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243 Cards in this Set
- Front
- Back
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Septic arthritis occurs most frequently in __________
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Infants and young children
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What are the most common causes of septic arthritis?
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Staph aureus, Haemophilius influenzae, Gonococcus spp.
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In septic arthritis bacteria lodge in the __________, sparking an __________ promoting __________ development
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No real membrane, inflammatory response, pannus
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How quickly does septic arthritis tend to progress?
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Maximum symptoms within 48 hours, irreversible damage within one week
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What are the signs and symptoms of septic arthritis?
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Inflammation of joint and decreased range of motion
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Septic arthritis tends to involve __________ joints and are __________-arthritic
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Large joints, mono-arthritic
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What are the laboratory results of septic arthritis?
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Increase ESR and joint aspiration, alk phos (acute = 0, chronic = mild increase), decrease in HLA B27 and RF
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Fungal arthritis is a rare and often a complication of __________, thus it affects the __________
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Neoplastic diseases, immunosuppressed
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Fungal arthritis is often associated with __________ or __________
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Primary lung fungal infection or athlete's foot
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Fugal arthritis of the spine presents like __________ since it is so __________
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Potts disease, destructive
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How is fungal arthritis treated?
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Strong drugs
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T or F? Cysts are non-neoplastic
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True
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Simple/______/______ bone cysts are a fluid filled cyst more common in __________ and lined with __________
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Unicameral/solitary, male, fibrous tissues
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Simple bone cysts are often secondary to __________?
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Trauma
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Why does bone reabsorption occur with a simple bone cyst?
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Expansion via fluid pressures
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What is the most common site for a simple bone cyst? When?
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Humerus and femur
14 years old |
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Simple bone cysts tend to be located how on a bone?
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Eucentric
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SBC's are __________ until fracture, and may be __________
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Asymptomatic/none painful, palpable
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Simple bone cysts are composed of __________
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Fibrous tissue, osteoclasts, macrophages, reactive bone
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How do you treat a simple bone cyst?
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Excise the protein lining to prevent recuration, replace with bone chips of healthy bone
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What is a cyst-like cavity filled with blood?
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Aneurysmal bone cysts
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What is the gross appearance of an aneurysmal bone cyst?
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Externally smooth with enlarged intact bone, internally cavernous with non-elastic septa (soap bubble)
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What are the cellular components of an aneursymal bone cyst?
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Granulation tissue, giant cells, minimal trabecular
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ABCs are __________ located and will __________
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Accentrically, expand greatly
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Aneurysmal bone cysts in vertebrae preference the __________
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Neural arch
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In an ABC, there is a proliferation of __________ whose pressure __________
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Vascular components, erodes/bulges bone
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An ABC may result in __________, __________, and __________
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Pain/swelling, fracture, neurological defects
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ABC usually onset __________ and occur __________ in males and females
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After age 20
Equally |
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How is an ABC treated?
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Scrape it out and bone pack; radiation if inoperable
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What are the cells that can develop into primary bone neoplasms?
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Bone, cartilage, fibroblasts, blood vessels, blood cells
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Neoplastic processes rarely cross __________ or __________, why?
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Growth plates or articulating cartilage
They're avascular areas |
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What type of bone tumor is always metatstatic?
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Secondary
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Osteoma's are densely __________ well formed __________ of __________ clinical significance
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Sclerotic, bony projections, little clinical significance
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What are the common locations of an osteoma?
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Face, scroll, sinuses, and tibia
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Multiple osteoma's with colon polyps is called?
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Gardner's syndrome
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Osteoid osteoma tends to affect whom?
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Males 5 - 25
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The osteoid osteoma tumor is referred to as a __________, which is _______ and less than _______ in size.
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Nidus, painful, 2 centimeters
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What does a nidus contain?
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Tiny trabecular a, vascular overgrowth and PGE2
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What is a nidus painful?
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PGE2 tells vessels to expand but they are compacted by the excessive bone
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How does a nidus appear on a radiograph?
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Tiny radiolucent center, radiodensity surrounding it due to reactive bone formation
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What is the classical presentation of osteoid osteoma?
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Pain at night, 18 year old male, relieved by aspirin/vasoconstrictive
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How is osteoid osteoma treated?
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Wait until maturity, and then surgically excise
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Where osteoid osteoma is most commonly located?
