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146 Cards in this Set
- Front
- Back
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Type II Collagen
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Articular Cartillage (Osteoarthritis; aneural, avascular)
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Type III Collagen
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Tendons (also type I collagen)
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Tendon Sheaths
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Diabetics; Dupuytren’s contractures = thickening of tendon sheaths
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High Elastin
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Ligaments (Type I Collagen)
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Avascular
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Articular Caritllage and CENTRAL part of Menisci
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Baker’s Cyst
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Popliteal cyst; bursa; rheumatoid arthritis
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Inflammatory Joint Fluid
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Low viscosity (low hyaluronic acid from fibroblasts; high synovial fluid), turbid color, high WBCs and high polys
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Synovial Effusions
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Reactive arthritis, lyme disease
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Ragocytes
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WBCs with debris; indicative of active synovium; rheumatoid arthritis
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Low hyaluonic acid
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Either (1) high volume or (2) hyaluronic acid breakdown (bacterial infection)
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DIP involvement
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NOT RA; could be Gout, post-infectious (reactive arthritis), osteoarthritis
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HLA B27
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Spondylarthropathies = 1) Alkylosing spondyltis 2) Reactive arthritis 3) psoriatic arthritis 4) IBD
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Enthesopathy
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Spondylarthropathies (inflammation at insertion of tendons/ligaments into bone), Lyme Chronic Arthritis
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Ro
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Neonatal SLE; associated with photosensitivity; in 60% patients with Schogrens
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Anti-centromere
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CREST
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Anti-mitochondrial
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Proimary biliary cirrhosis
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C Anca
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AKA antiserine proteinase 3; Wegener’s (Granulomatous Polyangitiis)
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P Anca
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AKA MPO; Churg-Strauss and Microscopic Polyangiitis
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Hep B
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Polyarteritis Nodosa (renal; patchy)
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Hep C
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Cryoglobulinemia; Schogrens
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SS(a)
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Ro
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SS(b)
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La; Schogrens (= Ro + La)
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T-cell mediated (Th1)
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Schogrens + Rheumatoid + Scleroderma
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Type III Hypersensitivity
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Rhematoid Arthritis, SLE
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HLA-DR4
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Rheumatoid Arthritis
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Osteophytes
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Osteoarthritis (bone spurs)
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Degeneration of articular cartillage
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Osteoarthritis (Non-inflammatory!)
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Syndesmophytes
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Spondyloarthropathies alkylosing spondylitis; bamboo spine (no path of discs!); acute angle
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Extra-articular manifestations of spondyloarthropathies
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Iritis, urethritis, IBD
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Lover’s heal; “fluffiness”
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Spondyloarthrpoathies: post-infectious!
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Sensitivie antibodies for SLE
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ANA
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SLE
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Small vessel vasculiitis; Type III hypersensitivity; deficiency early complement and abnormal apoptosis; EBV
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EBV
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SLE (anti-SM antibodies AND anti-Ro; molecular mimicry), Schogrens
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Specific antibodies for SLE
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DNA, Smith (SM)
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Pulmonary hypertension
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Scleroderma (progressive systemic sclerosis = PSS)
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Increased risk of B cell lymphoma
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Schogrens
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Red Joints
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Infectious arthritis / Gout
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Bilateral Joint Involvement
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Rheumatoid Arthritis
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Fibrinoid necrosis with histiocytes
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Rheumatoid Nodules (Rheumatoid arthritis); granulomas outside joint space
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Parvovirus B19
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Rheumatoid arthritis
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Alcohol negatively associated
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Rheumatoid arthritis
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Type A synovial membrane cells
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Macrophages
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Type B synovial membrane cells
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Fibroblasts (secrete hyaluronic acid and lubrican); become malignant in rheumatoid arthritis
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Pannus
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Rheumatoid arthritis; proliferating synovium; granulation tissue
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Rheumatoid Factor
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IgM that targets Fc portion of IgG
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TNF-alpha
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Required for rheumatoid nodules; anti-TNF-alpha therapy predisposes to TB + lupus-like syndrome
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Impaired opsonization
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Rheumatoid Arthritis
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Anti-CCP
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Rheumatoid Arthritis; more destructive; high specificity
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Extra-articular feature of RA
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Anemia of chronic disease= most common
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Secondary Schogrens
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Rheumatoid Arthritis; Scleroderma
