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70 Cards in this Set
- Front
- Back
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Synoviocytes synthesize
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Hyaluronic acid
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What triggers the degenerative process for cartilage matrix breakdown
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IL1 and TNF
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Osteoarthritis
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Progressive erosion of articulate cartilage, intrinsic disease instead of inflammatory disease, affects few joints, genetics and aging
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Joint mice
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Osteoarthritis, chunks of cartilage are loose bodies in the joint
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Joints have what type of cartilage
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Type 2
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Herbed nodules
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Prominent osteophytes at the distal interphalangeal joints common in women in osteoarthritis
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Rheumatoid arthritis
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Inflammatory disorder that affects the joints, skin, blood vessels, heart, lungs, and muscles; genetics, environment, and autoimmunity play a role
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Characteristics of rheumatoid arthritis
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Infiltration of lymphocytes in synovial stroma, increase vasculaity, aggregation of fibrin covering synovium and floating(rice bodies), accumulation of neutrophils in synovial fluid, osteoclastic activity in underlying bone, pan us formation
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Pannus
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Mass of synovium and synovial stroma consisting of inflammatory cells, granulation tissue, and synovial fibroblasts which grow over articulate cartilage and cause erosion
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Fibrous ankylosis
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Pannus bridges the opposing bones which eventually ossifies
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Rheumatoid nodules
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Central zone of fibroid necrosis surrounded by epitheliod histocytes and numerous lymphocytes
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Rheumatoid arthritis is triggered by
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Exposure of a genetically susceptible host to an arthritogenic antigen resulting in a breakdown of immunological self tolerance
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Genes in rheumatoid arthritis
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HLADRB1 and PRPN22
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Most individuals with rheumatoid arthritis have autoantibodies to
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The Fc portion of autologous IgG (IgM) and citruline modified peptides (CCP)
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What cytokine is firmly implicated in rheumatoid arthritis
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TNF
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Pattern of joint involvement in rheumatoid arthritis
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Symmetrical and the small joints are affected before larger ones; joints are swollen, warm, painful, and particularly stiff on arising or following inactivity
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What are lab indicators on rheumatoid arthritis
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Rf and antiCCP
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Patents on antiTNF agents are more susceptible to
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Tuberculosis
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Juvenile idiopathic arthritis
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Develop before 16, lots of joints, systemic, larger joints over smaller joints, Ana positive
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Systemic arthritis
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Abrupt onset, high fever, rash, hepatosplenomegaly, aero sites
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Oligoarthritis
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Affects 4 or fewer joints during the first six months in the absence of psoriasis and HLAB27, associated with iridoclyitis and positive Ana
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Runaround factor negative poky arthritis
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Involves more than five joints, stiffness but little swelling
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Enthesitis related arthritis
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Male children younger than six, HLAB27 positive, affects tendoligamentous insertion sites and joints in the lower extremities
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Ankylosing spondyloathritis
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Aka rheumatoid spondylitis or Marie strumpell disease, destruction of articulate cartilage and bony ankylosis of especially sacroiliac and apophyseal joints, inflammation of tendinoligamentous insertions and ossification, fusion of vertebral bodies, sever spinal immobility, low back pain, HLAB27, ARTS1 and IL23R
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Reiter syndrome
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Reactive arthritis defined by a triad of arthritis, nongonicoccal urethritis or cervicitis, and conjunctivitis, HLAB27; ankles, knees and feet, calcaneus spurs and bony outgrowths, sausage fingers or toes
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Enteritis associated arthritis
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Caused by yersinia, salmonella, shigella, and campylobacter; knees and ankles for about a year
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Psoriatic arthritis
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Affects peripheral and axial joints and enthuse and is associated with psoriasis; HLAB27 and HLACw6, joint involvement diverse
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Main cause of bacterial arthritis in children under two
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H. Influenza
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Main cause of bacterial arthritis in adolescents and young adults
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S. aureus
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Most cases of nongonicoccal bacterial arthritis involves what joint
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Single joint usually the knee
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Joints involved in tb arthritis
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Weight bearing joints
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Cause of lymes arthritis
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Bordelaise burgdorferi, large joints, HLADR, synovial Pannus
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What happens to arterial walls in lymes disease
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Onion skin thickening
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Causes of viral arthritis
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Alpha virus, parovirus B19, rubella, ebv, hep B and C
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Joints involved in tb arthritis
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Weight bearing joints