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Neural arches, tibia and femur (diaphysis or metaphysis)
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What is the rarely occurring osteosarcoma composed of?
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Osteoblasts, fibroblasts, and chondroblasts
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Where is a primary osteosarcoma most common?
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Males under 20, ends of long bone often around the knee
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What is the radiographic presentation of a primary osteosarcoma?
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Long transition, cortex disruption, periosteal lifting, and invasion of soft tissue
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What is the gross appearance of a primary osteosarcoma?
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Disorganized vasculature, local necrosis, no cortical line, excessive bony tissue
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Primary osteosarcoma is so aggressive that by diagnosis __% have metastasized, of which ___% die
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20%
90% |
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How do you treat osteosarcoma
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Surgery, chemo, radiation
(60%. Five year survival rate) |
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What is a secondary osteosarcoma
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Sarcoma originating from another bone pathology or from a carcinogen
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Where is secondary osteosarcoma most common?
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Males 25 years or up, in flat bones
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What is the most common bone neoplasm and what are its three presentations?
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Osteochondroma
SOLITARY, multiple, hereditary multiple exostosis (HME) |
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Osteochondroma presents with a bony __________ and a __________
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Exostosis, cartilage covered by fibrous membrane
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Which form of osteochondroma is least likely to become malignant?
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Solitary
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HME is more common in _______ and presents with _______ due to multiple osteochondromas
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Men, painless lumpy joint
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HME may affect the __________
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Growth plates
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How is HME treated? Why?
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Surgically
For cosmetic reasons, only 25% become malignant |
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What is the most common benign tumor of the hand and foot?
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Encondroma
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What type of lesion is enchondroma typically?
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Asymptomatic solitary
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What is enchondroma?
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Slow-growing mature cartilage enclosed by vascular stroma with irregular calcification
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What is left behind as the bone grows in enchondroma?
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Islands of cartilage
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Who more commonly gets enchondroma?
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Males
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What is the multiple form of enchodroma?
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Ollier's disease
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When may chondrosarcoma metastasize and what types of cell does it involve?
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Late stage, chondrocytes
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What percent of chondrosarcoma are primary?
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75%
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Who most commonly gets primary chondrosarcoma?
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45 year old males
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Where in the body are chondrosarcoma's most common?
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Ribs, shoulder, and pelvic girdle
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What is the gross tissue appearance of chondrosarcoma?
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Translucent gray white mast with necrosis and cysts centrally
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What are the radiographic findings of chondrosarcoma?
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Localized bone destruction, random increase densities, expanded bone, ST mass, 50% have stippled calcification
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How is chondrosarcoma treated?
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Surgery
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Where does chondrosarcoma tend to metastasize?
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Lung, liver, kidney and the brain
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What is the five year survival rate of chondrosarcoma?
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30 - 90% dependent on where it's located
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Why is drug and radiation therapy poorly effective for chondrosarcoma?
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Both treatments attack fast dividing cells, chondrosarcoma is very slow growing
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Fibrous dysplasia is a __________ lesion, commonly of the __________, __________, __________ and __________ bones
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Slowly expanding focal lesion
Femur, tibia, ribs and facial bones |
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Fibrous dysplasia contains what cellular components?
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Fibroblasts, collagen, irregular trabeculae, cysts, and slight hemorrhage
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Who gets fibrous dysplasia? What percent become malignant?
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Adults and children
Less than 1% |
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Which is the most common form of fibrous dysplasia?
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Monostotic
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How does monostotic fibrous dysplasia clinically present?
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Typically asymptomatic, enlarged bone, pathological fracture
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What is the clinical presentation of polyostotic fibrous dysplasia?
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Deformed shape and size of bone, limb length discrepancies, pathological fracture
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What are the radiographic findings of fibrous dysplasia?
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Well defined radiolucent lesions, enlarged bone, ground glass matrix
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Fibrous cortical defects aka __________, is common and effects __________
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Non-ossifying fibroma or fibroxanthoma
Children over 2 years |
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True or False: Fibrous cortical defects is not a neoplasm
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True
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Fibrous cortical defect tends to be ______cm lesions located in the __________, __________, or __________
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0.5 - 6cm
Tibia, fibula, femur |
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What is the cellular appearance of a fibrous cortical defect?