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Methotrexate
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Treatment for RA (gold standard)
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Rituximab
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Tx for RA, SLE, Schogrens
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Cyclosporine
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RA
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Drugs with SLE-like syndromes
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Phenytoin, Hydralazine; INH, D-penicillamide), Anti-TNF inhibitors
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Crithidian Test
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Test for DS DNA in SLE; prevent false positives
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Double Stranded DNA
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Associated with renal disease in SLE
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Pathopneuomonic for SLE
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Anti-SM antibodies
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Peripheral Rim pattern for ANA anti bodies
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Most specific for SLE; anti-DS DNA
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Subacute lupus rash
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1)
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2)
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Annjular rash with central clearning IF HAVE anti-RO
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Chronic lupus rash
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Chronic discoid rash = SCARRING
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Bimodal pattern (young and old)
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SLE
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Leibman-Sachs Endocarditis
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SLE; fibrinous vegetations on valve leaflets due to IC deposition
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Corticosteroid Tx
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Tx for SLE, Schogrens
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Anti-malarial drugs (hydroxchloroquine)
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Tx for SLE, Schogrens, Osteoarthritis (supplementary)
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Sicca
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Schogrens with no arthritis
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Diagnosis of Schogrens
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Lip biopsy; rho/la antibody
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Deficiency of androgens
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Schogren’s syndrome (androgen effect on epithelial cells, NOT lymphocytes)
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Treatment DHEA
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In SLE helpful for Women
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False + lip biopsy for Schogrens
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HIV, Chronic Hep C
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Perivascular + CD8+
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Hepatitis C
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Periductal + CD4
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Schogrens
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Anti-muscarinic antibodies
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Schogrens (not in SLE/RA!!!!!!!)
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Anti-TNF-alpha Tx
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Schogrens, Psoriatic Arthritis
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No rheumatoid factor
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Spondylarthropathies
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No rheumatoid nodules
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Spondyloarthropathies
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Mouth ulcer
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Spondyloarthropathies (painless); Essential Cryoglobulinemic Vasculitis
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Spondyloarthropathies signs
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Conjunctivitis, arthritis, tendonitis, urethritis, aortitis (aortic regurgitation)
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ARTS-1
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Spondyloarthropathies; ER-associated aminopeptidase; function = cleaves cytokine receptors and processes peptides for MHC-I
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CCSSY Bacteria
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Spondyloarthropathies; Chlamydia, Campylobacter, Shigella flexneri (NOT SONALI), Salmonella, Yersinia + HIV
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Romanus lesions
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Spondyloarthropathies; erosion of bone
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Marginal Syndesmophytes
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Ankylosing spondylitis at margins of intervertebral discs
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Nonmarginal Syndesmophytes
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Psoriatic and Reactive Arthritis
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Heat-shock proteins
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Rheumatoid Arthritis, Spondyloarthropathies
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Post-infectious reactive arthritis
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Can’t pee, can’t see, can’t climb a tree
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Bypass arthritis
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Spondylarthropathies; corrected w/ reversal; also have vasculitis, oral/genital ulceration/ iritis
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Sausage Fingers = Dactylitis
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Psoriatic arthritis
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Nail pitting
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Psoriatic arthritis
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Telescoping of fingers
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Psoriatic arthritis
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Asymmetric Arthritis
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Osteoarthritis
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Gel phenomenon
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Osteoarthritis
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Weather sensitivity
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Osteoarthritis
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Bland joint effusions with Calcium Pyrophosphate Dehydrogens (CPPD)
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Osteoarthritis
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Effusions of the knee, narrow joint space, bone spurs
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Osteoarthritis
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Acromegaly as secondary cause
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Osteoarthritis
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Hemochromatosis
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Osteoarthritis
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Cartillage swelling followed by aggregan decrease and inc MMP
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Osteoarthritis
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CPPD
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Pseudogout, Osteoarthritis (also can be seen in hyperparathyroidism)
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Edema of basement membrane on MRI
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Osteoarthritis
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Ebernation
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Osteoarthritis; polished bone
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AmidoPRT
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Initial and rate limiting step of de novo purine synthesis (adenine and guanine)
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“Purine disease”
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Gout
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Primary Gout
