Term
|
Definition
| "solid joints" provide structural integrity and minimal movement |
|
|
Term
| What are two examples of synarthroses? |
|
Definition
fibrous (cranial sutures, teeth/jaw)
cartilaginous (pubic symphysis) |
|
|
Term
| Joints with a joint space and wide range of motion are characteristic of what type of joint? |
|
Definition
|
|
Term
| What is the half life of cartilage? |
|
Definition
proteoglycans- weeks
type II collagen- years |
|
|
Term
| What is the most common joint disesase? |
|
Definition
|
|
Term
| What's another name for osteoarthritis? |
|
Definition
| degenerative joint disease |
|
|
Term
| T/F Osteoarthritis is characterized by/caused by inflammation. |
|
Definition
| false, osteoarthritis is not really an "itis" |
|
|
Term
| What is the pathological mechanism underlying osteoarthritis? |
|
Definition
| articular cartilage is eroded over time. This is a disease intrinsic to cartilage |
|
|
Term
| What are the typical features of osteoarthritis on clinical presentation? |
|
Definition
| age (aging) related, insidious onset (no apparent inciting event), oligoarticular |
|
|
Term
| What is secondary osteoarthritis? What causes it? Who gets it? Which joints does it affect? |
|
Definition
| ~5% of cases of osteoarthritis that presents in younger patients and is trauma related. Occurs in knees and hips (baseball elbow, basketball knees, etc.) |
|
|
Term
| What causes osteoarthritis? |
|
Definition
| multifactorial (multiple genes), and environmental factors such as aging and stress/trauma |
|
|
Term
| Describe the pathophysiology of osteoarthritis. |
|
Definition
| chondrocyte injury causes chondrocytes to proliferate (inflammatory mediators such as collagenase, protease, and proteoglycans), there is cartilaginous matrix remodeling and inflammatory changes of synovium and subchondral bone. Chronic inflammation and chondrocyte dropout causes marked loss of cartilage and extensive subchondral bone changes |
|
|
Term
| What is the morphology of osteoarthritis? |
|
Definition
| superficial tpye II collagen molecules are degraded, vertical and horizontal fibrillation and cracking, granular soft articular surface, chondrocytes die and are sloughed, cartilage is dislodged and "tumbles" into joint="joint mice" |
|
|
Term
| What happens when there is bone against bone in osteoarthritis? |
|
Definition
| exposed bone becomes the new articular surface and bone against bone friction causes burnishing. Apperance is that of ivory and is called "bone eburnation" |
|
|
Term
| What are the clinical symptoms of osteoarthritis? |
|
Definition
| pain that worsens with use, morning stiffness, limited ROM, one or few joints involved, heberden nodes in women, chronic progressive |
|
|
Term
| Which joints are commonly involved in osteoarthritis? |
|
Definition
| hips, knees, vertebrae, PIP, DIP |
|
|
Term
| T/F Rheumatoid arthritis is a localized joint disorder. |
|
Definition
| false! it is a chronic systemic disorder |
|
|
Term
| What tissues does rheumatoid arthritis affect? |
|
Definition
| joing, skin, heart, lungs, blood vessels |
|
|
Term
| What percent of the worlds population has rheumatoid arthritis? |
|
Definition
|
|
Term
| What is the typical RA pt? |
|
Definition
women are 3-5x more likely than men
age is >40 |
|
|
Term
| What morphological changes occur with RA. |
|
Definition
| nonsuppurative synovitis, destruction of articular cartilage and ankylosis of joint |
|
|
Term
|
Definition
| stiffness of a joint due to abnormal adhesion and rigidity of the bones of the joint which may be the result of injury or disease |
|
|
Term
| What is the histological appearance of RA? |
|
Definition
| dense, perivascular lymphocytic infiltrate, angiogenesis, increased vascularity, hemosiderin; free floating fibrin aggregates form rice bodies, superficial synovial neutrophilia, increased osteoclastic activity in underlying bone (erosions, subchondral cysts, osteoporosis), pannus formation |
|
|
Term
|
Definition
| a mass of synovium and synovial stroma consisting of inflammatory cells, granulation tissue, and fibroblasts, which grows over the articular cartilage and causes its erosion |
