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Arthritis

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Information about Arthritis
Education

Published on February 27, 2008

Author: Bianca

Source: authorstream.com

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“Things may come to those who wait, but only the things left by those who hustle.” – Abraham Lincoln :  “Things may come to those who wait, but only the things left by those who hustle.” – Abraham Lincoln Pathology of Arthritis:  Pathology of Arthritis Dr. Venkatesh M. Shashidhar. Associate Professor of Pathology Fiji School of Medicine Joints::  Joints: Mobility - Cranial sutures  Shoulder joint. Articular cartilage – hyaline – friction res. Synovial fluid – lubric/nutri, Type A & B synoviocytes. Hyaluronidase Continuous production and absorption. Affected by Inflammation, immobility. Capsule, ligaments, menisci. Vascular, rich nerve supply – Art. Cartilage* Joints - Anatomy:  Joints - Anatomy Arthritis - Introduction:  Arthritis - Introduction Inflammation of joints - Common Common site for autoimmune injury Heart valves & Joints - damage – Exposure of hidden antigens. Infections. Degeneration – Age/Stress/life style Use it or Loose it….! Arthritis – Clinical features::  Arthritis – Clinical features: Pain  Inflammation - capsule, synovium, periosteum. Swelling:  inflammation, effusion, proliferation. Restricted movement  pain, fluid, synovial swelling, damage. Deformity  mal-alignment, erosion, ankylosis Arthritis Clinical Classification::  Arthritis Clinical Classification: Monoarthritis: Local, asymmetric, secondary. Acute: Bacterial, Trauma, Crystal, Reactive Chronic :Tuberculosis, Lyme, Fungal, Trauma, Tumors. Polyarthritis: Chronic, symmetric, systemic. Autoimmune, degenerative, Crystal. Rarely infective. Polyarthritis Classification::  Polyarthritis Classification: Autoimmune: Rheumatic, Rheumatoid, Ankylosing spondylitis, Reiter syndrome etc. Degenerative: Osteroarthritis Crystal Deposition: Gout – Monosodium urate CPPD - Pseudo Gout Infective - Septic, TB, Lyme etc. rare. Rheumatoid Arthritis:  Rheumatoid Arthritis Epidemiology of RA:  Epidemiology of RA Prevalence about 1% of US population Female : Male ratio = 2:1 Strong association with HLA DR4. Concordance in identical twins only 30% RA - Definition::  RA - Definition: Chronic Multisystem autoimmune inflammatory disorder primarily affecting joints producing a proliferative synovitis that often progresses to destruction of the articular cartilage and ankylosis. Etiology::  Etiology: Genetic Susceptibility: HLA DR4, or DR1 in 65% to 80% cases. Microbial inciting agent: Epstein-Barr virus, Borrelia & Mycoplasma Autoimmunity: IGM anti IgG – RA Factor. Helper T cell (CD4) against type II collagen & cartilage glycoprotein-39 Immuno-dysregulation in RA:  Immuno-dysregulation in RA T lymphocytes  type II collagen & superantigen  releasing cytokines  inflammation. B cells  IgM Rheumatoid factor – anti IgG. Macrophages surround RF factor complex  type III injury (immune complex)  cytokine release  inflammation damage. Morphology::  Morphology: Proliferative synovitis with lymphocytes (CD4), plasma cell & macrophages Pannus. Organizing fibrin (rice bodies). Neutrophils on the joint surface and fluid. Juxta-articular erosions, cysts & osteoporosis Fibrous ankylosis. Skin - Rheumatoid nodules Vasculitis (commonly of digital arteries) Early Destruction in RA::  Early Destruction in RA: Swan Neck Deformity RA - Clinical Features::  RA - Clinical Features: Morning stiffness. Arthritis in 3 or more joint areas. Arthritis of small hand joints. Symmetric arthritis. Rheumatoid nodules. Serum rheumatoid factor. Typical radiographic changes At least 4 features for diagnosis. N.Synovium - - R.Arthritis::  N.Synovium - - R.Arthritis: RA - Pannus::  RA - Pannus: RA - Pannus::  RA - Pannus: Hyperplastic inflammed synovium Extra-Articular RA:  Extra-Articular RA Rheumatoid Nodules Vasculitis Pleuritis Pericarditis Tendonitis Skin RA Nodule::  Skin RA Nodule: Skin RA Nodule::  Skin RA Nodule: Rheumatoid Nodule (skin)::  Rheumatoid Nodule (skin): Palisading Macrophages Central Fibrinoid Necrosis Joint involvement in RA::  Joint involvement in RA: Swan Neck Deformity in RA::  Swan Neck Deformity in RA: Joint Destruction in RA::  Joint Destruction in RA: Swan Neck Deformity RA Joint destruction, ankylosis::  RA Joint destruction, ankylosis: Osteoarthritis:  Osteoarthritis Degenerative arthrosis. (Osteoarthrosis) Osteoarthritis::  Osteoarthritis: Degenerative end result - (ageing) >80% in >65y. Progressive erosion & fibrillation of articular cartilage  forms Loose bodies. Large weight bearing joints. Hardened articular bone – eburnation. & Subarticular cyst formation in bone. Periarticular osteophyte