Glossary of Block VIII, Week VI
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- what is a dysostoses?
- congenital malformation, realtively benign
- what is a craniorachischisis?
- failure of closure of spinal column and skull
*meningomyelocele - when meninges herniates
*meningoencephalocele - when meninges AND CNS herniate
- inheritance of osteogenesis imperfecta?
mutation results in?
*defect in synthesis of collagen type I
- manifestations of osteogenesis imperfecta?
- prominent skeletal malformations
*leads to osteopenia
- which form of OI is lethal?
- OI type II
- where is the mutation in achondroplasia?
- short arm of chromosome 4
(FGF receptor 3)
- consequences of the FGF receptor - 3 mutation seen in achondroplasia?
- mutation causes FGF receptor 3 to be constantly activated -> this inhibits cartilage proliferation in growth plate)
- phenotype of an individual with achondroplasia?
shortened proximal extremities
normal trunk length
(normal intelligence, longevity, repr. status)
- osteopetrosis is due to?
- mutation in gene for osteoclast formation/function
(causes net bone overgrowth and increased bone density)
- what are the consequences of the following in osteopetrosis: bone lacks a medullary canal
- decreased hematopoiesis
-anemia (extramedullary hematopoiesis, hepatosplenomegaly)
- what are the consequences of the following in osteopetrosis: small neural foramina
- see nerve compression
-visual disturbance, deafness
- describe the bones seen in osteopetrosis
- "brittle bone disease" - bones fracture like a piece of chalk
- treatment for osteopetrosis?
- bone marrow transplant
- describe Albers-Schonberg disease
- *group of RARE genetic diseases that manifest as osteopetrosis
- describe AD type II osteopetrosis
- *more common benign form
*seen in adolescents/adults
*may be asymptomatic
*mild CN deficits
- describe the AR malignant type of osteopetrosis
- *infantile, severe, often fatal
*manifests in utero or shortly after birth
(if survive into infancy - CN entrapment, death from severe anemia, infections)
- what is an osteochondroma?
- benign cartilage outgrowth of the metaphysis, arises from the epiphyseal cartilage(growth plate) of long bones
- describe a solitary osteochondroma
- *slow growing mass, diagnose in late adolescence, young adult
*often incidental finding
*painful if nerve entrapment, fracture of stalk
*usually stop growing at time of growth plate closure
- describe a hereditary exostosis
- multiple osteochondromas, AD inheritance
*men affected 3x>women
*underlying bones may be bowed and shortened
- hereditary exostosis may have an increased risk of developing?
- describe a chondroma
- * benign tumor of hyaline cartilage
* develops from rests of growth plate cartilage
* cartilage rest proliferates and slowly enlarges
- what is an endochondroma?
- a chondroma that lies within the medullary cavity
- what is a juxtacortical or subperiosteal chondroma?
- a chondroma that lies at the bone surface
- are chondromas MC multiple or solitary?
- are chondromas usually symptomatic or asymptomatic?
- most often asymptomatic
(sometimes painful and cause pathologic fractures)
- both ollier's disease and maffuci syndrome are syndromes involving?
- multiple endochondromas
- 1. ollier's disease is?
2. Maffuci sydrome is?
- 1. multiple endochondromas
2. multiple endochondromas PLUS soft tissue hemangiomas
- maffuci syndrome may have an increased risk of developing?
- other malignancies
(ovarian carcinoma, brain gliomas)
- endochondromatosis in general has a risk of what kind of transformation?
- in pyogenic osteomyelitis, how do most bacteria reach the bone?
- hematogenous spread
- 80% of all cases of pyogenic osteomyelitis are caused by?
- Staph aureus
- virulence factors of S. aureus when it comes to pyogenic osteomyelitis?
- produces receptors to bone matrix components (collagen) -> facilitates adherence to bone tissue
- 3 bacteria that cause pyogenic osteomyelitis that could come from a GU tract infection or IV drug abuse?
- E. coli
- 2 bacteria causing pyogenic osteomyelitis in neonates?
- Group B strep
- which bacteria is known to cause pyogenic osteomyelitis in sickle cell disease patients?
- where is pyogenic osteomyelitis commonly found in diabetics?
- small bones in feet
- why is pyogenic osteomyelitis found in different locations depending upon the age of the patient?