|
|
Term
| What percent of people have rheumatoid nodules? |
|
Definition
|
|
Term
| Where do rheumatoid nodules manifest? |
|
Definition
| pressure areas,= ulnar forearms, elbows, lumbosacral region |
|
|
Term
| What do rheumatoid nodules look like grossly? |
|
Definition
| subcutaneous round/oval nodules |
|
|
Term
| What do rheumatoid nodules look like histologically? |
|
Definition
| fibrinoid necrosis rimmed by activated macrophages and plasma cells |
|
|
Term
| What is fibrinoid necrosis? |
|
Definition
| necrosis in which the necrotic tissue has some staining reactions resembling fibrin and becomes deeply eosinophili, homogenous and refractile |
|
|
Term
| What is rheumatoid vasculitis? |
|
Definition
| in pts with high titer of RF, affects small to medium arteries, similar to polyarteritis nodosa (except kidneys are not usually involved) |
|
|
Term
|
Definition
| genetically predisposed person gets arthritogenic agent and tehre is a breakdown of self tolerance |
|
|
Term
| What genetic characteristics cause you to be susceptible to RA? |
|
Definition
|
|
Term
| What are the environmental arthritogens? |
|
Definition
| thought to be EBV, retroviruses, parvovirus, mycobacteria, borrelia, proteus, mycoplasma and citrullinated proteins (PERM PB, C, M) |
|
|
Term
| What type of autoimmune reaction causes RA? |
|
Definition
|
|
Term
| What is rheumatoid factor? |
|
Definition
| autoantibody to Fc portion of autologous IgG, usually IgM molecules |
|
|
Term
|
Definition
| disease activity (not causative) |
|
|
Term
| Besides RF, other antibodies found in RA patients are... |
|
Definition
| antibody to citrulline-modified peptides, anti-cyclic citrullinated peptide (CCP) antibodies |
|
|
Term
| What are the symptoms of RA? |
|
Definition
| variable, usually slow, insidious onset with generalized malaise, fatigue and muscle pain, joints become affected weeks to months later. Symmetric arthritis involving small joints that are swollen and painful, stiff in the morning and following activity |
|
|
Term
| What can you see on x ray of RA? |
|
Definition
| joint effusion, narrowing of joint space, loss of articular cartilage |
|
|
Term
| Which joints are generally affected by RA? |
|
Definition
| small joints: hands (MCP, PIP), wrist, elbow, ankle, knee |
|
|
Term
| What serologic tests are run for RA dx? |
|
Definition
| RF and anti-CCP antibody are fairly specific |
|
|
Term
| Diagnosis of RA requires at least ___ of the following criteria: |
|
Definition
4
morning stiffness, arthritis in 3 or more areas, arthritis of hand joints, symmetric arthritis, rheumatoid nodules, serum rheumatoid factor, characteristic radiographic findings |
|
|
Term
| What are the goals of RA tx and what drugs are used? |
|
Definition
| relieve pain and inflammaiton and stop or slow joint destruction; corticosteroids, methotrexate and TNF-antagonists |
|
|
Term
| How do you get infectious arthritis? |
|
Definition
| direct inoculation, bacteremia/sepsis, contiguous spread from soft tissue abscess, spread from osteomyelitis |
|
|
Term
| What are the systemic findings of infectious arthritis? |
|
Definition
| fever, leukocytosis, elevated sed rate |
|
|
Term
| What organisms cause infectious arthritis? |
|
Definition
| gonococcus, staphylococcus, streptococcus, haemophilus influenza, gram-negative bacilli |
|
|
Term
| infectious arthritis in a child under 2 yoa= |
|
Definition
|
|
Term
| infectious arthritis in late adolescence/ early adulthood= |
|
Definition
|
|
Term
| Infectious arthritis in older children and adults= |
|
Definition
|
|
Term
| Infectious arthritis in sickle cell disease pt= |
|
Definition
|
|
Term
| What age groups get infectious arthritis from TB? |
|
Definition
|
|
Term
| Describe where you get infectious arthritis by TB? |
|
Definition
| monoarticular, hips, knees, ankles |
|
|
Term
| What characterizes infectious arthritis caused by tb? |
|
Definition
| granulomas, caseous necrosis |
|
|
Term
| Chronic infectious arthritis caused by TB leads to... |
|
Definition
