Musculoskeltal System: Lec.4 - Joints

Front 1

Musculoskeltal System:
Lec.4 - Joints

Back 1

Musculoskeltal System:
Lec.4 - Joints

Front 2

Q4:

List some overall characteristics of
Osteoarthritis

Back 2

- Wear and Tear
- Degeneration of articular cartilage
- Weight bearing joints (knees, hips, spine)
- Asymetrical

Front 3

Q4:

What is the most common form of Arthritis?

Back 3

- OA
- Increased risk with age
- Affects at least one joint in 80% of people over 70yoa

Front 4

Q3:

Clinical Features of OA?

Back 4

-Insidious onset of joint stiffness
-Deep, aching joint pain, which -worsens with repetitive motion
-Decreased range of motion
-Crepitus
-Joint effusions and swelling
-Osteophytes may cause nerve compression

Front 5

Q3:

How does OA present on X-Ray?

Back 5

- Narrowing of the joint space due to loss of cartilage
- Osteosclerosis and bone cysts
- Osteophytes (osteophytic lipping)

Front 6

Q4:

What is the pathogenesis of OA?

Back 6

- DAMAGE TO THE CONDRACYTE
- Wear and tear damage, condrocyte injury and abnormal collagen activity
- predisposing factors, obesity, previous joint injury, DM, trauma, hemearthrosis, ochronosis (collection of metabolites

Front 7

Q4:

What joints are the worse with OA?

Back 7

- Knees, hips, and spine
- Assymetrical
- Eburnation (exposed bone become polished)

Front 8

Q4:

Osteophytes (bone spurs):
- Heberden nodes
- Bouchard nodes

Back 8

-Heberden nodes: osteophytes at the distal interphalangeal (DIP) joints

-Bouchard nodes: osteophytes at the proximal interphalangeal (PIP) joints.

Front 9

Q4:

Describe Rheumatoid Arthritis (RA)

Back 9

- A systemic, chronic, inflamatory disease characterized by progressive arthritis, production of rheumatoid factor, and extra-articular manifestations.

Front 10

Q4:

Give an overview of RA

Back 10

- Systemic autoimmune disease
(+) Rheumatoid factor
(+) Rheumatoid nodules

- Synovial proliferation
- Small joints (hands and feet)
- Symmetrical and Migratory

Front 11

Q4:

What is the incidence of RA?

Back 11

females > males (4:1)
Highest incidence at age 20-50
Genetic predisposition (HLA-DR4 and DR1)

Front 12

Q4:

What is the etiology of RA?

Back 12

- Thought to be an autoimmune reaction triggered by an infectios agent in a genetically susceptible individual.

Front 13

Q4:

Clinical features of RA?

Back 13

- Hand, wrist, knee, and ankle joints most commonly involvedd
- Symmetrical involvement
- Morning stiffness, that improves with activity
- Fusiform swelling interphalangeal (PIP) joint.

Front 14

Q4:

What is observed with x-ray inspection of the joints of someone with RA?

Back 14

- Juxta-articular osteoporosis and bone erosions
- joint effusion

Front 15

Q4:

What is the pannus formation?

Back 15

proliferation of the synovium and granulation tissue over the articular cartilage of the joint

Front 16

Q4:

What sorts of joint defformity are seen with RA?

Back 16

- Radial Deviation of the wrist and ulnar deviation of the fingers
- Swan neck: hyperextension of PIP and flexion of distal interphalangeal (DIP) joints
- Boutoniere: Flexion of PIP and extension of DIP joints

Front 17

Q4:

What sorts of proliferation will you see within the joint of someone with RA?

Back 17

- Lymphcyte round cell proliferation, almost like the inside of a lymph node

Front 18

Q4:

What types of lab tests can you run for RA?

Back 18

- RHeumatoid factor is + in about 80% of those with RA, Titer of RF correlates with the severity of arthritis and prognosis

Front 19

Q4:

what are,
Rheumatoid nodules

Back 19

- seen in about 25% of those with RA
- Composed of central fibroid necrosis, surrounded by epithelioid marcophages, lymphocytes and granulation tissue
-May also be found on heart valves, pericardium, spleen, lung.

Front 20

Q4:

What are some Extra-articular manifestations of RA?

Back 20

- Arteritis (Arteries may show acute necrotizing vasculitis due to circulating antigenantibody complexes
- Sjogren syndrome (15%)
- Felty Syndrome: RA+ Splenomegaly + neutropenia
-Caplan Syndrome : association with pneumoconiosis
-Amyloidosis

Front 21

Q4:

What is
Felty Syndrome?

