Pathology of Joints (Articular Cartilage)

What is the term for inflammation of a joint?

Arthritis

What is the clinical term for degeneration of articular cartilage?

Osteoarthritis

What is the MC joint disorder?

Osteoarthritis

What kind of osteoarthritis is insidious, oligoarticular, is the MC, and involves no significant trauma?

Primary

What kind of osteoarthritis is caused by a previous injury or deformity? This can include trauma or disease/deformity.

Secondary

Where are the common locations of osteoarthritis?

Cervical/lumbar spine

Knees and hips

DIP joints, 1st MCP joint, 1st TMT joint

What are the steps of osteoarthritis progression?

1. Matrix cracks (fibrillation)

2. Softens (chondromalacia)

3. Exposes subchondral bone

What is antoher term for matrix cracks?

Fibrillation

What are the signs of osteoarthritis?

Crepitus

Decreased ROM

Severe osteophytes may impinge nerve roots

Radiculopathy, spasm, atrophy

T/F: Osteoarthritis involves NO ankylosis.

True

What occurs in the medial joint space in osteoarthritis?

Narrowing of medial joint space

What occurs in the hands of osteoarthritis?

Heberden’s Nodes @ DIP

Bouchard’s Nodes @ PIP

Osteochondrosis is a group of disorders affecting what?

Growing bones and apophyses

What is another name for tibial tuberosity apophysitis?

Osgood-Schlatter Disease

What condition involves ‘wedge-shaped’ vertebrae, found above a 5 degree angle and more than 3 consecutive vertebrae?

Scheuermann’s disease

Scheuermann’s disease involves abnormalities of what?

Endplates

What is a defining feature of Scheuermann’s disease?

Schmorl’s nodes

What age range is MC affected by Scheuermann’s disease?

Adolescent (juvenile) males

What kind of arthritis is an inflammatory autoimmune disease that involves chronic and systemic inflammation?

Rheumatoid arthritis

What cells are involved in RA?

CD4+ T cells and macrophages

What does a diagnostic test look for when diagnosing RA?

Rheumatoid factor (TF)

also an IgM

What does RA affect first?

Small joints - hands/wrist, feet/ankles

RA involves instability of what joint?

Atlantoaxial

What is the defining tissue found in RA?

Pannus - destructive inflammatory tissue

What are some of the RA finger deformities?

Central slip (tendon) rupture

Volar plate (ligament) rupture

What group is MC affected by RA?

Women aged 30-50

Felty Syndrome is a combination of what conditions?

RA

Neutropenia

Splenomegaly

Caplan Syndrome is a combination of what conditions?

RA

Pneumoconiosis (fibrosis, lung condition)

What condition involves autoimmunity of multiple tissues in ages 16 or younger and pain/inflammation present for more than 6 weeks?

Juvenile Idiopathic Arthritis

T/F: Juvenile Idiopathic Arthritis is negative for RF.

True

What is the name for systemic JIA that involves arthritis and a spiking fever, rash, and pericarditis?

Still’s disease

What age is most commonly affected by JIA?

age 1-3

T/F: Seronegative Spondyloathropathies are RF negative and HLA-B27 positive.

True

What gene is involved in seronegative spondyloarthropathies?

HLA-B27

What joint is commonly affected by seronegative spondyloarthoropathies?

SI joints

What kind of arthritis is HLA-B27 positive and involves a history of psoriasis of skin?

Psoriatic arthritis

What are the features of psoriatic arthritis?

Mutilans

Enthesiopathy

Swelling

Swollen digit

What is the defining feature of enteropathic arthritis?

history of GI inflammatory disorder

What parts of the body are primarily affected by enteropathic arthritis?

SI joint

Axial skeleton

Arthritis

What disease is characterized by chronic inflammation, pain, and ankylosis that occurs in the axial skeleton SI joint) and sites of ligament attachment?

Ankylosing spondylitis

Who is primarily affected by ankylosing spondylitis?

Men prior to age 40

What condition is associated with sacroiliitis, enthesopathies, and syndesmophytes?

Ankylosing spondylitis

What disease involves ‘bamboo spine"?

Ankylosing spondylitis

What condition involves autoimmune cross reactivity with GI/GU pathogen, lower extremity arthritis, conjunctivitis, and urethritis?

Reactive arthritis

What is another name for reactive arthritis?

Reiter’s disease

What condition is indicated by ‘can’t see, can’t pee, can’t climb a tree’?

Reactive arthritis

Who is affected by reactive arthritis?

those with history of high-risk infections and high-risk HLA-B27

What disease is characterized by acute shoulder pain and myalgia?

Polymyalgia rheymatica

T/F: Polymyalgia rheumatica response well to corticosteroids.

True

Who is affected by polymyalgia rheumatica?

Older women with history of temporal arteritis

Where is gout MC found?

Big toe

What disease is characterized by abnormal uric acid/crystals deposited in synovial joints and involves the cardinal signs of inflammation?

Gout

What accumulates in gout?

Uric acid and monosodium urate crystals

What causes gout?

abnormal purine metabolism

What is a key feature of chronic gout?

Tophus

What condition involves altered pyrophosphate metabolism?

Calcium Pyrophosphate Deposition Disease (CPDD)

What are the three stages of gout?

1. Asymptomatic Hyperuricemia

2. Acute Gouty Arthritis

3. Chronic Tophaceous Arthritis

Where is CPDD most commonly found?

Knee

What demographic is primarily affected by CPDD?

50+ with pre-existing arthritis

What condition is characterized by calcification of tendons, primarily the supraspinatus?

Hydroxyapatite deposition disease (HADD)

Who is affected by HADD?

age 40+ with pre-existing shoulder issues

What does DISH stand for?

Diffuse idiopathic skeletal hyperostosis

What ligament is affected by DISH?

Anterior longitudinal ligament

T/F: DISH is non-inflammatory.

True

What age group is affected by DISH?

50-70

What condition should be associated by hyperglycemia?

DISH

What is the most common cause of infections arthritis?

Bacterial - staph aureus

What are the symptoms of suppurative arthritis?

Pain, decreased ROM, fever, increased ESR

What is the identifying feature of lyme disease/tick bite?

Erythema chronicum migrans

What is a primary feature of phase 2 of lyme disease?

Migratory joint pain and myalgia