| joint destruction/fibrous ankylosis |
|
|
Term
| What is the appearance of lyme disease organisms? |
|
Definition
|
|
Term
| What is the course/symptoms of lyme dissease? |
|
Definition
| skin infection followed by dissemination (a few weeks to 2 years), arthritis involving large joints (knees, shoulders, elbows and ankles), migratory and transient |
|
|
Term
| What tyeps of crystals cause gout? |
|
Definition
|
|
Term
| What types of crystals cause pseudogout? |
|
Definition
|
|
Term
| At what uric acid level do you get crystal deposition in joints? |
|
Definition
|
|
Term
| What are the four stages of gout? |
|
Definition
| acute arthritis, chronic arthritis, tophi, urate nephropathy |
|
|
Term
| What are the predisposing factors to gout? |
|
Definition
| age of pt and duration of hyperuricemia, genetic predisposition, heavy alcohol consumption, obesity, drugs that reduce urate excretion, lead toxicity |
|
|
Term
| When is MSU less soluble? |
|
Definition
| at lower temperatures and in synovial fluid |
|
|
Term
| How is gout precipitated? |
|
Definition
| pricipitation event (trauma) releases nucleating agents that set off cascade |
|
|
Term
| What is the morphology of gout? |
|
Definition
| negatively birefrigent MSU crystals, dense neutrophilic infiltrate, crystals within neutrophils, macrophages, lymphocytes, plasma cells |
|
|
Term
| What does it mean to say that MSU crystals are birefrigent? |
|
Definition
| urate cyrstals appear yellow when their long axes are aligned parallel to that of a red compensator filter |
|
|
Term
| What is tophaceous arthritis? |
|
Definition
| follows multiple bouts of acute arthritis, urates may encrust articular surface, synovium becomes fibrotic and thickened, joint cartilage destruction --> bone erosions, ankylosis --> loss of joint function |
|
|
Term
| What is the pathognomonic hallmark of gout? |
|
Definition
|
|
Term
|
Definition
| urate crystal aggregates surrounded by macrophages, lymphocytes and foreign body giant cells |
|
|
Term
|
Definition
| joints, tendons, soft tissue, kidneys, skin |
|
|
Term
| What is gouty nephropathy? |
|
Definition
| MSU crystals in the renal medullary interstitium. May include intra-tubular uric acid crystals, tophus formation, uric acid renal stones |
|
|
Term
| What is the clinical course of gout? |
|
Definition
| asymptomatic hyperuricemia, acute gouty arthritis, intercritical gout, chronic tophaceous gout |
|
|
Term
| When does asymptomatic hypercemia occur in men? women? |
|
Definition
| puberty in men, menopause in women |
|
|
Term
| What is a typical presentation of acute new onset gouty arthritis? |
|
Definition
| sudden onset of excruiciating pain in the MP joint of big toe |
|
|
Term
| Where is a typical location of the 2nd episode of acute gouty arthritis? |
|
Definition
| instep, ankles, heels, knees, wrist, fingers, elbow |
|
|
Term
|
Definition
|
|
Term
| What is intercritical gout? |
|
Definition
gout that follows resolution of acute episode, may be forever (rare)
subsequent episodes within months to years |
|
|
Term
| How long after the first episode does chronic tophaceus gout occur? |
|
Definition
| average of 12 years after first episode |
|
|
Term
| What does chronic tophaceous gout look like on xray? |
|
Definition
| bone resorption and loss of joint space |
|
|
Term
| What are two other names for pseudo-gout? |
|
Definition
calcium pyrophosphate cyrstal deposition disease (CPPD)
chondrocalcinosis |
|
|
Term
| What populations (age and gender) are usually affected by pseudogout? |
|
Definition
|
|
Term
| What are the three categories of pseudogout? |
|
Definition
| sporadic, hereditary, and secondary |
|
|
Term
| What is secondary pseudogout? |
|
Definition
| secondary to previous trauma or metabolic derangements like diabetes, hyperparathyroidism, hemochromatosis, hypomagnesemia, hypothyroidism |
|
|
Term
| What is the gross morphology of pseudogout? |
|
Definition
| white-chalky friable deposits |
|
|
Term
| Where do calcium pyrophosphate crystals come from when they form pseudogout? |
|
Definition