Back 21

RA + Splenomegaly + neutropenia

Front 22

Q4:

What is
Caplan Syndrome?

Back 22

RA associated with pneumoconiosis

Front 23

Q4:

Ankylosing spondylitis

Back 23

-Occurs in young men with HLA-B27 (90%)
- Usually involves the SI joints and Spine
- May be associated with Inflammatory bowel disease

Front 24

Q4:

Reiter Syndrome?

Back 24

- Males > females onset 20-30yoa
- Classic triad (Conjunctivitis, urethritis, arthritis)
(can't see, pee, or take a knee)
- Arthritis often effects the kneens and ankles
-Onset often follows a venereal disease or bacillary dysentery
-Associated with HLA-B27 (90%)

Front 25

Q4:

Enteropathic Arthritis

Back 25

- Occurs in 10-20% of people with UC
- May develop peripheral arthritis or spondylitis
- May respond with treatment of the UC
- Associated with HLA-B27

Front 26

Q4:

Psoriatic Arthritis

Back 26

- Affects 5-10% of those with psoriasis
- Often mild and slowly progressive
- Pathology similar to RA
-Associated with HLA-B27

Front 27

Q4:

Suppurative arthritis, routes of infection?

Back 27

- Hematogenous spread (most common, seeding of joint durring bactermia)
- Spread from an adjacent site of infection
- Dirrect inoculation (needle of a joint, be sure skin is sterile.)

Front 28

Q4:

Common organisms for suppurative arthritis?

Back 28

- Gonococci
- Stph
- Strep
- Haemophilus influenzae
- Gram (-) bacilli

Front 29

Q4:

Describe,
Lyme Disease

Back 29

- Spirochete: Borrelia burgdorferi
- Arthropod-borne disease: deer ticks
- Skin Rash (erythema chronica migrans)
- Migratory arthritis (involving knees, shoulders, and elbows)
- Histologically silimar to RA
- CNS and Cardiac involvement

Front 30

Q4:

Define Gout

Back 30

Hyperuricemia and deposition of monosodium urate srystals in joints, resulting in recurrent bouts of acute arthritis

Front 31

Q4:

What is the pathogenesis of Gout?

Back 31

- Overproductoin or underexcretion of uric acid
- Primary gout 90% idiopathic
- Secondary gout (10%)
- excessive cell break down, as in leukemia
- renal disease
-Lesch-nyhan syndrome

Front 32

Q4:

What is the incidence of gout in men to women?

Back 32

men> women

Front 33

Q4:

Where does the disease present itself?

Back 33

- Great toe (podagra)
- Ankle
-Heal
-Wrist
(painful inflammation)

Front 34

Q4:

What is the goss and joint aspiratoin appearance, of gout?

Back 34

-Aspiration: Negatively bifriengent, needle shaped uric acid crystals

- Gross: Tophi appear as chalky white deposits, skin ulceration and destruction of adjacent joints may occur

Front 35

Q4:

Complication of Gout?

Back 35

- joint destruction
- uric acid renal calculi
- renal failure

Front 36

Q4:

Treatment of Gout?

Back 36

- NSAIDs
- Colchicine
-Probenecid
-Allopurinol

Front 37

Q4:

Pseudogout (chondrocalcinosis)

Back 37

- Age >50
- Deposition of calcium pyrophosphate crystals
- Positively birefringent (weak), rhomboid-shaped crystals (crystals are much larger and fatter)
- Knee joint most commonly involved
- Associated with many metabolic diseases (DM, hypothyroidism, ochronosis)
- May mimic RA or OA

Front 38

Q4:

Ganglion cyst

Back 38

- up to 1.5cm
- joint capsule or tendon sheath
- no communication with joint space
- tend to recur after excision

Front 39

Q4:

Synovial Cyst

Back 39

- Herniation of synovium through a joint capsule
- massive enlargement of a bursa

Front 40

Q4:

Pigmented villonodular Synovitis (PVNS)

Back 40

- True Neoplasm (not reactive lesion)
- Monoarticular - Knee in 80%
- Pain, locking, swelling, decrease ROM

Front 41

Q4:

Giant Cell Tumor of Tendon Sheath (GCT)

Back 41

- Slow growing & Painless
- Solitary lesion of wrist or finger

Front 42

Q4:

What are some common similarities to both GCT and PVNS?

Back 42

- cells look like synovial lining cells
-hemosiderin deposits in cells
- multinucleated giant cells

Front 43

Q4:

Describe
Synovial Sarcoma

Back 43

- Origin unclear
- <10% are really in the joint
- 20-40 years old
- 60-70% lower extremities