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Well demarcated soft yellow/gray tissue comprised of fibroblasts and giant cells
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In fibrous cortical defect, there is no new __________, rather __________
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Bone formation, cortical replacement
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Fibrous cortical defects clinically present as __________, and rarely results in a __________
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Nocturnal leg pain
Pathological fracture |
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How is fibrous cortical defects treated?
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It's not
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Fibrosarcoma is composed of what?
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Primitive connective tissue, fibroblasts, sheets of malignant fibrous tissue
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Fibrosarcoma develops __________ overtime, most commonly in whom?
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Slowly
Males 30 to 40 years |
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What are the signs/symptoms of fibrosarcoma?
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Two year duration of local low-grade pain and swelling, often referring to a joint
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How is fibrosarcoma treated and what happens if it is left untreated?
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Surgical removal
Metastasizes to the lungs and lymph nodes |
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What are the blood tumors of bone?
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Giant cell tumor and multiple myeloma
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The uncommon giant cell tumor involves __________ cells, of __________ origin
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Multinucleated, monocyte and macrophage origin
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Who gets benign giant cell tumors? Malignant giant cell tumors?
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Benign: females 20 to 40 years
Malignant: males 20 to 40 years |
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Giant cell tumors arise in the __________ and are __________ lesions extending into the epiphysis
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Metaphysis of tubular bone, large solitary lesion
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What is the cellular appearance of a giant cell tumor?
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Multi-lobar with areas of hemorrhage, cysts and yellow necrosis
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Giant cell tumors tend to be benign or malignant?
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Benign
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What are the signs and symptoms of giant cell tumor?
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Non-specific local pain/tenderness, functional disability, pathological fracture
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What is the radiographic appearance of giant cell tumor?
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Large radiolucent lesion of epiphysis, pinning cortex, septa, "soap bubble appearance"
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How are giant cell tumors treated?
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Standard (surgical, drugs, radiation)
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Multiple myeloma is a malignant proliferation of __________ that infiltrate __________
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Plasma cells
Bone marrow |
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Describe the lesions associated with multiple myeloma
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1-5 mm lesions that appear osteolytic and round, "punched out" appearance
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Who commonly gets multiple myeloma?
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Males 50 - 70 years, farmers with pesticide exposure or men's hair coloring
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What are the clinical findings of multiple myeloma?
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Anemia, osteopenia, renal disease, increased immunoglobulins/serum and urinary proteins
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What is the pain related symptoms of multiple myeloma?
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Intermittent Px becoming continuous, worse at daytime/activity/weight-bearing, rapid onset post-trauma
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Multiple myeloma commonly occurs where?
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Vertebral body, skull, pelvis
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What is the etiology of multiple myeloma?
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Unknown
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How is multiple myeloma treated? Thus, what is the survival rate?
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Most palliative, marrow transplant or thalidomide may also work
90% die in three years |
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What pathologies may be confused with a primary bone tumor?
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Hemangioma
Ewing's sarcoma |
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What are the non-pain related symptoms of multiple myeloma?
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Weight loss, cachexia, anemia, unexplained osteopenia
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What is hemangioma?
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Congenital vascular variant with large thin walls and sinuses surrounded by trabeculae and reactive bone
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Hemangiomas are generally clinically __________, and presents with __________
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Clinically silent
Localized pain, muscle spasm, neurological compromise |
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In an x-ray, a hemangioma will have a __________ appearance of vertebral bodies
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Striped/corduroy appearance
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Ewing's sarcoma is classically described as having __________
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Small, round closely packed cells
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Who MC gets Ewing's sarcoma?
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Males 5 to 30 years old
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A Ewing's sarcoma tumor is __________ necrotic and the disease may be __________
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Highly necrotic
Genetic |
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Where does Ewings sarcoma like to occur?
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Any bone, prefers midshaft of long bones and pelvis, arises and medually cavity
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In an x-ray, Ewing's sarcoma has a __________ appearance
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Periosteal "onionskin" appearance
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How is Ewing sarcoma treated? What is the survival rate?
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Standard, 75% five year survival
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Extraosseous Ewing sarcoma has identical pathologies and descriptions of __________, but has no __________
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Metastatic bone tumor, bone involvement
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________% of bone tumors are metastatic in origin
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70%
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Malignant bone tumors tend to come from what locations?
