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Joints and Crystal Synovitis
Lectures 2 & 3
50
Medical
Professional
10/17/2011

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Cards

Term
Where is synovial tissue found? Not found?
Definition
Lining fibrous joint capsule, covers tendons & ligaments. Not on articular surfaces or menisci.
Term
What cell type coats the surface of synovial tissue?
Definition
Synoviocytes
Term
What are the 2 types of synoviocytes & how do they differ?
Definition

Type 1 (A): Phagocytic cells, therefore ↑ lysosomes/vacuoles

Type 2 (B): Synthesizing cells (make hyaluronate), therefore ↑ RER

Term
Main component of synovial fluid?
Definition
Glycosaminoglycans, specifically hyaluronic acid
Term
Physical characteristics of normal synovial fluid?
Definition
Clear, highly viscous (like egg whites)
Term
Function of synovial fluid?
Definition
Lubricate articular cartilage & provide nourishment via diffusion
Term
3 types of joint lubrication? + describe
Definition
1)Boundary - molecular film very thin,
2)Weeping - pressure to cartilage causes fluid to weep out,
3) Boosted - fluid in peaks & valleys
Term
Characteristics of Inflammatory synovial fluid?
Definition
Increased vloume, low viscosity, cloudy yellow, increased WBCs/PMNs
Term
What type of synovial fluid would be found w crystal synovitis or RA?
Definition
Inflammatory
Term
Characteristics of SEPTIC synovial fluid?
Definition
Increased volume, mixed viscosity, opaque, increased WBCs/PMNs, Gram +
Term
What type of joint is synovial?
Definition
Diarthrodial
Term
2 layers of joint capsule in synovial joints?
Definition
Outer=fibrous layer,
Inner=highly vascular synovial membrane
Term
Function of menisci in joints?
Definition
Fibrocartilagenous washer, aids in rotation stability.
Term
In which 3 joints would you find menisci?
Definition
Knee, radiocarpal joint, sternoclavicular.
Term
What does the Mucin Clot test test for and how?
Definition
Addition of acetic acid to normal joint fluid should cause all the hyaluronic acid (mucopolysaccharide) to clump into a mucin clot. In RA damage to the synovial cells causes decreased hyaluronate production & there is either no mucin clot or it just falls apart, making the lqd look cloudy.
Term
What mucopolysaccharide is found in the synovial fluid around joints & in the vitreous humor of eyes?
Definition
Hyaluronic acid
Term
What is hyperuricemia and why does it occur?
Definition
High concentration of uric acid in the blood due to overproduction or underexcretion.
Term
Which is more common, the overproduction or underexcretion of uric acid?
Definition
Underexcretion (90%)
Term
3 causes of uric acid overproduction?
Definition
1)Ethanol, 2)Genetics, 3)Myeloproliferative disorders (ie psoriasis)
Term
How can renal insufficiency contribute to gout?
Definition
Underexcretion of uric acid.
Term
4 drugs that can lead to underexcretion of uric acid?
Definition
Diuretics (CHF), low dose Aspirin, Heparin, Cyclosporine (transplant pts)
Term
When are women more susceptible to gout & why?
Definition
After menopause, estrogen has a uricosuric effect.
Term
4 phases of gout?
Definition
1)Asymptomatic Hyperuricemia, 2)Acute Gout, 3)Intercritical Gout, 4)Chronic Tophaceous Gout
Term
What causes pain in Acute Gout?
Definition
Precipitating uric acid crystals are being phagocytosed by WBCs causing an inflammatory cascade.
Term
During what phase is a good time to initiate uric acid lowering therapy?
Definition
Intercritical (eye of the storm)
Term
[image]
Definition
Term
What do gout crystals look like under the microscope?
Definition
Negatively bifringent (yellow when parallel to polarizing light), needle shaped, intracellular.
Term
What do pseudogout crystals look like under the microscope?
Definition
Positively bifringent (blue when parallel to polarizing light), rhomboid shaped
Term
What are pseudogout crystals made of?
Definition
Calcium Pyrophosphate
Term
How does Chronic Tophaceous Gout present?
Definition
Polyarticular synovitis & Tophi on joints.
Term
What are the 4 most common sites to be affected by gout?
Definition
Big toe, heel, ankle, instep
Term
What attributes of septic arthritis aspirate differentiate it from that of gout?
Definition
Low glucose (vs normal), extra-cellular crystals
Term
What would aspirate of a tophus look like under microscope?
Definition
Gout crystals but no cells
Term
What is the most important disease to r/o when diagnosing gout & why?
Definition
Septic arthritis, can cause irreversible destruction of cartilage in 2 days
Term
What bacteria is most likely to grow in synovial fluid w extracellular crystals & WBC >80,000?
Definition
Staph Aureus
Term
What is contraindicated in acute gout?
Definition
Uric acid lowering agents
Term
Treatment choices for acute gout?
Definition
NSAIDs, Colchicine, Intraarticular Steroids, Systemic Steroids
Term
How does colchicine prophylaxis prevent gout attacks?
Definition
Keeps tubules from forming --> stops macrophages from dividing
Term
What are 4 situations that would indicate initiation of Uric Acid lowering therapy?
Definition
1)Recurrent attacks (despite colchicine), 2)Uric acid stones (could be in kidney), 3)Tophi (could also be in kidney), 4)Prior to chemo (which lyses a ton o cells)
Term
Who would benefit from a Uricosuric agent?
Definition
Uric acid underexcretor
Term
Which uric acid lowering therapy is indicated for an overproducer?
Definition
Xanthine Oxidase Inhibitor
Term
Is hypercalcemia a risk factor for pseudogout?
Definition
Nope
Term
9 risk factors for pseudogout?
Definition
Hyperparathyroidism, hypothyroidism, diabetes, advanced age, acute illness, Wilson's disease, hemochromatosis, ochronosis, osteoarthritis
Term
4 most common sites for pseudogout?
Definition
knee, ankle, wrist, shoulder
Term
Risk factors for Milwaukee Shoulder?
Definition
Old lady w severe chronic synovitis, Overuse & osteoarthritis in dominant arm, Rotator cuff tear
Term
What is Milwaulkee Shoulder (pathogenesis)?
Definition
Rapidly progressive destructive arthritis due to Calcium Hydroxy Apatite deposition, CHA crystals are phagocytosed --> inflammatory cascade
Term
How does the CHA that causes Milwaukee Shoulder get into the joint fluid in the first place?
Definition
Overuse & wear n tear shears it off bone
Term
What is the method of diagnosis for Milwaukee Shoulder?
Definition
CHA crystals on Electron Microscope
Term
Treatment for Milwaukee Shoulder?
Definition
NSAIDs, colchicine, aspiration, intra-articular steroids, rehab
Term
What is the only true "cure" for Milkwaukee Shoulder?
Definition
Rotator cuff repair &/or complete shoulder replacement
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