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musculoskeletal system
1. pathology of osteoarthritis, rheumatoid arthritis, gout and chondocalcinosis
84
Bible Studies
Graduate
07/31/2012

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Term
slowly progressive destruction of articular cartilage that affects weight bearing joints and fingers of older persons or the joints of younger persons subjected to trauma
Definition
osteoarthritis
Term
the most common type of joint disease and one of the 10 most disabling conditions in developed nations
Definition
osteoarthritis
Term
an intrinsic disease of cartilage
Definition
osteoarthritis
Term
wear-tear arthritis and degenerative joint disease
Definition
primary osteoarthritis
Term
has a known underlying cause, including congenital or aquired incongruity of joints, trauma, crystal deposits, infection, metabolic diseases, endocrinopathies, inflammatory diseases
Definition
secondary osteoarthritis
Term
the biochemical changes of osteoarthritis mainly involved
Definition
proteglycans
Term
proteoglycan content and aggregation
Definition
decrease
Term
collagen fibers are
Definition
thicker than normal
Term
water content of osteoarthritic cartilage
Definition
increases
Term
cartilage is
Definition
fibrillated and swells
Term
occurs due to local increases in IL-1betha, TNF-alpha, and matrix metalloproteinase
Definition
condrocyte apoptosis, decreased type II collagen synthesis and extracellular matrix breakdown
Term
gene for type II collagen
Definition
COL2A1
Term
joints commonly affected by osteoarthritis
Definition
PIP, DIP, joints in arms, knees, hips, cervical spine, lumbar spine
Term
characterized radiologically
Definition
narrowing of joint space, increased thickness of subchondral bone, subchondral bone cysts, large peripheral growths of bone and artilage called osteophytes
Term
large peripheral growths of bone and cartilage
Definition
osteophytes
Term
empty lacunae in articular cartilage indicate
Definition
chondrocytes have died
Term
surface cracks parallel to the long axis of the articular surface
Definition
fibrillation
Term
induces inflammation resulting in hyperemic and hypertrophied synovium
Definition
pieces of articular cartilage break off and lodge in the synovium
Term
neovascularization from the epiphysis and subchondral bone induces
Definition
subchondral osteoclastic bone resorption and adjacent osteoblastic activity resulting in thickening of the subchondral bone plate
Term
after neovascularization a ______ forms as a poor substitute for the articular hyaline cartilage
Definition
fibrocartilage
Term
exposed areas of subchondral bone
Definition
eburnated (ivory like) bone
Term
eburnated bone cracks and allows synovial fluid to extend from the joint surface into the subchondral bone marrow producing
Definition
subchondral bone cyst
Term
usualy develops in the lateral portions of the joint
Definition
osteophyte (bony spurs)
Term
pearly grayish bone nodules in the periphery of the joint surface
Definition
osteophytes
Term
produces the "lipping" pattern seen on radiologi studies of the spine
Definition
osteophyte at lateral edges of intervertebral disks
Term
osteophyte at the distal interphalangeal joints
Definition
heberden nodes
Term
deep achy oint pain that follows activity and is relieved by rest
Definition
clinical hallmark of osteoarthritis
Term
pain arises in
Definition
pariarticular structures
Term
a systemic chronic inflammatory disease in which chronic polyarthritis involves diarthrodial joints symmetrically and bilaterally
Definition
rheumatoid arthritis
Term
cause of rheumatoid arthritis
Definition
unknown
Term
have pivotal roles in the development, progresion and chronicity of RA
Definition
genetic predisposition, environment, and autoimmunity
Term
10% of patients with classic RA are positive for
Definition
rheumatoid factor RF
Term
RA patients have increased levels of
Definition
IgM, IgA, IgG
Term
presence of RF in high titer is associated with
Definition
severe disease, many systemic complications, and a serious prognosis
Term
Joint destruction in RA reflects
Definition
local productoin of cytokines, especially TNF and IL-1
Term
most patients with RA develop antibodies against
Definition
a nuclear antigen in B cell infected with EBV
Term
RA joint pathology
Definition
infiltration of synovial stroma by a dense perivascular inflammatory infiltrate
Term
small fibrin nodules that float in the joint
Definition
rice bodies
Term
RA forms _____
Definition
pannus
Term
mass of synovium and synovial stroma consisting of inflammatory cells, granulation tissue, and synovial fibroblasts which grows over the articular cartilage and penetrates the subchondral bone