- vascular circulation varies with age
- where is osteomyelitis MC found in neonates and why?
- metaphysis, epiphysis or both
(metaphyseal vessels penetrate the growth plate)
- where is osteomyelitis MC found in kids?
- metaphyseal leasions
- where is osteomyelitis MC found in adults and why?
- epiphyses and subchondral bone
(metaphyseal vessels reuinte with epiphyseal counterparts after growth plate closure)
- pathophysiology of pyogenic osteomyelitis?
- *bacteria proliferate in bone
*death of osteocytes
*necrosis of bone
3. Brodie abscess
- 1. dead piece of bone
2. sleeve of reactive bone surrounding sequestrum
3. intraosseous abscess walled off by reactive bone
- in infants: where does an epiphyseal osteomyelitis infection tend to spread
- symptoms of pyogenic osteomyelitis?
- variable (malaise, chills, fever, leukocytosis, throbbing pain in affected bone)
* adults - localized bone pain w/o fever
*infants - unexplained fever (more subtle)
- what would be seen in an Xray of a bone with osteomyelitis?
- lytic bone destruction with surrounding sclerosis
- treatment for pyogenic osteomyelitis?
- surgical drainage
- complications of pyogenic osteomyelitis?
- *acute flare-ups
*SCC in sinus tract
*sarcoma in infected bone (rare)
- 1/3 of patients with TB have this bone complication
- tuberculous osteomyelitis
- where is tuberculous osteomyelitis MC found?
- thoracic/lumbar vertebrae
(usually solitary, multifocal in AIDS)
- which is more destructive: tuberculous or pyogenic osteomyelitis?
- what is Pott's disease?
- tuberculous osteomyelitis, with involvement of the thoracic/lumbar spine
*see necrosis of intervertebral discs with extension to soft tissues (causes deformities)
- deformities and complications seen in Pott's disease?
- *permanent compression fractures -> kyphosis
*nerve impingement -> deficits
- 3 complications of pathologic fractures?
- overview of steps in fracture repair?
- soft tissue callus -> provisional callus -> Bony callus
- describe formation of a soft tissue callus
- *hematoma forms between broken bones
*this provides a firbin mesh which seals fracture stie
*osteoprogenitor cells are activated, see osteoclast and osteoblast activity
*formation of fusiform uncalcified soft tissue (no structural support)
- describe the formation of a provisional callus from a soft tissue callus
- *activated progenitor cells deposit trabeculae
*mesenchymal cells differentiate in to chondroblasts -> form fibrous and hyaline cartilage
*endochondral ossification occurs
- describe the formation of a bony callus
- remodeled and matured provisional callus (forms along weight bearing lines)
*unstressed portions are resorbed
*medullary cavity restored
- complications of fracture repair?
- *delayed healing/deformed callus
*devitalized bone fragments
*inadequate immobilization (may result in delayed union, pseudoarthrosis)
**complications may be caused by malnutrition, vascular insufficiency, systemic disease, old age**
- what is one reason that the elderly have an increased risk of osteoporosis?
- *decreased osteoblastic activity
- connection between physical activity and rate of bone loss?
- physical activity decreases the rate of bone loss
- a calcium deficiency at which time in life will put an individual at greatest risk of osteoporosis?
- rapid bone growth (adolescence)
*stunted peak bone mass
- changes in bone metabolism during menopause?
- *estrogen deficiency leads to increased osteoclast activity (increased IL-1)
- Rickets/Osteomalacia is a defect in bone mineralization due to?
- liack of vitamin D or a disturbance in metabolism
(results in accumulation of unmineralized bone matrix)
- manifestations of Rickets in children?
- rickets - "to twist"
irregular epiphyseal growth plates around kneww and wrist (bowed legs)
- what is osteomalacia and what does it result in?
- undermineralized bone, results in osteopenia and fractures
- what is seen upon Xray of rickets or osteomalacia?
- generalized osteopenia
also, stress fractures (multiple bilateral and symmetrical liner fractures)
- how is rickets or osteomalacia diagnosed?
- biopsy of long bone or iliac crest
adults - wide noncalcifies matrix of newly formed bone
kids - thickened, poorly defined growth plate
- metabolic bone disease is due to what parathyroid disorder?
