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Diseases of Joints


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Primary osteoarthritis clinical features of mild disease
(hands, spine)
no eburnation
heberden notes (osteophytes of DIP joints of hands)
primary osteoarthritis clinical features severe disease
(knee, hip)
secondary osteoarthritis definition
osteoarthritis resulting from derangements of joint function brought about by antecedent disease
histopathology of osteoarthritis
initial loss of proteolycan matrix around chondrocytes
fibrillation of cartilage, chondrocytic proliferation -> chondrocytic apoptosis and cartilage erosion
eburnation (dense reactive bone)
common causitive agenets of arthritis due to infection
staph aureus
H flu (kids)
pseudomonas (drug addicts)
salmonella (pts with sickle cell)
gonococci (sexually active young adults)
lyme disease, borrellia burgdoferi
immune complex mediated arthritis predisposing conditions (2)
hepatitis B and bacterial endocarditis. Viral/bacterial antigen and antibodies settling in joints
rheumatic fever arthritis clinical features
rheumatic fever following group a hemolytic strep
presents as migratory arthritis affecting large joints
transitory, no deformity
reactive arthritis features
acute sterile inflammatory arthritis after an infection remote from primary infection
includes reiter's syndrome
patients usually HLA-B27
juvenile rheumatoid distinction from rheumatoid arthritis
large joints more promintly involved than small joints
only a minority have rheuatoid factors
subcutaneus nodules are rare
pericarditis hepatitis and uveitis more common
excelent prognosis
3 clinical presentations of juvenile rheumatoid arthritis
polyarticular, oligoarticular, systemic
nasty complication of polyarticular juvenile rheumatoid arthritis
usually mild, but inflammation may distort bone growth leading to micrognathia (small mandible) if TMJ involved
major comorbidity of oglioarticular juvenile rheumatoid arthritis
clinical features of systemic juvenile rheumatoid arthritis (still's disease)
high fever
skin rash
chronic arthritis in minority
ankylosing spondylitis pathology, joints involved, symptoms, genetics
fibrosis and ossification at site of insertion of ligaments and joint capsules into bone
sacroiliac joints bilaterally and spine (ascending)
pain and progressive rigidity
95% have HLA-B27
Reiter's syndrome triad, cause, genetics
triad of arthritis, non gonococcal urethritis, and conjunctivitis
triggered by chlamydia urethritis or shigella dysentery
mostly male and 80% HLA B 27
enteropathic arthritis definition
arthritis in crohn's disease or ulcerative colitis
defect which causes gout
underexcretion or overproduction of uric acid
gout characteristics (5)
hyperuricemia (serum urate >7.0 mg/dl)
recurrent acute monarticular arthritis, often metatarsal phalnageal joint of big toe (podagra)
monosodium urate in leudocytes of synovial fluid
periarticualr aggregated deposits around joints (if large called tophi)
renal disease including kidney stones
pseudoggout characteristics (4)
1 arthritis attacks due to rupture o fpreformed clusters of calcium pyrophosphate from local avascular cartilage into synovial cavity
2 pain stiffness and heat over affected joint
3 precipitated by abdominal surgery stroke myocardial infarction etc
4 diagnosis by calcification of cartilage in x ra and confirmed by crystals of calcium pyrophosphate in synovial fluid
shape, number, and birefringence of urate (gout) vs calcium pyrophosphate (pseudogout) crystals
needle vs rhomboid
many vs few
negative vs weak positive

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