Term
| what is the most common dissability after heart disease |
|
Definition
|
|
Term
| what are the 3 most common symptoms of joint pathology |
|
Definition
| joint swelling, limitation of motion, pain of motion |
|
|
Term
| what is the most common joint disorder |
|
Definition
|
|
Term
| what is the most important cause of physical dissbility |
|
Definition
|
|
Term
| what are the risk factors for primary osteoarthritis |
|
Definition
|
|
Term
| what are the risk factors for secondary osteoarthritis |
|
Definition
| family history, excess weight, joint injury, complication of other arthritis, repetitive movement, disease |
|
|
Term
| what is the main problem in osteoarthritis |
|
Definition
| degeneration of articular cartilage causes it to get thin and crack |
|
|
Term
| in osteoarthritis once the cartilage cracks what happens |
|
Definition
chondromalacia
subchondral bone exposure > friction > bone eburnation > small fractures |
|
|
Term
|
Definition
| granular appearance cartiladge takes on in osteoarthritis after it cracks |
|
|
Term
|
Definition
| polished ivory look to bone after the subchondrial cartilage has been exposed in osteoarthritis and friction has occured |
|
|
Term
| what are the complications of small fractures after subchondrial cartiladge is exposed in osteoarthritis |
|
Definition
let synovial fluid in causing cysts and osteophytes
dislodge pieces causing joint mice
damage can progress to serious permanent joint deformity |
|
|
Term
| histologically/radiologically, what can be seen in osteoarthritis |
|
Definition
fibrosis
synovitis
cartiladge failure
hyaluronic acid depolymerized
subchondrial cysts
rought eburnated irregular bone
not symmetrical
sublexation
sclerosis
osteophyte |
|
|
Term
|
Definition
| cyst on bone just under cartilage |
|
|
Term
|
Definition
| boen is moved causing decreased joint space |
|
|
Term
|
Definition
whitening at edges of bone on x ray
how bone responds to repetitive movement |
|
|
Term
|
Definition
bone spur from bone on bone
often form due to vertebral disc degeneration |
|
|
Term
| how does it feel when somoene has osteoarthritis |
|
Definition
pain worsens with use in morning
grating feeling |
|
|
Term
| where is osteoarthritis usually located |
|
Definition
asymmetric
knees, hips, hands, spine
lipping of vertebral bodies |
|
|
Term
| where is osteoarthritis most common in women |
|
Definition
heberdens nodes: DIP swelling
bouchards nodes: PIP swelling
knees |
|
|
Term
| where is osteoarthritis most common in men |
|
Definition
|
|
Term
| where in the bone is septic arthritis in kids, what condition does it cause |
|
Definition
growth plate
hematogenous osteomyelitis |
|
|
Term
| where in the bone is septic arthritis in adults, what condition does it cause |
|
Definition
joint cavity
hematogenous infective arthritis |
|
|
Term
| how are septic arthritis microbes introduced |
|
Definition
osteomyelitis spreads
innoculation
soft tissue abscess
trauma
IV drug use |
|
|
Term
| location of septic arthritis |
|
Definition
asymmetric
monoarticular: knee mostly, hip, shoulder, elbow, ankle, wrist, SC |
|
|
Term
| clinical signs of septic arthritis |
|
Definition
extreme acute joint pain
red, inflammed, warm
defmority - can be permanent |
|
|
Term
| what are the two types of septic arthritis |
|
Definition
suppurative arthritis
lyme arthritis |
|
|
Term
| cause of suppurative arthritis in kids |
|
Definition
|
|
Term
| cause of suppurative arthritis in young women |
|
Definition
| if sexually active N. gonorrhea GPC |
|
|
Term
| how does N. gonorrhea septic arthritis present, what is a risk factor |
|
Definition
often with skin rash
increased gonorrhea dissemination with C5-7 deficiency |
|
|
Term
| cause of suppurative arthritis in people with sickle cell |
|
Definition
|
|
Term
| cause of suppurative arthritis in adults |
|
Definition
s. aureus GPC
E. coli GNR
pseudomonas GNR |
|
|
Term
| clinical signs of suppurative arthritis |
|
Definition
| fever, hot, swollen, tender joint |
|
|
Term
| lab signs of suppurative arthritis |
|