- what is a musculoskeletal complication of hyperparathyroidism if it is not caught early?
- osteitis fibrosa cystica
- 1. two primary reasons for increased PTH?
2. secondary reasons for increased PTH?
- 1. hyperplasia or adenoma of PT gland
2. chronic hypocalcemia, renal disease, Vit. D deficiency
- for osteitis fibrosa cystica, describe:
1. early stage
2. second stage
3. third stage
- 1. increased osteoclastic acticity - osteitis
2. resorped bone replaced by fibrosis, hemorrhage, hemosiderin, microfractures (fibrosa)
3. cystic degeneration (cystica)
- what is a Brown tumor?
- reparative reaction, not a true tumor
(multinucleated cells, osteoclasts, hemosiderin, fibrosis, hemorrhage)
- skeletal changes due to chronic renal disease is called?
- renal osteodystrophy
- what are some manifestations of renal osteodystrophy?
- *increased resorption of bone
*delayed matrix mineralization
- describe osteonecrosis
- avascular/ischemic necrosis
-necrosis of bone and marrow IN THE ABSENCE OF INFECTION
- what is Legg-Calve-Perthes disease?
- osteonecrosis of the femoral head in children
- where does Osgood-Schlatter's manifest?
- tibial tuberosity
- pathophysiology of osteonecrosis?
- *initially necrosis of trabecular bone and marrow
*then see subchondral infarcts (triangular shaped necrosis with subchondral bone as its base)
*overlying articular cartilage normal
*creeping substitution (dead trabeculae serve as scaffolds for deposition of new living bone)
- gross manifestatons of osteonecrosis?
- intact overlying articular cartilage, underlying yellow necrotic area
- micro manifestations of osteonecrosis?
- *dead trabeculae with empty lacunae
*Ca++ salts due to necrotic fatty marrow
- other disorders associated with osteonecrosis?
thrombosis & embolism
- how common is Paget's disease?
(90% of patients >65 yrs)
MC in whites
- hypothesis for the etiology of paget's disease?
- slow virus infection (paramyxovirus)
- two types of Paget's disease?
- polyostotic (85%)
- where is polyostotic Paget's disease MC found?
- where is monostotic Paget's disease MC found?
- tibia, ilium, femur, skull, vertebrae, humerus
- late Xray findings for Paget's disease?
- increased bone density, loss of distinction between cortex and medulla
- Symptoms of Paget's?
- *mild localized pain due to microfractures
*high output CHF in polyostotic form (hypervascular bone)
- Labs in Paget's disease?
- elevated alk. phos.
elevated urinary hydroxyproline
- Rx. of Paget's disease?
- complications of Paget's?
- development of a sarcoma (osteosarcoma, malignant fibrous histiocytoma, chondrosarcoma)
- three phases/descriptions of Paget's disease?
- 1. osteolytic phase (excessive osteoclastic bone absorption, large osteoclasts with excessive nuclei)
2. mixed osteoclastic/osteoblastic phase (hectic bone formation)
3. osteosclerotic/burnt out phase (gain in bone mass but disordered, mosaic bone pattern, jigsaw puzzle)
- describe fibrous dysplasia
- localized developmental abnormality of bone forming mesenchyme, hyperfunction of mesenchymal cells, bone arrested at woven stage
- 3 MC locations of fibrous dysplasia?
- craniofacial bones
- in relation to fibrous dysplasia:
1. 70% of cases are of which type?
2. 27% of cases are of which type?
- 1. monostotic
- gender differences in monostotic fibrous dysplasia?
- where does monostotic fibrous dysplasia MC manifest?
- ribs, femur, tibia, jaw
- what is a major difference between monostotic and polyostotic fibrous dysplasia?
- monostotic - resolves after puberty
polyostotic - persists into adulthood (progression)
- describe the progression of polyostotic fibrous dysplasia
- recurring fractures, long bone and facial deformities
(rare malignant transformation)
- what is McCune Albright syndrome?
- polyostotic fibrous dysplasia + endocrinopathies
- describe the manifestations of McCune-Albright syndrome
- cafe-au-lait spots
precocius puberty in girls
also see endocrinopathies (sexual precocity, hyperthyroidism, pituitary adenomas w/ GH secretion, primary adrenal hyperplasia)
*skin pigmentation on same side of body as bone lesion
- hypertrophic osteoarthropathy is due to a paraneoplastic syndrome. what are the three components seen?
