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68 Cards in this Set

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Label
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What type of Collagen is present in Cartilage?
Type II Collagen
Discuss the Synovium of joints
-Arranged in Villi projection lined by Synovial epithelial cells
-Synovial fluid is very low in protein but has alot of mucin
-Cartilage does not have its own blood supply & must rely on the Synovium for nutrition
Define Gout
Hyperuricemia & deposition of Monosodium Urate Crystals in joints, resulting in recurrent bouts of Acute Arthritis
Describe the etiology of Primary Gout
Multifactorial hereditary disease due to over-synthesis of uric acid from purine nucleotides

Most common in MALES
What are 3 possible causes of Secondary Gout?
1. Leukemia = due to increased nuclear cell turnover -> increased Purine metabolism

2. Decreased renal urate excretion in renal disease

3. Lesch-Nyhan Syndrome = deficiency of HGPRT causing hyperuricemia
-Mental retardation
-Spasticity
-X-linked
Gout
-Podagra = inflammed MTP joint of big toe
What type of arthritis?
Gout
-joint surface is covered with white chalky material = Urate crystals = Tophi
-Tophi = clusters of Urate crystals surrounded by fibroblasts, lymphocytes, & Giant cells located in cartilage or soft tissues
What type of arthritis?
Gout
What type of Arthritis are Tophi associated with?
Tophus in Gout
-center is accumulation of Urate crystals
-chronic lymphocytic infiltration
-MNGC's are present
What is this?
Gout
-Podagra = Metatarsophalangeal (MTP) joint in the big toe
What type Arthritis?
What are 3 complications of Hyperuricemia?
1. Chronic renal failure requiring dialysis

2. Atherosclerosis

3. Deformity due to destruction of articular surfaces
What is Lesch-Nyhan Syndrome?
X-linked absence of Hypoxanthine-guanine Phosphoribosyl Transferase (HGPRT)
1. Hyperuricemia -> Gout
2. Mental retardation
3. Spasticity
4. Self-mutilating behaviors
Pseudogout = Chondrocalcinosis
What type of arthritis is this?
What is the pathogenesis of Pseudogout?
Calcium Pyrophosphate crystal deposition into Articular Cartilage
Basophilic, rhomboid crystals that are weakly positively birefringent
Pseudogout
Pseudogout:
1. commonly what joint?
2. what age?
1. knee
2. > 50; Both sexes affected equally
Pseudogout = Calcium Pyrophosphate crystals
-no inflammation
-cartilage looks normal
-large deposits of acellular material
What is seen here?
Pseudogout = Chondrocalcinosis
-Calcium Pyrophosphate Crystals
Weakly Positively Birefringent
Pseudogout
Basophilic Rhomboid Crystals under scanning EM
Calcium Hydroxyapatite deposition arthritis
What is "Milwaukee Shoulder"
Calcium Hydroxyapatite deposition arthritis = Milwaukee Shoulder
This was taken from a shoulder, what type of Arthritis?
Septic Arthritis
Monoarticular
MCC
-Gonococci = MCC in urban population
-S. aureus
-Strep
-Mycobacterium
What is this?
How do you know?
Most common causes?
Septic Arthritis
-subarticular cartilage surface is lined by PMN's & bacteria
What is this showing?
Tuberculous Arthritis of the Spine = Pott's disease
What is this?
Tuberculous Arthritis
-Granuloma with Caseous Necrosis in the center surrounded by MNGC's
What is this? How do you know?
A young man has Arthritis & Achilles tendon periostitis, Urethritis, & Conjunctivitis. What is the disease? What usually precedes the reaction? What HLA is it associated with?
Reiter's Syndrome

Venereal disease (C. trachomatis)

HLA-B27 = autoimmune component
Osteoarthritis:
1. cause?
2. Gender?
3. Age?
1. "wear & tear"

2. Females

3. usually > 50
Most common form of Arthritis
Osteoarthritis
What is the pathogenesis of Osteoarthritis?
Proteolytic degradation of cartilage matrix -> loss of resilience of Articular cartilage -> surface irregularity of Subchondral Bone
Osteoarthritis
-loss of Proteoglycans
-shrinkage of the cartilage & the chondrocytes tend to cluster
What is the bottom pic showing?
Osteoarthritis

*Fibrillation = clefts develop in the surface of Cartilage
What arthritis is Fibrillation common in?
Osteoarthritis
-Green = Collagen = worn away
-Osteophyte = bone spur = mushroom-like mass on the lateral edges of the joint
What is this from? How do you know?
Hebreden's node = DIP joint Osteophyte

Osteoarthritis
What is this called? What arthritis?
What is a Bouchard node? What arthritis is it seen in?
Osteophyte at the PIP joint

Osteoarthritis
Osteoarthritis

Osteophytes are present
What type of Arthritis? How do you know?
Eburnation = polished, ivory-like appearance of bone -> due to rubbing of bone on bone