Definition
increased WBC, EST
synovial fluid: >50,000 WBC, >90% neutrophils |
|
|
Term
| what causes lyme arthritis |
|
Definition
| borelia burgdorferi spead by ioxdes deer tick |
|
|
Term
| why is lyme arthritis a big concern |
|
Definition
| needs to be tx quickly to prevent rapid destruction |
|
|
Term
| what are the three phases of lyme disease and their timeline |
|
Definition
acute illness - weeks
dissemination - weeks to months
late chronic - 2 to 3 years later |
|
|
Term
| what are the signs of acute illness lyme disease |
|
Definition
| tick bite causes erthematous papule, erthyema, cornicum magrans, lymphadenitis |
|
|
Term
| what are the signs of the dissemination stage of lyme disease |
|
Definition
| meningoencephalitis, cranial neuritis, heart block, pericarditis, myocarditis, hepatomeagly, lymphedema, arrhythmia |
|
|
Term
| what are the signs of the chronic stage of lyme disease |
|
Definition
| destructive chronic arthritis, acrodermatitis atrophicans, neuropathy, papillary synovitis, hyperplasia, fibrin, monocyte increase, onion skin arteries |
|
|
Term
| what causes chronic stage lyme disease |
|
Definition
| borella antigens attack joint |
|
|
Term
| location of lyme arthritis |
|
Definition
| large joints - knee, shoulder, elbow, ankle |
|
|
Term
| how is septic arthritis diagnosed |
|
Definition
50% will have positive blood culture
synovial aspirate |
|
|
Term
| what are the 5 synovial aspirate colors and their meaning |
|
Definition
1. cloudy - gout (urate crystals and WBC)
2. clear - normal or osteoarthritis
3. yellow - TA
4. orange - trauma (due to blood)
5. cloudy - septic or RA |
|
|
Term
| what are the WBC and PMN levels in normal, osteoarthritis, inflammatory arthritis, and septic arthriris joint fluid |
|
Definition
normal WBC <200, PMN <25%
osteoarthritis WBC <2000, PMN <25%
inflammatory arthritis WBC<50,000, PMN >75%
septic arthritis WBC >50,000, PMN >90% |
|
|
Term
|
Definition
women > men
usually 30-40 yo |
|
|
Term
| what disease does RA look like |
|
Definition
|
|
Term
|
Definition
HLA-DRB loci polymorphism on PTPN22 gene stops tyrosine phosphatase so it cannot stop CD4 activity
infections activate T and B cells and anto-CCP is made during inflammatory process |
|
|
Term
| how does RA cause destruction |
|
Definition
gene mutation activates TH1 and TH17 which activates....
...B cells, plasma cells, macrophages, cytokines (recruit more), inflammation. increasing collagenase which destories joint
...RANK which increases osteoclast activity which bridges opposing bones forming fibrous anylosis that ossifies
...accumulation of neutrophils in synovial fluid and surface
rheumatoid factors causes damage |
|
|
Term
| wha are rheumatoid factors, what do they do |
|
Definition
auto IgM that bind Fc on IgG and deposit in joints causing vascular syndromes
acute necrotizing vasculitis, fibrinous pleuritis, keritnoconjunctivitis |
|
|
Term
| what are histological / radiological signs of RA |
|
Definition
panus formation
rice bodies
chronic papillary synovitis
articular cartilage chondrolysis
villous hypertrophy and hyperplasia
bursa formation |
|
|
Term
| pannus: formation, composition, location |
|
Definition
synovium and stroma thicken and become hyperplastic and inflammed
inflammatory cells, granulation tissue, fibroblasts, stroma (B cells, CD4 Th, plasma cells, macrophages) |
|
|
Term
|
Definition
| aggregation of fibrin and synovium in joint space |
|
|
Term
| 5 causes of chronic papillary synovitis |
|
Definition
synovial cell proliferation
increased perivascular inflammation infiltrate (CD4 and macrophages)
increased vascularity (angiogenesis)
neutrophil/fibrin aggregates
increased osteoclast activity causes erosion |
|
|
Term
|
Definition
malaise, low fever
symmetric polyarticular arthritis
aching, stiffness - esp morning
enlarged joints
decreased ROM
ankylosis
swan neck deformity
bouronniere deformity
hammer toe
raynaud phenomenon
chronic leg ulcers
rheumatoid SC nodules |
|
|
Term
| what joints are involved in RA |
|
Definition
| PIP, MCP, spares DIP, sometimes C spine |