- 1. clubbing of fingers
2. periostitis with new bone formation at distal end of long bones
- hypertrophic osteoarthropathy is MC seen with which cancer?
- bronchogenic carcinoma
- most bone tumors are benign in what age group and malignant in what age group?
- benign - kids
malignant - elderly
- clinical significance of an osteoma?
- benign, rare, slow growing (little clinical significance, but may obstruct sinus cavity, impinge on brain, eye; cosmetic problem)
- osteoid osteomas are MC in:
1. what age group
2. what sex?
2. what bones?
- 1. under 25 yrs
2. males (2:1)
3. femur/tibia (50%)
- why is an osteoid osteoma so painful?
- pain is caused by excess prostaglandin E2 produced by proliferating osteoblasts
(pain relief with ASA)
- Xray manifestations of an osteoid osteoma?
- small round lucency with variable mineralization surrounded by extensive sclerosis
- Treatment for an osteoid osteoma?
- what is the MC primary bone tumor after myeloma?
- pathophysiology of an osteosarcoma?
- *malignant spindle osteoblasts produce malignant bone matrix. *arise in the metaphyseal region of long bones (60% around the knee)
*associated with p53 mutation
- what would be seen upon Xray of an osteosarcoma?
- large destructive lesion or blastic mass
- What is Codman's triangle and what is it a result of?
- triangular shadow between cortex and raised periostium (result of reactive bone formation)
- clinical sx. of an osteosarcoma?
- painful, rapidly enlarging mass
(fracture may be 1st symptom)
- 10-20% of people with osteosarcoma have what else at the time of diagnosis?
- lung mets
- treatment of osteosarcoma?
limb salvage therapy
(5 yr survival - 70%)
- what is the 3rd MC bone malignancy after myeloma, osteosarcoma?
- chrondoma may arise from?
- chondrosarcoma MC effects:
1. what age group?
2. what sex?
3. what sites?
- 1. 40 yrs +
2. men > women
3. large bones (pelvis, ribs, femur, humerus, vertebrae)
- what is seen upon Xray of a chondrosarcoma?
- large tumor
- what does a chondrosarcoma look like grossly?
- pearly white or light blue
- micro characteristics of a chondrosarcoma?
- malignant chonrocytes produce cartilagenous matrix
- is a giant cell tumor of bone benign or malignant?
- benign (but locally aggressive)
- in a giant cell tumor of bone what forms the giant cells?
- fusion of monunuclear cells
- in relation to a giant cell tumor of bone:
1. MC age?
2. MC site?
- 1. 20-40 yrs
2. knee (but any bone can be involved)
- treatment for a giant cell tumor of bone?
- surgical curetage
(radiation only if surgery impossible)
- Ewing sarcoma involves what genetic mutation?
- 11:22 translocation
- age group affected by Ewing sarcoma?
- majority <20 yrs
- where does Ewing sarcoma MC arise?
- medullary cavity of diaphysis of long bones (femur, tibia, humerus, fibula)
- how does Ewing sarcoma present?
- painful enlarging mass
*site is tender, warm, swollen
- gross manifestations of ewing sarcoma?
- white fleshy/necrotic
- treatment for ewing sarcoma?
- preop chemo
- prognosis for ewing sarcoma?
5 yr survival ~75%
- what four carcinomas commonly metastasize to bone?
- what are the 3 pathways of spread for metastatic cancer to bone?
- 1. direct extension
2. lymphatic or hematogenous spread
3. intraspinal seeding
- which type of arthritis is caused by bacterial infections in general?
- pyogenic arthritis
- which type of arthritis is caused by mycobacterium tuberculosis?
- tuberculous arthritis
- which type of arthritis is a sequelae to a Group A Strep infection?
- arthritis of acute rheumatic fever
- which type of arthritis is caused by borrelia burgdorferi?
- Lyme arthritis
- pyogenic arthritis is also known as?
usual result of?
- acute suppurative arthritis
(usually the result of hematogenous spread, occasionally bacteria infect joints)
- what are the MC organisms in pyogenic arthritis?
