Pathology - S2B3 - Bone - Bone 5 Arthritis

Front 1

Label

Back 1

-

Front 2

What type of Collagen is present in Cartilage?

Back 2

Type II Collagen

Front 3

Discuss the Synovium of joints

Back 3

-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

Front 4

Define Gout

Back 4

Hyperuricemia & deposition of Monosodium Urate Crystals in joints, resulting in recurrent bouts of Acute Arthritis

Front 5

Describe the etiology of Primary Gout

Back 5

Multifactorial hereditary disease due to over-synthesis of uric acid from purine nucleotides

Most common in MALES

Front 6

What are 3 possible causes of Secondary Gout?

Back 6

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

Front 7

Gout
-Podagra = inflammed MTP joint of big toe

Back 7

What type of arthritis?

Front 8

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

Back 8

What type of arthritis?

Front 9

Gout

Back 9

What type of Arthritis are Tophi associated with?

Front 10

Tophus in Gout
-center is accumulation of Urate crystals
-chronic lymphocytic infiltration
-MNGC's are present

Back 10

What is this?

Front 11

Gout
-Podagra = Metatarsophalangeal (MTP) joint in the big toe

Back 11

What type Arthritis?

Front 12

What are 3 complications of Hyperuricemia?

Back 12

1. Chronic renal failure requiring dialysis

2. Atherosclerosis

3. Deformity due to destruction of articular surfaces

Front 13

What is Lesch-Nyhan Syndrome?

Back 13

X-linked absence of Hypoxanthine-guanine Phosphoribosyl Transferase (HGPRT)
1. Hyperuricemia -> Gout
2. Mental retardation
3. Spasticity
4. Self-mutilating behaviors

Front 14

Pseudogout = Chondrocalcinosis

Back 14

What type of arthritis is this?

Front 15

What is the pathogenesis of Pseudogout?

Back 15

Calcium Pyrophosphate crystal deposition into Articular Cartilage

Front 16

Basophilic, rhomboid crystals that are weakly positively birefringent

Back 16

Pseudogout

Front 17

Pseudogout:
1. commonly what joint?
2. what age?

Back 17

1. knee
2. > 50; Both sexes affected equally

Front 18

Pseudogout = Calcium Pyrophosphate crystals
-no inflammation
-cartilage looks normal
-large deposits of acellular material

Back 18

What is seen here?

Front 19

Pseudogout = Chondrocalcinosis
-Calcium Pyrophosphate Crystals

Back 19

Weakly Positively Birefringent

Front 20

Pseudogout

Back 20

Basophilic Rhomboid Crystals under scanning EM

Front 21

Calcium Hydroxyapatite deposition arthritis

Back 21

What is "Milwaukee Shoulder"

Front 22

Calcium Hydroxyapatite deposition arthritis = Milwaukee Shoulder

Back 22

This was taken from a shoulder, what type of Arthritis?

Front 23

Septic Arthritis
Monoarticular
MCC
-Gonococci = MCC in urban population
-S. aureus
-Strep
-Mycobacterium

Back 23

What is this?
How do you know?
Most common causes?

Front 24

Septic Arthritis
-subarticular cartilage surface is lined by PMN's & bacteria

Back 24

What is this showing?

Front 25

Tuberculous Arthritis of the Spine = Pott's disease

Back 25

What is this?

Front 26

Tuberculous Arthritis
-Granuloma with Caseous Necrosis in the center surrounded by MNGC's

Back 26

What is this? How do you know?

Front 27

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?

Back 27

Reiter's Syndrome

Venereal disease (C. trachomatis)

HLA-B27 = autoimmune component

Front 28

Osteoarthritis:
1. cause?
2. Gender?
3. Age?

Back 28

1. "wear & tear"

2. Females

3. usually > 50

Front 29

Most common form of Arthritis

Back 29

Osteoarthritis

Front 30

What is the pathogenesis of Osteoarthritis?

Back 30

Proteolytic degradation of cartilage matrix -> loss of resilience of Articular cartilage -> surface irregularity of Subchondral Bone

Front 31

Osteoarthritis
-loss of Proteoglycans
-shrinkage of the cartilage & the chondrocytes tend to cluster

Back 31

What is the bottom pic showing?

Front 32

Osteoarthritis

*Fibrillation = clefts develop in the surface of Cartilage

Back 32

What arthritis is Fibrillation common in?

Front 33

Osteoarthritis
-Green = Collagen = worn away
-Osteophyte = bone spur = mushroom-like mass on the lateral edges of the joint

Back 33

What is this from? How do you know?