| crystal seed joint from nearby articular matrix, menisci, intervertebral disks |
|
|
Term
| What do calcium pyrophosphate crystals look like microscopically? |
|
Definition
| geometric crystals, weakly birefringent |
|
|
Term
| What does it mean to say that pseudogout is weakly birefringent? |
|
Definition
| calcium pyrophosphate crystals appear blue when their long axes are aligned parallel to that of a red compensator filter |
|
|
Term
| What joints does pseudogout affect? |
|
Definition
| monoarticular or polyarticular; knees, wrists, elbows, shoulders, ankles |
|
|
Term
| How do you treat pseudogout? |
|
Definition
|
|
Term
| What percent of patients with pseudogout experience severe joint damage? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Where are ganglion located? |
|
Definition
| near joint capsule or tendon sheath, especially wrist |
|
|
Term
| What are ganglion made out of? |
|
Definition
| myxoid or cystic degeneration of conective tissue, not a true cyst because lacks epithelial lining, no communication with the joint space |
|
|
Term
|
Definition
| herniation of synovium through joint capsule or massive enlargement of bursa |
|
|
Term
| What do you call a synovial cyst in the popliteal space in pts with rheumatoid arthritis? |
|
Definition
|
|
Term
| What are synovial cysts lined with? |
|
Definition
| synovium that may be inflamed, fibrinous, or hyperplastic |
|
|
Term
| Is a tenosynovial giant cell tumor benign or malignant? |
|
Definition
|
|
Term
| How does a genetic mutation cause tenosynovial giant-cell tumors? |
|
Definition
| t(1;2)(P13;q37); fuses the promoter of collagen type IV to the coding sequence for colony-stimulating factor 1 (CSF1). CSF1 is chemoattractant for macrophages which then aggregate and infiltrate |
|
|
Term
| What age is associated with tenosynovial giant cell tumors? What gender? |
|
Definition
|
|
Term
| What do tenosynovial giant cell tumors look like microscopically? |
|
Definition
| neoplastic cells are polyhedral and make up only a small fraction of the lesion. Heavy infiltration of macrophages with hemosiderin and/or lipid, and multinucleated giant cells |
|
|
Term
| How do describe the gross presentation of diffuse tenosynovial giant cell tumors? |
|
Definition
| affects one or more joints (knee, hip, ankle). Synovium is "tangled mat of red-brown folds, finger-like projections, and nodules" Can erode adjacent bones and soft tissue |
|
|
Term
| What's another name for diffuse tenosynovial giant cell tumor? |
|
Definition
| pigmented villonodular synovitis |
|
|
Term
| What is the gross description of localized tenosynovial giant cell tumor variants? |
|
Definition
| localized attached to sheath (hand). Well-circumscribed; resembles "walnut", slowgrowing mass that is often painless |
|
|
Term
| What are the symptoms of tenosynovial giant cell tumors? |
|
Definition
| pain, swelling, locking of joint |
|
|
Term
| How do you treat tenosynovial giant cell tumors? |
|
Definition
| surgical, however lesions can recur often |
|
|
Term
|
Definition
|
|
Term
|
Definition
| degenerative osteoarthritis of the joints between the spinal vertebrae and/or neural foramina. May cause pressure on nerve root with subsequent sensory and/or motor disturbances such as pain, paresthesia, or muscle weakness in the limbs |
|
|
Term
|
Definition
| inflammation of the vertebra; a form of spondylopathy. In many cases, spondylitis involves one or more vertebral joints as well, which itself is called spondylarthritis |
|
|
Term
|
Definition
| defect of vertebra, particularly the pars interarticularis. Occurs most commonly in lumbar vertebrae 5 but can also occur in other lumbar vertebrae and thoracic vertebrae |
|
|
Term
| What is spondylolisthesis? |
|
Definition
| the anterior or posterior displacement of a vertebra or the vertebral column in relation to the vertebrae below |
|
|
Term
| What is a hangman's fracture? |
|
Definition
| type of spondylolisthesis in which the C2 vertebra is displaced anteriorly relative to the C3 vertebra due to fractures of the C2 vertebra's pedicles |
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