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Breast, lung, prostate and kidney
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__________ spread is metastatic disease's favorite method
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Hematogenous
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Most metastatic tumors in bone of females comes from where? In males?
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Breast
Prostate |
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What is the most common bone effected by metastatic disease?
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Vertebrae
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Metastatic disease tends to occur when?
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Second half of the life
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What is the clinical presentation of metastatic disease?
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Weight loss, anemia, skeletal pain, fever
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What is the quality of pain and metastatic disease?
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Deep boring unrelieved by rest may worsen at night
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What is the radiographic appearance of metastatic disease?
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Lytic (70%), blastic (15%), mixed (5%)
Moth eaten permeative |
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Why many a bone become osteoblastic in metastatic disease?
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Body's natural response to invasion of tissue
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How would the blood test appear with metastatic disease?
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Increase in ESR, normal alk phos, anemia, decrease WBC
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What are the characteristics of a secondary bone tumor?
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No periosteal lift, rare st masses, small lesions, multi-site, structures not visualized, no bone expansion
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How is metastatic disease treated? What is the prognosis?
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Standard
Poor |
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Ligaments are composed of __________ that allow for __________
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Densely packed Type I collagen, little stretch
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The synovial membrane lines __________ except the __________
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All internal aspects of a joint
Articular surface |
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Why is the synovium not a true membrane?
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No basement membrane or gap junction
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Type A cells are __________
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Macrophages
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Type B cells are __________ and produce __________
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Secretory
Hyaluronic acid |
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What increases surface area of the synovium?
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Villi and microvilli
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What is sub-synovial tissue?
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Loose highly vascularized areolar tissue
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Where is the synovium in the knee?
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Posteriorly overlying the fat pad
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Synovial fluid is a __________
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Plasma filtrate
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Synovial fluids should not contain __________ and should appear __________
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Fibrinogen and alpha-2 macroglobulin, clear
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What allows for the proper viscosity of synovial fluid?
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Hyaluronate is highly negative with a high water affinity
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What is the importance of viscosity of synovial fluid?
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Molecular sieve (forces debris away from joint surfaces and into macrophagic membrane)
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Why is articular cartilage limited to 6mm thick?
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Is diffusion dependent
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Articular cartilage changes in thickness with stress/exercise due to __________, allowing for __________
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Fluid absorption, better fits and better weight distribution
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Which zones of cartilage are radio dense?
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Calcified and subchondral
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Where is the blueline/tide mark?
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Between the radial and calcified zones
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The blue line is the interface between what?
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Cartilage and mineralized tissue
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When do chondrocytes replicate and migrate above the tide mark? What about below?
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All the time
Only with chemical stimulus (example: acromegaly) |
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70 - 80% of articular cartilage weights is compromise of __________, the rest being __________ & __________
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Water
Type II collagen and proteoglycans |
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Proteoglycans make up the __________ and the __________
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Intercellular matrix of hyaline, nucleus pulposis
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What is Hilton's law?
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Referred nerve pain due to joint disturbance
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Encapsulated endings respond to __________ stimuli, such as __________ & __________
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Mechanical stimuli
Pressure and stretch |
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The golgi tendon organs respond to __________ at the __________
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Tension
Musculotendinous junction |
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Pacinian corpuscles respond to __________
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Initiation and cessation of movement
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Free nerve endings respond to __________
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Pain
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What is a bursae? When are they developed?
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Closed sacs with moist walls
Fetal (deep bursae), jt/subcutaneous (friction response) |
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Tendon sheaths are __________. What are the gaps called?
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Complex tubes wrapping tendons
Mesotendons |
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Tendon sheaths have a __________ lining both layers
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Synovial membrane
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Degenerative diseases are actually __________ diseases
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Bone building
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What is cartilage fibrillation?
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Excess of deposition of fibrillin in cartilage
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What are the general characteristics of non-inflammatory joint diseases?
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Asymmetric, joint space loss, subchondral sclerosing, osteoclasts, mechanical pattern of wear
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DJD aka __________, is a reactive pattern of joint tissues to __________
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Osteoarthritis or osteoarthrosis, mechanical and biological factors
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DJD most commonly affects what types of joint?
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Synovial
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Who has DJD? Where is it most often found?
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95% of us, 40 - 50 year old men is most common
Older people in weight bearing joints |
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Who most commonly gets moderate or severe DJD?
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Women
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What race has DJD more than anyone else?