|
|
Term
| what is swan neck deformity |
|
Definition
| fingers stuck in swan like position in RA |
|
|
Term
| what is bouronniere deformity |
|
Definition
| bowing of pinkey outward in RA |
|
|
Term
|
Definition
|
|
Term
| clinical presentation of rheumatoid SC nodules |
|
Definition
seen in 25%
firm, non-tender, round
common on finger joints, spine, elbow, dorsal hand |
|
|
Term
| cause of rheumatoid SC nodules |
|
Definition
| central fibrous necrosis and macrophages surrounded by granulation tissue and WBC |
|
|
Term
| what is the minority of prognosis for RA |
|
Definition
| disease stabilizes or regresses |
|
|
Term
| what is the majority of prognosis for RA |
|
Definition
chronic remitting relapsiing course
surgical joint replacement may be needed (often after 15-20 y)
life expectancy reduced by 3-7 y |
|
|
Term
|
Definition
group of multifocal disorders due to enivornment and genetics
HLA PTPN22 genetic susceptibility and infection activation |
|
|
Term
| clinical signs of juvenile RA |
|
Definition
>6 weeks
swelling, pain, decreased function
oligoarthritis in 1-4 joints
possible systemic onset |
|
|
Term
| lab / histological signs of juvenile RA |
|
Definition
ANA seropositive
no RF or rheumatoid nodules |
|
|
Term
|
Definition
| often in large joints - knees, wrists, elbows, ankles |
|
|
Term
| signs of juvenile RA systemic onset (Still's disease) |
|
Definition
high fever
migratory transient skin rash
HSM
serositis |
|
|
Term
| cause of seronegative spondyloarthopathies - microbe hypothesis |
|
Definition
microbe (yersinia/klebsiella) causes immune response that cross reacts with HLAB71
HLAB27, yersinis, and klebsiella have similar proteins |
|
|
Term
| causes of seronegative spondyloarthopathies - enteropathy hypothesis |
|
Definition
| mucosal damage permits leakage of normal bacterial flora into circulation causing joint and initiate immune reaction |
|
|
Term
| three types of seronegative spondyloarthopathies |
|
Definition
ankylosing spondylitis
psoriatic arthritis
reiter syndrome |
|
|
Term
| define ankylosing spondylitis |
|
Definition
anylosing: immobilization of joint
spondylitis: inflammation of spone |
|
|
Term
| signs of ankylosing spondylitis |
|
Definition
|
|
Term
| cause of posriatic arthritis |
|
Definition
| not the same as other seronegative spondyloarthopathies, no HLDB27 involvement |
|
|
Term
| signs of psoriatic arthritis |
|
Definition
erosions
enthopathy: usually at insertion of achilles tendon and plantar fascia |
|
|
Term
|
Definition
| occurs with conjunctivits and uveitis |
|
|
Term
| histological / lab signs of seronegative spondyloarthopathies |
|
Definition
pathological causes in ligamentous attachments to bone rather than synovium
involvement of SI 0 sacroliliitis
no rheumatoid or serological factors
enthuses: changes at tendon and ligament insertions |
|
|
Term
| location of seronegative spondyloarthopathies |
|
Definition
joint inflammation of spine and peripherial joints
involvement of SI joints - sacroilitis |
|
|
Term
| diagnosis of seronegative spondyloarthopathies, why is it a concern |
|
Definition
| enthescopathy: can cause ossification at sites of enthuses |
|
|
Term
| why is RA synovial fluid cloudy or yellow |
|
Definition
| due to B cells, plasma cells, macrophages, cytokines (recruit more immune cells), and inflammation in synovium |
|
|
Term
| what does it mean if someone is RA seropositive |
|
Definition
| they have RA, some other autoimmune disease, or are just a "asymptomatic carrier" |
|
|
Term
| what does it mean if someone is ANA seropositive |
|
Definition
| they have juvenile RA or another autoimmune disease |
|
|
Term
| in general what is seronegative spondyloarthopathy |
|
Definition
| erosion that begins in ligament attached to bone, not syovium |
|
|
Term
| enteropathy: define, what disease is it in, where is it usually located |
|
Definition
insertion of achilles tendon and plantar fascia
ossification
psoriatic arthritis - seronegative spondyloarthopathy |
|
|
Term
| who is at the highest risk for gout |