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Protein, Alcohol, Thiazides
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Secondary Gout
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Genetic (PRPP EXCESS, HGPRT deficiency = Lesch-Nyhan), Leukmia, Von Gierke’s (glycogen storage disease)
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PMNs required
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Acute gout
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Podagra
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Inflammation of 1st MTP (can also occur with osteoarthritis)
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Radiology for gout
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Rat bite lesion, tophi, cysts
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Acute Gout Tx
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NSAIDs (contraindicated if on coumadin); Colchicines, Corticosteroids
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Long Term Gout Tx
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Allopurinol (for OVERPRODUCTION) and Probenecid (Underexcretor)
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XO inhibitor
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Allopurinol and Febuxastat
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Knee and wrist
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Pseudogout (calcium pyrophosphate dehydrogenase)
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Chondocalcinosis
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Pseudogout; precipitation of Ca within cartilage
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Ankle and toe
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Gout (monosodium urate)
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Short term tx pseudogout
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NSAIDs, Corticosteroids
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Longer term tx pseudogout
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NONE
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Basic Calcium Pyrophosphate Disease (BCP)
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Hydroxyapetite only on EM! Milwaukee shoulder/knee syndrome (intense arthritis of dominant shoulder; tx w/ corticosteroids)
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Dialysis arthritis
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Basic Calcium Phosphate Crystal Disease; CAN SEE BCP crystals in and around joints
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“Candle dripping”
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Diffuse Idiopathic Skeletal Hyperostosis (DISH); osteophytes
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Cutaneous luekocytoelastic Angitis
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True hypersensitivity vasculitis; postcapillary venules inflammation; palpable patechiae; associated with meds and recent infection
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Essential Cryoglobulinemic Vasculitis
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Small vessel; Type II cryoglobulin hep C association; mouth ulcers; old men
Check for high RF! |
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Wegner’s Granulomatosis
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AKA Granulomatosis with polyangitis: Saddle nose deformity, sinusitis/URIs, nephritis, C-ANCA; 3 Cs of Wegner’s = 1) C-anca; 2) Cyclophosphamide; 3) Corticosteroids
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Microscopic Polyangitis
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Wegener’s WITHOUT granulomas
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Churg-Strauss Syndrome
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Allergic granulomatosis and angiitis; ASTHMA!
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Vasculitis + Eosinophilia
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Churg-Strauss Syndrome
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Saddle-nose deformity
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Wegener’s granulomatosis (AKA granulomatosis with polyangitis); necrotizing vasculitis, lung granulomas, glomerulonephritis; c-anca= antiserine proteinase 3
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Tissue deposition of Ig-A in post-capulary venules
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Henoch-Schonlein purpura
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Conjunctivitis + fever + Strawberry tongue + Coronary Aneurisms
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Kawasaki Disease
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Mononeuritis Multiplex
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Footdrop; seen with Polyarteritis nodosa; can also see with Sjogren's
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Granulomatous inflammation of aortic arch; weak/absent pulses in both upper extremities
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Takayasu arteritis
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Henoch-Schonlein Purpura
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Children; IgA complexes; palpable purpura; GI discomfort and renal disease
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Polyarteritis Nodosa
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Patchy distribution of vasculitis; renal, hep B, mononeuritis multiplex, KIDNEY DISEASE (hematuria)
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Unilateral headache, jaw claudication, impaired vision, inc ESR/CRP
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Temporal arteritis (tx with glucocorticoids); associated with polymyalgia rheumatica
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Acute Septic Arthritis Organisms
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Staph, Strep, Gonorrhea
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Chronic arthritis infectious agents
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Lyme (B. bergdorfi), and TB (myocbacteria)
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Mechanism of septic arthritis spread
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Most common = hematogenous; direct = injection; contiguous = children
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Gonorrhea Arthritis
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Monoarticular; migratory, asymmetrical; tx with cephtriaxone
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Parvovirus B19 septic arthritis
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Multiple joints; Symmetric, self-limiting; IgM positive; no permanent damage!
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HIV Associate dArthritis
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Associated with Spondyloarthropathies, Sjogren’s; usually hip/knee
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Osp-A
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Lyme Disease Arthritis; downregulated to move from gut to salivatory glands
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Lyme Arthritis
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Knee arthritis; large joint effusions!; enthesopathy; persistent is HLA-DR4 / antibodies to OspA; tx with doxycycline or ceftriaxone
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Complement Deficiency
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SLE; Scleroderma
(note that schogrens is deficiency in androgens!) |
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Anti-topoisomerase I
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Anti-Scl-70 antibody; associated with diffuse cutaneous scleroderma
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Anti-centromere
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CREST
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Treatment for Scleroderma
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NOT corticosteroids; alpha-1 blockers early then prostacylcins/PDE inhibitors/ET receptor blockers / cyclophosphamide; give ACE inhibitors for renal crisis
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Increase TGF-beta; decrease INF-gamma
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Scleroderma: causes fibrosis component (vascular component is IL-1)
TGF-B increase --> inc in collagen and ECM dep and dec in MMP activity! |
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Chronic GVHD
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Scleroderma
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