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Native Americans
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What can cause cartilaginous damage and thus DJD?
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Trauma, infection, repetitive use, heredity, immobility
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Gravity leads to what type of osteoarthritis? Trauma?
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Primary
Secondary |
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What factors promote DJD?
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Genetically poor cartilage, injury, increased stiffness of subchondral bone
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What makes cartilage genetically poor?
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Fibrillin
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How does stiffening of subchondral bone occur in why will it promote DJD?
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Stiffness causes increased stress to be transmitted into the cartilage
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In DJD there is a loss of __________, and __________ & __________ of the cartilage
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Chondrocytes, erosion, softening (fibrocartilage imbibs water)
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In DJD, what is found around the chondrocytes
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Matrix destroying proteases and fat
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The cartilage repair of DJD is composed of __________
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Hyaline (good), fibrocartilage (bad)
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What is a subchondral cyst?
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Subchondral fissure that balloons out with synovial fluid
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When does fibrocartilage formation begin?
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Injury to the vascularized bone
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What would the blood test for DJD look like?
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Normal, because it is a very slow process
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In DJD, where is new bone formed?
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Joint margins (eg. osteophytes) and subchondral bones (via subadjacent marrow)
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Osteophytes are an attempt to __________ and are developmentally guided by __________
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Repair and increase load surface
Mechanical forces |
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What covers the surface of osteophytes?
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Fibrocartilage and fibrous tissue
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Vertebral osteophytes result from __________
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Pulling of annulus at the periosteal attachment
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Why are the facets commonly severely affected in vertebral DJD?
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Disc degeneration shifts weight to the already degenerated facets
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What is eburnation?
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Articular surface polished causing death of osteophytes
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What are the soft tissue changes of subchondral cyst? What is it also known as?
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Synovial villus hypertrophy, capsular care, ligaments/menisci fray
Geode |
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What is the clinical presentation of DJD?
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Aching joint, worse with activity and prolonged rest, better with rest, DIPS and PIPs, doctor observes decreased range of motion
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What common orientation is seen in the foot of a DJD patient?
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Hallux valgus
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What is a common secondary DJD process?
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Localized swelling
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What are the radiographic findings of DJD?
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Asymmetrical, joint space loss, subchondral sclerosing, cysts, loose bodies, vacuum sign
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Except in severe _____, ______ or ______ DJD, degeneration does not correlate with the presence of symptoms
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Lumbar, hip, knee
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What is a vacuum sign?
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Common in spine, nitrogen gas from disc degeneration appears as radiolucent pockets
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What is the "most overworked and imprecise diagnosis of the knee" associated with anterior knee pain
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Chondromalacia patella
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CMP has been used interchangeably with __________ of the knee
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DJD
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What are the cartilage changes in chondromalacia patella?
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Softening, fissuring, and fibrillation
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Softening of cartilage is or is not symptomatic?
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IS NOT
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What are the causal theories of chondromalacia patella?
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Inherent cart defect, abnormal synovial membrane, loss of contact with articular cartilage
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CMP occurs between __ - ___ years, equally between men and females, and has an __________ onset
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16 - 30 years
Insidious without recent trauma |
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Is chondromalacia patella a normal aging process?
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Possible minor changes occur in everyone by 25 years and 50% show gross changes
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Chondromalacia patella involves what signs/smptoms?
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Diffuse fairly constant ache, worse with stairs anda ctivity, squatting impossible, overall stiffness, crepitus
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The symptoms of CMP are associated with what 5 things?
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Improper appliances (knee braces), immobilization/casts, repetitive loading and medial meniscetomy
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What incidents are statistically associated with CMP?
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Poor extensor mechanism, function incongruity, misaligned lower extremity, recurrent subluxation/dislocation, patellar instability
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Too much or too little pressure leads to __________ and __________
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CMP and changes in calcification and vascularization of subchondral bone
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What is the best way to visualize CMP?
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MRI
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How may chondromalacia patella be treated?
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Balance muscles, reduce tracking, cortisone, NSAIDS, cut 'er open
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What is destructive articular disease secondary to neural damage?
|
Neuropathic arthopathy or Charcot's joint
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In neuropathic arthropathy, the patient experience __________ degeneration resulting in __________
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Premature and excessive traumatic
Severe destruction and instability |
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What is the etiology of neuropathic arthropathy?
