Pathology Ch. 22 Part 2

Front 1

Diseases of Joints and Related Tissues

Back 1

•Note that in synovial joints the synovial membrane does not cover the artificial surface

Front 2

Diseases of Joints and Related Tissues

Major Determinants of Disease

Back 2

•Mechanical wear and tear causes osteoarthritis, the most common form of arthritis

•Arthritis is a common manifestation of autoimmune disease

•Joints are inherently unstable and subject to injury

Front 3

Osteoarthritis

Back 3

•Narrowed joint spaces Swollen distal interphalangeal joints

(Heberden Node)

•Activity related joint pain relieved by short rest crepitus

Front 4

Ostioarthritis

Primary Osteoarthritis

Back 4

•Associated with genetic predisposition and age-related mechanical wear and tear.

•Affected joints rarely show inflammation change.

Front 5

Rheumatoid Arthritis

Systemic Autoimmune Disease of Synovial Joints

Back 5

1. Frontal (coronal) section of normal knee

2. Osteoarthritis. Cartilage and bone damage; no inflammation is present.

3. Rheumatoid Arthritis.

-The joint capsule (Synovial membrane) is inflamed, and a pannus of inflammatory tissue has formed across the articular surface

Front 6

Rheumatoid Arthritis

Pannus

Back 6

•Highly vascular inflammatory membrane covering normal cartilage surface

Front 7

Rheumatoid Arthritis

Ankylosis

Back 7

•Fibrous binding and welding of a joint

Front 8

Rheumatoid Arthritis

Rheumatoid Factor (RF)

Back 8

•B cells must be helping with T-cell Auto-immune synovial joint destruction. 75% pts. With RA exhibit it.

Front 9

Rheumatoid Arthritis

Z deformity

Back 9

•Ulnar drift with fingers deviating oppositely (Toward Ulna)

Front 10

Rheumatoid Arthritis

Rheumatoid Nodules

Back 10

•Painless 1-2cm inflammation nodes

Front 11

Rheumatoid Arthritis

Secondary amyloidosis

Back 11

•Autoimmune lg complexes deposit in kidneys, liver, spleen, adrenals

Front 12

Rheumatoid Arthritis

Juvenile Rheumatoid Arthritis

Back 12

•Sudden, systemic, toxic, no RF antibodies but instead anti-nuclear antibodies

Front 13

Spondyloarthropathies

Back 13

•Autoimmune - genetic influence, arthritic

•Seronegative

Differs from RA:

-Confined to vertebrae & SI joints -Inflammation involves tendons

-RH factor is absent

-Human Leukocyte Antigen Present

Front 14

Spondyloarthropathies

Ankylosing Spondylitis

Back 14

•Relapsing, vertebral fibrous fusion, stiff spine, chronic back pain

Front 15

Spondyloarthropathies

Reactive arthritis

Back 15

•Presents 1 mo. Post Infection

(Ex: Chlamydia).

Front 16

Spondyloarthropathies

Psoriatic Arthritis

Back 16

•10% of psoriasis (skin dis.) Pts. Small Joints of hands, feet first

Front 17

Other Types of Arthritis

Gout

Back 17

•Metabolic, inflammatory disease. Men. Uric acid crystals in joints. Usually big toe.

-Renal failure/stones

-Familial tendency

-Atherosclerosis accelerated by high serum uric acid

Front 18

Other Types of Arthritis

Secondary Gout

Back 18

•Lymphoma, Leukemia as large amounts of uric acid produced when DNA from dying cells metabolized

Front 19

Other Types of Arthritis

Lyme Disease

Back 19

•Bacterial Infection; Deer tick vector. Late stage = arthritis, WI and MN are primary band of states involved.

Front 20

Other Types of Arthritis

Polymyalgia Rheumatic

Back 20

•Dx made in absence of other Dx. Shoulder pain, stiffness, malaise, moodiness; no arthritic Inflammation.

•Giant Cell Arteritis

Front 21

Injuries to Ligaments, Tendons, Joints

Subluxation

Back 21

•Separation of one bone in a joint

(Malaligned)

Front 22

Injuries to Ligaments, Tendons, Joints

Sprain

Back 22

•Stretch injury to ligament

Front 23

Injuries to Ligaments, Tendons, Joints

Strain

Back 23

•Stretch injury to tendon

Front 24

Injuries to Ligaments, Tendons, Joints

Avulsion

Back 24

•Tear tendon or ligament from its attachment

Front 25

Periarticular Pain Syndrome

Degenerative disc disease

Back 25

•Rind of tough cartilage around discs bulges or ruptures allowing central pulp to herniate laterally

(Herniated discs).

•Then pressure on spinal root nerves = pain, tingling, numbness, paralysis

Front 26

Periarticular Pain Syndrome

Spondylolisthesis

Back 26

•Sliding lumbar vertebrae from abnormal joint stress, usually asymptomatic

Front 27

Periarticular Pain Syndrome

Bursitis

Back 27

•Inflamed bursal sacs that lubricate tendons sliding over bones or where bone is near skin

Front 28

Periarticular Pain Syndrome

Tendinitis

Back 28

•Inflammed tendons "Strained Ankle"

Front 29

Periarticular Pain Syndrome

Fibromyalgia

Back 29

•Chronic pain, perceived swelling, little physical evidence (X-ray, blood work), malfunction of brain pain centers? Dx by exclusion of others.

•Anti-depressants and exercise often help

•Anti-inflammatory meds are not effective