- Cocci (gonococcus, staphylococcus, streptococcus)
Gram neg. bacilli (E.coli, salmonella, pseudomonas)
- MCC of pyogenic arthritis in children <2 yrs?
- H. infuenzae
- MCC of pyogenic arthritis in adults and older children?
- staph aureus
- MCC of pyogenic arthritis in sexually active young adults?
- N. gonorrhea
(oligoarthritis - only a few joints involved)
- MCC of pyogenic arthritis in sickle cell disease?
- predisposing conditions to pyogenic arthritis?
- IV drug abuse
- is pyogenic arthritis usually monoauricular or polyauricular?
(mainly large joints)
- describe the synovial effusion seen in pyogenic arthritis
- type III (septic,pus)
- in pyogenic arthritis, if the culture fails to yield a common pyogen - what should we be thinking?
- what would be seen upon a synovial biopsy of a joint with pyogenic arthritis?
- acute inflammation
(congestion, edema, neutrophilic infiltrates)
- tuberculous arthritis is a complication of?
- tuberculous osteomyelitis
primary TB infection
- what is the MC site of tuberculous arthritis?
(tuberculous spondylitis = Pott's disease)
- what type of effusion would be seen in a case of tuberculous arthritis?
- type III effusion (septic)
- what is seen in the synovium of a joint with tuberculous arthritis?
- granulomatous inflammation
(more destructive process than pyogenic arthritis - may see obliteration of the joint space, infection may erode the joint capsule)
- how is tuberculous arthritis diagnosed?
- tissue biopsy and culture
(see caseating granulomas and acid fast bacilli)
- arthritis of acute rheumatic fever primarily effects which age group?
- describe the arthritis seen in acute rheumatic fever arthritis
- *acute onset (few wks. after group A strep URI)
*polyarticular (large joints)
- what type of synovium is seen in acute rheumatic fever arthritis?
- type II (inflammatory, slightly turbid due to increased white cells, sterile culture)
- lyme disease is a multisystem infection. besides the joints, what else is affected?
- nervous system
- three manifestations/stages of lyme disease
- 1. erythema migrans (bullseye rash at bite site)
2. neurologic/cardiac abnormalities
- describe the clinical features of oligoarthritis seen in lyme disease
- *usually involves 1 or 2 large joints
*transient remitting migratory polyarthritis
*most resolve w/o permanent joint damage (may have chronic symmetric polyarthritis)
- describe the gross anatomic changes seen in lyme disease arthitis.
- resemble RA
*chronic proliferative synovitis, pannus formation
*hyperplastic "onion skin" thickening of arteriole walls
- treatment for lyme arthritis?
- what is the primary feature of RA?
- progressive inflammatory synovitis
destruction of synovial cartilage
- systemic affects of RA?
- may affect
- which sex is RA MC seen in?
- females (2-3x)
- where does RA begin?
- small joints
*hands - MCP and PIP
*feet (MTP and IP)
larger joint involvement follows (wrists,ankles, elbows, knees)
- describe the synovial fluid seen in RA
- type II (inflammatory)
-increased neutrophils, low mucin
- radiologic findings seen in RA?
- narowing of joint space
(loss of articular cartilage, bone erosions)
- describe some characteristic joint deformities seen in RA
- *destruction of tendons, ligaments, joint capsules (see radial deviation of wrist, ulnar deviation of fingers)
*deformed joints with no stability, limited to no ROM
- some complications of RA that may ultimately lead to fatalities?
- systemic amyloidosis
iatrogenic effects of therapy (GI bleeding due to NSAIDs, infections due to chonic steroid use)
- what can be found in the serum that helps us make the diagnosis of RA?
- serum rhematoid factor (seen in 80% of cases)
-not specifically diagnostic for RA, also occurs in collagen vascular diseases, others
- where are rheumatoid nodules most likely to develop?
- in skin subject to pressure (ulnar forearm, elbows, occiput, lumbosacal area)
- can rheumatoid nodules develop in the viscera?
(lungs, pleura, spleen, heart)
- what is the characteristic histology of a rheumatoid nodule?
- *central fibrinoid necrosis
*palisading epithelioid histiocytes, lymphocytes, plasma cells
- the pathogenesis of RA is multifactorial. major contributing factors?