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Congenital, acquired and latrogenic (doctor induced)
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What may lead to acquired neuropathic arthropathy?
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MS, syphilis, alcoholism, Type I diabetes, trauma
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What are the clinical features of neuropathic arthropathy?
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In ankles/feet, altered gait, loss of deep tendon reflex, insensitivity to pain, instability, joint enlargement
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How quickly may neuropathic arthropathy form?
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Weeks to years
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What is the radiographic appearance of neuropathic arthopathy?
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Initially insignificant
Later- DJD, dislocation, subchondral sclerosis, "bag of bones" debris appearance |
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What are the 6 D's of neuropathic arthropathy?
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Density, debris, destruction, dislocation, distention and degeneration
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What are the characteristics of an inflammatory joint disease?
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Lytic, symmetrical, erosion, of joint margins, ligamentous laxity, cysts
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Rheumatoid arthritis is a __________ disease that affects the __________
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Systemical inflammatory
Skin, blood, joints, muscle, heart, lungs |
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Rheumatoid arthritis is not _______; it is a _______ synovitis leading to destruction of ____ & _______ of joints
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Rheumatism, non-supperative proliferative, articular cartilage, ankylosis of joints
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Who most commonly gets RA?
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Females in their 30 - 40s
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What is the etiology of RA?
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Unknown, may be viral, genetic or autoimmune
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RA is highly unpredictable or predictable? Although ___% have a _______ onset with the greatest damage occurring in _________
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Unpredictable
90% Gradual First 5 years |
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What joints are most commonly involved in RA? Where in the spine may it be found?
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Smaller joints of extremities in a symmetrical distribution
Cervical |
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RA Begins as what type of inflammation?
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Non-distinct
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What cells deposit in the areolar tissue of RA?
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Inflammation (helper T cells, plasma cells and macrophages)
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In RA, what occurs with the synovium?
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Becomes edematous, thickens, and hyperplasia. Fibrin covers portions of it
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IN RA, within the joint space there is __________ and __________
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Villi production, rice bodies (fibrin pieces)
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The inflammatory cell's PGE2 stimulates __________, thus leading to __________ and __________
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Osteoclastic activity
Juxta-articular erosion and osteoporosis Subchondral cysts |
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What is an inflamed and hypertrophied synovium?
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Pannus
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What does a pannus do?
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Fill joint space
Produce protease, elastase, collagenase Decrease proteoglycans Increase fibroblasts Decreases ROM |
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What is the immune response associated with RA?
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Autoimmunity to type II collagen due to immune complex RA-IgG found in synovial fluid, hyaline, and fibrous tissue
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At the end of RA, tissue is organized into __________ leading to __________, and possibly eventually __________.
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Fibrous bands within pannus, fibrous ankylosis, bony ankylosis
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What are the lab findings of RA?
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Increase ESR, normal alkaline phosphatase levels, mild anemia, rheumatoid factor
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Why is a bone scan a poor method of detecting RA?
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Although sensitive, poorly visualizes lytic changes
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In RA,there tends to be __________ deviation of the wrist, and __________ deviation of the fingers
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Radial
Ulnar |
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What % of RA patients are seropositive? What % of the normal population?
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90% of RA
5% of normal |
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What is the basic clinical presentation of RA?
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Malaise, fever, non-local pain --> becomes local, inflammation, stiffness with activity, conjunctivitis
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What is seen in severe RA?
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Rheumatoid nodules of the elbows/forearms, acute vasculitis
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What is a rheumatoid nodule?
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Areas of fibrous necrosis surrounded by lymphocytes and granulation tissue
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What are the radiographic findings of RA?
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Bilateral symmetrical, pseudocysts, "rat bite" lesion, uniform joint space loss, soft tissue swelling, osteoporosis
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Juvenile RA aka __________, occurs in people under _____, and appear identical to adult RA with the exception of __________
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Still's disease
16 years Less inflammation and pannus formation |
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What may juvenile RA do to the growth plate?
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Increase growth plate activity, or cause premature fusion
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Juvenile RA may be ____, _____ or _______ arthritis
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Mono, oligo or systemic
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What is the most commonly involved joint of juvenile RA? What may also occur in JRA?
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Knees
Fever, rash and organ enlargement |
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What percent of JRA patients undergo complete remission?
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70 - 90%
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