|
Definition
men>women
30yo +
alcoholic
obese
diabetic
metabolic syndromes
renal failure
increased protein intake |
|
|
Term
|
Definition
chronic renal failure reduces urate excretion
cancer causes high turnover og nucleic acids
primary hyperuricemia 90%
lesh nyhan syndrome
secondary hyperuricemia 10% |
|
|
Term
| how does primary hyperuricemia cause gout |
|
Definition
reduced renal excretion (exacerbated by high protein or alcohol)
uric acid over production (abnormal purine production in salage or de novo pathway) |
|
|
Term
| how does lesh nyhan syndrome cause gout |
|
Definition
decreased salvage pathway enzyme
due to HGPRI gene mutation |
|
|
Term
| how does secondary hyperuricemia cause gout |
|
Definition
chemo, lymphome, leukemia, thiazide diruetics
causes cell lysis releasing urate |
|
|
Term
| what is occuring to cause gout |
|
Definition
| purine breakdown yields monosodium urates which are found in plasma, ECF, synovial fluid. >7mg/dL causes hyperuremia and build up in joints |
|
|
Term
| how do urate crystals cause symptoms |
|
Definition
phagocytosis by PMN cause lysis and release crystals which kill more neutrophils and release lysosomal enzymes, LTB4, prostaglandings, ROS which cause tissue inflammation and injury
phagocytosis by monocytes releases IL-1, TNF, IL-6, IL-8, which recruit more neutrophils and cause release of proteases from cartilage weakining it |
|
|
Term
| what do urate crystals looke like, how are they examined |
|
Definition
light yellow negative biefringent in polarized light
long, slender needles in cytoplasm and synovium |
|
|
Term
| what lab finding can help identify gout |
|
Definition
urate crystals plus...
neutrophil infiltrate in synovium! |
|
|
Term
| where is gout normally located |
|
Definition
| 90% monoarticular: 50% being in big toe |
|
|
Term
| what are the 5 phases of gout, how long do each last |
|
Definition
1. asymptomatic: unknown, often waits for males in puberty or post-menopause
2. acute arthritis: hours to weeks
3. intracritical gout: latentency, unknown timing
5. chronic trophaceous gout |
|
|
Term
| signs of acute arthritic gout |
|
Definition
| sudden pain, redness, swelling of joints |
|
|
Term
| signs of chronic trophaceous gout |
|
Definition
trophi
loss of digits
gout nephropathy
chronic trophaceous arthritis
podagra |
|
|
Term
|
Definition
| in chronic gout mass or urate surrounded by fibroinflammatory tissue causes bone erosion |
|
|
Term
| what causes gout nephropathy |
|
Definition
| medullary and intratubular trophi and crystals in caniculi |
|
|
Term
| what causes chronic trophacous arthritis, what is the effect |
|
Definition
| repetitive percipitation causes hyperplastic fibrous synovium leading to inflammation and pannus formation which destories cartilage and erodes bone |
|
|
Term
|
Definition
| inflammation of big toe due to crystal build up |
|
|
Term
| what is the prognosis of gout |
|
Definition
usually get second attack in a year or two
20% die from enal failure |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| Ca pyrophosphate crystals due to over production or decreased break down of pyrophosphate due to transporter mutation |
|
|
Term
|
Definition
failure of chondrocytes ro maintain ECM causing Ca pyrophosphate crystals to form and shed from cartilage into joint causing synovitis
crystal arthropathies caused by debris from prosthetic joints
first occurs in menisci/intervetebral disc and articular surface then ruptures causing inflammation |
|
|
Term
| what does the Ca pyrophosphate in pseudogout look like |
|
Definition
rhomboid shaped crystals
positively bifrinegent |
|
|
Term
| how long does pseudogout last |
|
Definition
|
|
Term
| where is pseudogout often located |
|
Definition
acute synovitis
knee most common
monoarticular |
|
|
Term
| what is chronic pyrophosphate arthropathy |
|
Definition
| a type of pseudogout that mimics primary osteoarthritis |
|
|
Term
| where is chronic pyrophosphate arthropathy usually located |
|
Definition
| in knee, hip, wrist, MCP, elbow |
|
|