*arthritogen (? microbial antigens)
*autoimmune (see activated CD4+ T cells, B-lymphocytes, immune complexes)
- some mediatiors of joint damage?
- what is the antimicrobial antigen that is thought to be arthritogenic?
- parvovirus B19
- the diagnosis of RA requires 4 of what?
- morning stiffness
arthritis in 3 or more joints
arthritis of typical hand joints
typical radiographic changes
- describe the panus found in RA
- *edematous and thick hypertrophic synovium
*may invade bone at articular margin, joint capsule, periarticular soft tissue
- micro characteristics of RA?
- proliferative/hyperplastic synovitis
increased vascularity with hemosiderin
- when is juvenile RA MC found?
which sex is it MC in?
- early childhood
- how long must a child have arthritis before it can be classified as juvenile RA?
- >6 wks
- what is meant if juvenile RA is classified as:
3. systemic variant
- 1. <5 joints involved (MC)
2. >5 joints
3. equal sexes, abrupt onset of fever, skin rash, hepatosplenomegaly
- how does childhood RA differ from adult RA?
- oligoarthritis MC
large joints > small joints
systemic onset more frequent
NO rheumatoid nodules
NO rheumatoid factor
HAVE antinuclear antibody
- how is childhood RA similar to adult RA?
- similar extra-articular manifestations
similar joint pathology
- what is a group of disorders with seronegativity for RA, have an association with HLA-B27, MC seen in young men?
- what are the 4 spondyloarthropathies?
- ankylosing spondylitis
- ankylosing spondyloarthritis MC affects which joints?
- axial (SI joint)
- ankylosing spondyloarthritis MC affects which sex?
- ankylosing spondyloarthritis is associated with what HLA?
- what is ankylosing spondylitis?
- inflammation of the teninoligamentous insertion sites
*see ossification and bony outgrowths
*leads to severe spinal immobility
- how do patients with ankylosing spondylitis present?
- low back pain that is chronic/progressive
- complications of ankylosing spondylitis?
- fracture of the spine
- which type of arthritis am I?
episode of non-infectious arthritis that occurs within 1 month of a primary infection elsewhere (AI rxn initiated by prior infx)
- reactive arthritis
- pathogen from GU system that can cause reactive arthritis?
- GI pathogens that can cause reactive arthritis?
- mechanism of LPS causing reactive arthritis?
- LPS antigen stimulates an immune response - see an abrupt onset in knees and ankles which lasts about a year
- what is the triad seen in reiter's syndrome?
nongonococcal urethritis or cervicitis
"can't see, can't pee, can't climb a tree"
- joint symptoms seen in reiter's syndrome?
- low back pain
- clinical course of reactive arthritis?
- *waxes and wanes over several weeks to months
*50% have functional disability (recurrent arthritis, tendinitis, fasciitis, lumbosacral back pain)
- psoriatic arthritis primarily affects which joints?
- DIP of hands and feet (symmetric)
*may involve large joints or SI joints
- extraarticular manifestations of psoriatic arthritis?
- what is the MC form of joint disease?
(intrinsic disease of articular cartilage)
- where is OA commonly seen?
- hips (men)
knees and hands (women)
- secondary OA is due to a predisposing condition. examples?
- *abnormal mechanical stressors (sprotes, congenital defects)
*underlying systemic disease (DM, obesity)
- etiology of primary OA?
("wear and tear arthritis")
- what is chondromalacia?
- a subcategory of OA
affects patellar surface of femoral condyles of young persons (produces pain and stiffness of the knee)
- what are Heberden nodes
- osteophytes at the DIP joints of the fingers, characteristic in women and seen in OA
- which joints in the feet are commonly affected in OA?
- first carpometacarpal joints
- besides fingers and feet: other joints that are affected in OA?
cervical, lumbar spine
- pathogenesis of OA?
- *degeneration of cartilage, weakening of cartilage network
*increased levels of IL-1, TNF, NO (appear to be responsible for cartilage changes)
*death of chondrocyte -> viable chondrocytes aggregate -> fibrillation -> parralel surface cracks -> synovial fluid fills cracks -> cracks become more vertical -> cartilage pieces break off -> loose bodies -> synovial inflammation/hypertrophy.
*eventually it's bone against bone
- biochemical abnomalities seen in OA?
