders and hips, often with fever, malaise and weight loss, > 50 year of ae, associated with temporal (giant cell) arteritis, increased ESR, normal CK

Back 29

Polymyalgia rheumatica

Front 30

What is the treatment for polymyalgia rheumatica?

Back 30

Prednisone

Front 31

Disease: progressive symmetric muscle weakness, increased CK, increased aldolase, positive ANA and anti-Jo-1

Back 31

Polymyositis casued by CD8+ T-cell-induced injury to myofibers, diagnosed by muscle biopsy showing inflammation

Front 32

Disease: progressive symmetric muscle weakness, heliotrope rash, shawl and face rash, increased risk of malignancy, increased CK, increaed aldolase, positive ANA, anti-Jo-1

Front 33

How do you treat polymyositis and dermatomyositis?

Back 33

Steroids

Front 34

What is the cause of myasthenia gravis?

Back 34

IgG autoantibodies to postsynaptic AChR, type II hypersensitivity

Front 35

Disease: proximal muscle weakness improving with muscle use, associated with paraneoplastic diseases (eg small cell lung cancer), affects autonmic function as well

Back 35

Lambert-Eaton syndrome

Front 36

What is the cause of Lambert-Eaton syndrome?

Back 36

Autoantibodies to presynaptic Ca2+ channels resulting in decreased ACh release

Front 37

Disease: Raynaud's phenomenon, arthraldias, myalgias, fatigue, esophageal hypomotility, antibodies to U1RNP, responsiveness to steroids

Back 37

Mixed connective tissue disease

Front 38

Disease: sclerosis of skin, rapid progression, female (75%), telangiectasia, Raynaud's, dysphagia for solids, sclerodactyly, early visceral involvement (kidneys, lungs, heart, GIT)

Back 38

Diffuse scleroderma

Front 39

Disease: Calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, telangiectasia, limited skin involvement - typically only fingers and face, does not affect kideys

Back 39

CREST syndrome

Front 40

What antibody is involved in diffuse scleroderma?

Back 40

anti-Scl-70 antibody

Front 41

What antibody is involved in CREST syndrome?

Back 41

anticentromere antibody