Front 34

Hebreden's node = DIP joint Osteophyte

Osteoarthritis

Back 34

What is this called? What arthritis?

Front 35

What is a Bouchard node? What arthritis is it seen in?

Back 35

Osteophyte at the PIP joint

Osteoarthritis

Front 36

Osteoarthritis

Osteophytes are present

Back 36

What type of Arthritis? How do you know?

Front 37

Eburnation = polished, ivory-like appearance of bone -> due to rubbing of bone on bone

Osteoarthritis
-Subchondral bone sclerosis = red

Back 37

What is seen at the arrow? What type of Arthritis?

Front 38

Type of arthritis in which the joint pain becomes worse later in the day after use

Back 38

Osteoarthritis

Front 39

What are the risk factors for Rheumatoid Arthritis?

Back 39

1. HLA-DR4

2. EBV infection

Front 40

Rheumatoid Arthritis:
1. Gender preference

2. Age of onset

Back 40

1. Females (4:1)

2. 20-50 years of age

Front 41

Describe the pathogenesis of Rheumatoid Arthritis

Back 41

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)

Front 42

Rheumatoid Arthritis

Villi that extend into the Synovial Cavity are enlarged due to Chronic Inflammation

Back 42

Type of Arthritis? How do you know?

Front 43

Rheumatoid Arthritis

Back 43

This is an inflammed Synovial Villus...what type of Arthritis?

Front 44

Pannus = proliferation of the Synovium & granulation tissue over the Articular Cartilage of the joint

Rheumatoid Arthritis

Back 44

What is this called? What is it? What type of arthritis?

Front 45

Subcutaneous Rheumatoid Nodule

Back 45

What is seen here?

Front 46

Rheumatoid Nodule
-central FIBRINOID NECROSIS surrounded by epitheloid macrophages, lymphocytes, & granulation tissue

Back 46

What is this?

Front 47

Subluxation

Rheumatoid Arthritis

Back 47

What is happening here? What type of arthritis is it common in?

Front 48

Rheumatoid Arthritis

Back 48

What type of arthritis is this common in?

Front 49

Ulnar deviation of the fingers + Subluxation of the knuckles

Rheumatoid Arthritis

Back 49

What is this pathology called? What type of arthritis?

Front 50

Ankylosis

Rheumatoid arthritis

Back 50

This is fibrous fusion of the joints, what is the proper term? What type of arthritis?

Front 51

Ankylosis = bony fusion across the joint space

Rheumatoid arthritis

Back 51

What has happened here? What type of arthritis?

Front 52

Rheumatoid Arthritis

Back 52

What are these 2 deformities common in?

Front 53

What is Still's Disease?

Back 53

Rheumatoid Arthritis in Children with RF usually absent
-often preceded by generalized lymphadenopathy & hepatosplenomegaly & acute onset marked by fever

Front 54

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

Back 54

Ankylosing Spondylitis

Front 55

Rheumatoid Arthritis + Splenomegaly + Neutropenia = ?

Back 55

Felty's Syndrome

Front 56

RA with marked chronic inflammation & enlargement of Lacrymal & Salivary glands. Associated with dryness of eyes & mouth

Back 56

Sjogren's syndrome

Front 57

Erythema Chronicum Migrans

Lyme Disease = Borrelia Burgdorferi

Back 57

What is this called? What is it due to?

Front 58

Borrelia Burgdorferi = Spirochete

Lyme Disease

Back 58

What is this? What does it cause?

Front 59

How is Lyme Disease contracted?

Back 59

Ixodes dammini tick

Front 60

What are the late sequelae of Lyme Disease?

Back 60

1. Polyarticular arthritis
2. Neuropathy
3. Cardiac Arrhythmias

Front 61

Ganglion Cyst of the wrist = Small, non-neoplastic cystic tumor arising in the joint capsule or adjacent tendon sheath, usually in the wrist

Back 61

What is seen here?

Front 62

Surgically removed Ganglion Cyst

Back 62

What is this?

Front 63

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

Back 63

What are these?

Front 64

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

Back 64

What is this?

Front 65

Biphasic soft tissue tumor
-Epithelial cells forming glands + intervening Spindle cells

Back 65

Synovial Sarcoma

Front 66

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

Back 66

What is this?

Front 67

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

Back 67

What soft tissue tumor is this?

Front 68

Arthritis in which the joint pain is more severe in the morning but resolves within a couple hours

Back 68

Rheumatoid Arthritis