Osteoarthritis
-Subchondral bone sclerosis = red
What is seen at the arrow? What type of Arthritis?
Type of arthritis in which the joint pain becomes worse later in the day after use
Osteoarthritis
What are the risk factors for Rheumatoid Arthritis?
1. HLA-DR4

2. EBV infection
Rheumatoid Arthritis:
1. Gender preference

2. Age of onset
1. Females (4:1)

2. 20-50 years of age
Describe the pathogenesis of Rheumatoid Arthritis
1. B cells in the joint produce RF complexes
-RF complexes are IgM auto-Ab's against the Fc receptor of IgG
-RF complexes are also present in the serum of 70-90% of cases
-Type III HS

2. RF complexes activate complement = attracts Neutrophils
-Neutrophils produce acute inflammation of Synovial tissue
-Neutrophil phagocytosis of RF complexes produces Ragocytes

3. Chronically inflammed Synovial tissue proliferates (forms Pannus)
-Pannus releases cytokines that destroy Articular Cartilage
-End result is reactive fibrosis & joint fusion (Ankylosis)
Rheumatoid Arthritis

Villi that extend into the Synovial Cavity are enlarged due to Chronic Inflammation
Type of Arthritis? How do you know?
Rheumatoid Arthritis
This is an inflammed Synovial Villus...what type of Arthritis?
Pannus = proliferation of the Synovium & granulation tissue over the Articular Cartilage of the joint

Rheumatoid Arthritis
What is this called? What is it? What type of arthritis?
Subcutaneous Rheumatoid Nodule
What is seen here?
Rheumatoid Nodule
-central FIBRINOID NECROSIS surrounded by epitheloid macrophages, lymphocytes, & granulation tissue
What is this?
Subluxation

Rheumatoid Arthritis
What is happening here? What type of arthritis is it common in?
Rheumatoid Arthritis
What type of arthritis is this common in?
Ulnar deviation of the fingers + Subluxation of the knuckles

Rheumatoid Arthritis
What is this pathology called? What type of arthritis?
Ankylosis

Rheumatoid arthritis
This is fibrous fusion of the joints, what is the proper term? What type of arthritis?
Ankylosis = bony fusion across the joint space

Rheumatoid arthritis
What has happened here? What type of arthritis?
Rheumatoid Arthritis
What are these 2 deformities common in?
What is Still's Disease?
Rheumatoid Arthritis in Children with RF usually absent
-often preceded by generalized lymphadenopathy & hepatosplenomegaly & acute onset marked by fever
HLA-B27 associated disease in which the spine & sacroiliac joints are affected & can lead to rigidity & fixation of the spine as a result of bone fusion
-may be associated with IBD
Ankylosing Spondylitis
Rheumatoid Arthritis + Splenomegaly + Neutropenia = ?
Felty's Syndrome
RA with marked chronic inflammation & enlargement of Lacrymal & Salivary glands. Associated with dryness of eyes & mouth
Sjogren's syndrome
Erythema Chronicum Migrans

Lyme Disease = Borrelia Burgdorferi
What is this called? What is it due to?
Borrelia Burgdorferi = Spirochete

Lyme Disease
What is this? What does it cause?
How is Lyme Disease contracted?
Ixodes dammini tick
What are the late sequelae of Lyme Disease?
1. Polyarticular arthritis
2. Neuropathy
3. Cardiac Arrhythmias
Ganglion Cyst of the wrist = Small, non-neoplastic cystic tumor arising in the joint capsule or adjacent tendon sheath, usually in the wrist
What is seen here?
Surgically removed Ganglion Cyst
What is this?
Giant Cell tumor of tendon sheath (Pigmented Villonodular Tenosynovitis)
-Benign tumor of giant cells in the vicinity of a joint. This lesion is probably non-neoplastic, and is closely related to pigmented villonodular synovitis. The latter condition is characterized by an exuberant, heavily pigmented villous synovial overgrowth containing pigmented cells, lipid-laden histiocytes, and multinucleated giant cells
What are these?
Giant Cell Tumor of Tendon Sheath
-Benign tumor of giant cells in the vicinity of a joint. This lesion is probably non-neoplastic, and is closely related to pigmented villonodular synovitis. The latter condition is characterized by an exuberant, heavily pigmented villous synovial overgrowth containing pigmented cells, lipid-laden histiocytes, and multinucleated giant cells
What is this?
Biphasic soft tissue tumor
-Epithelial cells forming glands + intervening Spindle cells
Synovial Sarcoma
Synovial Sarcoma
-A highly malignant soft tissue tumor arising in the vicinity of a joint. It is characterized by a biphasic microscopic pattern with intermixed atypical spindle cells and nests of epithelial cells with cleft-like spaces
What is this?
Synovial Sarcoma
-A highly malignant soft tissue tumor arising in the vicinity of a joint. It is characterized by a biphasic microscopic pattern with intermixed atypical spindle cells and nests of epithelial cells with cleft-like spaces
What soft tissue tumor is this?
Arthritis in which the joint pain is more severe in the morning but resolves within a couple hours
Rheumatoid Arthritis