Definition
the pannus
Term
pannus may also involve
Definition
tendons and ligaments - deformities and instabilities
Term
forms when the pannus bridges the opposing bones
Definition
fibrous ankylosis which eventually ossifies and results in bony ankylosis
Term
found in extra-articular locations
Definition
rheumatoid nodule
Term
has a central core of fibrinoid necrosis
Definition
rheumatoid nodule
Term
RA initial signs
Definition
malaise, fatigue, generalized MSK pain
Term
____ joints are affected before _____ ones
Definition
smaller, larger. symmetrical pattern
Term
RA symptoms usually develop in the _____ and _______
Definition
hands, feet. followed by wrists, ankles, elbows, knees
Term
RA joints are
Definition
swollen, warm, painful, stiff
Term
clinical features to diagnose RA
Definition
1. morning stiffness
2. arthritis in three or more joint areas
3. arthritis of hand joints
4. symmetri arthritis
5. rheumatoid nodules
6. serum rheumatoid factor
7. typical radiographic changes
Term
most common cutaneous lesion in RA
Definition
rheumatoid nodules in areas of the skin that are subjected to pressure
Term
radiographic hallmarks of RA
Definition
joint effusions and juxtra-articular osteopenia with erosions and narrowing of the joint space with loss of articular cartilage
Term
acute necrotizing vasculatis (with RA) affects what organ
Definition
any
Term
increased serum uric acid and urate crystal deposition in joints and kidneys
Definition
gout
Term
fewer than __% of people with hyperuricemia have gout
Definition
15
Term
uric acid results from
Definition
purine catabolism
Term
uric acid is only eliminated in
Definition
urine
Term
normal blood uric acid level
Definition
>7 mg/dl men, >6 mg/dl women
Term
gout can result from
Definition
overproduction of purines
increased catabolism of nucleic acids due to greater cell turnover
decreased salvage of fre purine bases
decreased urinary uric acid excretion
Term
most cases 85% of idiopathic gout result from
Definition
unexplained impairment of renal uric acid excretion
Term
has a genetic predisposition
Definition
gout
Term
inherited, Xlinked deficiency of HPRT, a defect that enhances purine synthesis
Definition
lesch-nylan syndrome
Term
babies are normal but exhibit delays in development and neurological dysfunction within the first year
Definition
lesch-nylan syndrome
Term
heavy alcohol consumption predisposes to
Definition
gouty arthritis
Term
obesity increases the risk of
Definition
asymptomatic gout
Term
lead toxicity increases the tendency to develop
Definition
saturnine gout
Term
painful and red first metatarsophalangeal joint
Definition
podagra
Term
common in later course of gout
Definition
polyarticular involvement with fever
Term
urate crystals in synovial membrane stiumlate
Definition
acute inflammation
Term
diagnostic of gout
Definition
long needle shaped crystals that are negatively berefrigent under polaried light
Term
intercritical period of gout
Definition
asymptomatic interval between the initial acute attack and subsequent episodes (up to 10 years)
Term
appears in the untreated patient in the form of trophi in the cartilage, synovial membranes, tendons, and soft tissues
Definition
chronic tophaceous gout
Term
an extracellular soft tissue deposit of urate crystal surrounded by foreign body giant cells and associated inflammatory cells
Definition
tophus
Term
responsible for 10% of deaths in persons with gout
Definition
renal failure
Term
10% of all renal calculi in USA
Definition
urate nephropathy (urate stones)
Term
accumulation of calcium pyrophosphate dihydrate (CPPD) in synovial membranes (pseudogout), joint cartilage (chondocalcinosis), ligaments and tendons
Definition
calcium pyrophosphate dihydrate deposition disease
Term
etiology of CPPD
Definition
idiopathic, trauma, metabolic disorders, rarely hereditary
Term
half of those over 85 are affected with
Definition
CPPD deposition disease
Term
most CPPD cases in elderly are
Definition
asymptomatic
Term
self limited attacks of acute arthritis of gout like symptoms
Definition
pseudogout
Term
variant of CPPD depositions disease in which multiple joints are chronically involved
Definition
pseudorheumatoid arthritis
Term
characterized by joint destruction severe enough to resemble a neurtropic joint
Definition
pseudoneurotrophic disease
Term
CPPD deposits appear as
Definition
chalky white areas on carilaginous surfaces
Term
stubby short and rhomboid (coffin shapes)
Definition
CPPD crystals
Term
weak positive birefringence under polarized light
Definition
CPPD crystals
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