- decreased proteoglycan content
increased water content
- clinical features of OA?
- moning stiffness
deep achy pain (worse w/use)
enlarged, tender, boggy, crepitus
- when would nerve root compression be seen in OA?
- when osteophytes impinge on spinal foramina
- what is seen upon Xray of a joint with OA?
- narrowed joint space
hypertrophied subchondral bone
subchondral bone cysts
osteophytes (peripheral bone/cartilage growths)
- cause of gouty arthritis?
- above what serum levels of uric acid does crystal deposition begin to ocur?
- risk factors for the development of gout?
- age>30 yrs
etoh, obesity, thiazides, lead toxicity
- uric acid is the end product of what metabolism?
- what are the two pathways of uric acid synthesis?
- 1. de novo (purines from nonpurine precursors)
2. salvage (free purine bases from breakdown of nucleic acids, HGPRT enzyme)
- why does uric acid crystallize in the joints?
- synovial fluid is a poorer solvent than plasma for urates
(also lower T in foot, therefore crystallize there)
- characteristics of synovium seen in acute gouty arthritis?
dense neutrophilic infiltrate
- what happens in acute gouty arthritis when the crystals are resolubilized?
- acute attack subsides
- describe the clinical s/s of acute gouty arthritis
- *sudden onset of excruciating pain
*extremely tender and warm joints with hyperemia
- where do most cases of acute gouty arthritis occur?
- first metatarsophalangeal joint (big toe)
*then see in ankles, heels, knees, wrists, fingers, elbows
- chronic gouty arthritis is repetetive urate crystal deposition from acute attacks. where do these crystals MC deposit?
periarticular joint tissue
(deposits become grossly visible)
- describe the synovium of chronic gouty arthritis
- Pannus - hypertrophy, fibrosis, inflammatory cells
(see cytokine mediated cartilage destruction and juxta-articular bone erosions -> loss of joint function)
- what type of synovial effusion is seen in gout?
- type IV synovial effusion
(grossly white-gray granular appearance, birefringent needle shaped crystals under polarized light)
- gross appearance of chronic gout?
- chalky white chunky deposits in and around joints in soft tissue
- what is a tophi?
- large aggregates/masses of urate crystals with surrounding inflammatory rxn. Involves articular and periarticular tissues
- what is gouty nephropathy?
- deposition of urate crystals in the renal medulla.
see tophi, intratubular precipitates, free uric acid crystals and uric acid renal stones
- four stages of gout?
- 1. asymptomatic hyperuricemia
2. acute gouty arthritis (monoarticular)
3. intercritical gout (recurrent-relapsing, polyarticular)
4. chronic tophaceous gout (bone erosion)
- "pseudogout" involves deposition of what kind of crystals?
- calcium pyrophosphate crystals. (common in arthritic joints)
- avg. age of pts affected by calcium crystal arthritis?
- 50 yrs or older
- which areas does calcium crystal arthritis tend do affect?
- describe the hereditary variant of calcium crystal arthritis
- symptoms early in life
- secondary type of calcium crystal arthritis is associated with what disorders?
- prior joint damage
- what type of synovial fluid is seen in calcium crystal arthritis?
- group IV
(chalky white deposits)
micro - see small rectangular crystals, weakly birefringent
- a synovial cyst in the popliteal space is known as?
- Baker's cyst
(herniation of the synovial membrane through the posterior joint capsule due to excess fluid)
- Baker's cysts are associated with?
- micro characteristics of a Baker's cyst?
- cyst lined by synovial epithelium
- treatment of a Baker's cyst?
- treat cause of excess fluid
- clinical s/s of bursitis?
- pain, erythema, swelling of bursa
(result of chronic trauma)
- gross characteristics of bursitis?
- thickened, erythematous, shaggy bursal wall with fibrinous exudate
- micro characteristics of bursitis?
- fibrous scarring of the wall with chronic inflammation
- a cystic mass near a joint capsule or tendon sheath is called?
- where are the MC sites of a ganglion cyst?
- wrist and fingers
(due to overuse injury)
- gross characteristics of a ganglion cyst?
- small cystic mass
usually does not communicate with joint space
fluid similar to synovial fluid
- micro characteristics of a ganglion cyst?
- fibrous walled cyst with no synovial or epithelial lining
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