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Cause of lymes arthritis
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Bordelaise burgdorferi, large joints, HLADR, synovial Pannus
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What happens to arterial walls in lymes disease
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Onion skin thickening
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Causes of viral arthritis
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Alpha virus, parovirus B19, rubella, ebv, hep B and C
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Crystal induced arthritis causes
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Cytokine mediated cartilage destruction
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Humans lack what enzyme that breaks down unix acid
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Uricase
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Gout
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Transient acute attack arthritis, crystallization of urates within joints, appearance of Toni
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Tophi
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Large aggregates of urate crystals and the surrounding inflammatory reaction
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Uris acid is the end product of what
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Purine metabolism
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What reabsorbs urate in the kidney
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URAT1
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Two pathways in purine synthesis
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Purines are synthesized from nonpurine precursors and salvage (HGPRT)
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Leach nyham syndrome
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Lack of HGPRT, salvage pathway enzyme, x linked
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Risk factors for hyperuricemia
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After 30, genetics, alcohol, obesity, thiazides, lead toxicity
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Mono sodium urate is less soluble at what temp
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Low (toe)
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MSU crystals are phagocytized by
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Macrophages, activate NALP3 and protease caspases 1 which cleave IL18 and IL1B which causes expression of CXCL8 for localization of neutrophils
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Acute arthritis in gout is characterized by
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Dense neutrophil if infiltrates
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Gouty nephropathy
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MSU crystals in the renal medullary interstium, can cause urinary obstruction
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Four stages of gout
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Asymptomatic hyperuricemia, acute gouty arthritis, intercritical gout, chronic toothache outs gout
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Pseudo gout
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Calcium pyro phosphate crystals, ANKH-encodes a transmembrane pyro phosphate transport channel, develops in articulate matrix, meniscus and intervertebral discs, crystals are chalky white friable deposits that stain as oval blue purple aggregates, knees commonly affected
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Ganglion synovial cyst
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Located near joint capsule or tendon sheath, usually wrist, pea sized translucent nodule, myxoid degeneration of connective tissue, synovial cyst is herniation through joint capsule
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Tenosynovial giant cell tumor
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Benign neoplasm, colony stimulating factor fuses with collagen type four gene, chemo attractant for macrophages, red brown to orange yellow, resemble a walnut, presents in knees, can erode into adjacent bone and sift tissue
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Spindle cell
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Rod shaped, long axis,
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Small round cell
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Size of lymphocyte with little cytoplasm
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Epitheliod
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Polyhedral with abundant cytoplasm, nucleus is centrally located
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Liposarcoma
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Deep soft tissues of the proximal extremities and retro peritoneum, supernumerary rings and giant rod chromosomes, M2M oncogene that inhibits p53
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Lipoblasts
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Mimic fetal fat cells and contain round clear cytoplasmic vacuoles of lipid that scallop the nucleus
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Nodular fasciitis
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Pseudo sarcoma, volvar aspect of the forearm, chest or back; deep dermis, subcutis, or muscle; poorly defined margins, richly cellular fibroblasts, contains lymphocytes and rbcs
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Myosotis ossificans
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Metaplastic bone, athletic adolescents and young adults, musculature of the proximal extremities, fibroblast and mayo fibroblast cells surrounded by osteoblasts , entire lesion ossifies
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Fibromatoses
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Fibroblasts surrounded by dense collagen, palmar, plantar and penile
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Desmond tumors
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Deep seated fibromatosis, extra abdominal, abdominal, and intraabdominal, large masses, banal well differentiated fibroblasts, mutations in APC or B crate in genes; gray white, firm, portly demarcated, rubbery and tough
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Fibrosarcomas
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Deep soft tissues of the extremities, unencapsulated, infiltrating, soft, fish flesh masses often having hemorrhage and necrosis, slow growing, herringbone pattern, aggressive tumor
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Fibrohistocytic tumors
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Fibroblasts plus macrophages, firm small, mobile nodule present in the dermis and subcutis
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Skeletal muscle neoplasms are almost all
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Malignant
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Leiomyomas
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Benign smooth muscle tissue tumors, uterus, arrector pili muscles, predisposition to renal cell carcinoma
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Leiomyosarcoma
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Cigar shaped nuclei, retroperitoneal tumors, pinocytic vessels, surrounded by basal laminate, smooth muscle tumor
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Synovial sarcoma
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Deep soft tissue tumor in lower extremities, cells form glands or grow in cords, monophasic spindle cells, calcified concretions, SS18-SSX1, SSX2,and SSX4
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