formation. Mild inflammation but painful, morning stiffness. Limited range of movements Heberden nodes (F) Normal -- Femur Head -- OA:  Normal -- Femur Head -- OA Normal Osteoarthritis Femur Osteroarthritis::  Femur Osteroarthritis: Joint Mice or Loose Bodies::  Joint Mice or Loose Bodies: Spine Osteophytes (OA)::  Spine Osteophytes (OA): Radiologic Features::  Radiologic Features: nonuniform joint space loss, osteophyte formation, cyst formation subchondral sclerosis Sclerosis, ankylosis & deformity. Osteoarthritis::  Osteoarthritis: Narrow joint space Lipping – osteophyte Dislocation Osteoporosis. Osteophyte formation::  Osteophyte formation: Bone cysts in OA::  Bone cysts in OA: Osteoarthritis: Ankylosis:  Osteoarthritis: Ankylosis varus deformity of the knee and collapse of the joint space with destruction of the medial cartilage and the subchondral cortex (open arrowheads). Osteoarthritis::  Osteoarthritis: Lateral view of the left knee shows sclerosis with marked osteophyte formation (arrows). The osteophytes are best seen in this view. Osteoarthritis::  Osteoarthritis: Subchondral cysts (solid arrowhead) OA Fingers::  OA Fingers: OA Hip::  OA Hip: OA Hip: 1997, bilateral, joint space narrowing (arrows) at the hips that is worse on the left side :  OA Hip: 1997, bilateral, joint space narrowing (arrows) at the hips that is worse on the left side OA Hip: Subchondral sclerosis (solid arrowhead) and cyst (arrow) formation are also noted on the left side :  OA Hip: Subchondral sclerosis (solid arrowhead) and cyst (arrow) formation are also noted on the left side OA Hip:left hip arthroplasty :  OA Hip:left hip arthroplasty OA - Clinical Features::  OA - Clinical Features: pain worsens with activity & improves on rest. Instability of joints – Knee. Crepitus, limitation of motion. Muscle spasm, and tendon and capsular contractures. Early morning stiffness lasts 1 hour or more. bony overgrowth – interphalangeal joints distal(Heberden's) proximal (Bouchard's). Differentiating Features::  Differentiating Features: Rheumatoid Arthritis: Young, small joints Autoimmune. Synovial Inflammation synovium  Cartilage Osteoarthritis: Old, Large joints Degenerative. Cartilage degeneration. Cartilage  Synovium Arthritis Other :  Arthritis Other Infective, traumatic, secondary to systemic diseases. Seronegative arthropathies:  Seronegative arthropathies Ankylosing Spondylitis: Adolescent boys, HLA B27, axial joints (sacroiliac) Reiter Syndrome: Triad of arthritis, urethritis/cervicits & conjuctivitis Autoimmune but initiated by bacterial infection. Enteropathic Arthritis: Secondary to bowel infections (salmonella, shigella) HLA B27 positive Psoriatic Arthritis: 5% of patients, starts in DIP joints, similar to RA. Septic Arthritis::  Septic Arthritis: Gonococcal Arthritis::  Gonococcal Arthritis: Juvenile Rheumatoid Arthritis::  Juvenile Rheumatoid Arthritis: Before age 16 Multisystem involement - Spleenomegaly, Starts with systemic involvement unlike RA. No serum RA Factor – Seronegative Antinuclear Antibody (ANA) +ve  autoimmune. Big Toe in Gout::  Big Toe in Gout: Joint Destruction in Gout::  Joint Destruction in Gout: Gout Tophi::  Gout Tophi: Urate Crystals (Gout)::  Urate Crystals (Gout): Pseudo Gout:  Pseudo Gout Calcium PyroPhosphate Deposition disease CPPD Chondrocalcinosis. CPPD – (Chondrocalcinosis):  CPPD – (Chondrocalcinosis) Type A – Pseudo gout – Knee, men Type B – Pseudo rheumatoid - polyarthritis Type C – Pseudo OA + acute attacks, women Type D – Pseudo OA - acute attacks, hands Type E – Asymptomatic Type F – Pseudoneuropathic CPPD-Arthritis (pseudo gout)::  CPPD-Arthritis (pseudo gout): Pseudo Gout – Calcium pyrophoshate:  Pseudo Gout – Calcium pyrophoshate Ankylosing Spondylitis:  Ankylosing Spondylitis Marie-Strumpell Arthritis Young males, 90% HLA B27 + <1% Rheumatoid factor – seronegative. >25% have iritis 10% Aortic insufficiency Strongly familial, 100% concordance in monozygotic twins. AS - fusion of vertebral bodies due to bridging syndesmophytes.:  AS - fusion of vertebral bodies due to bridging syndesmophytes. Scoliosis in Ankylosing Spondylitis:  Scoliosis in Ankylosing Spondylitis Organisms in Reiter’s :  Organisms in Reiter’s Shigella Flexneri Salmonella S.typimurium – others Yersinia enterocolitica Campylobacter Jejuni Chlamydia trachomatis Ureaplasma urealyticum Arthritis Comparison::  Arthritis Comparison: Slide66:  "The gem cannot be polished without friction, nor man perfected without trials or problems (or exams)…!." --Chinese proverb Pathology of Reiter’s Syndrome:  Pathology of Reiter’s Syndrome Acute Synovitis Chronic changes (in some) Unilateral Sacroilitis Ascending arthropathy Ossification & enthesopathy Ileal, colonic or urethral - non specific mucosal inflammation Reiter’s Syndrome::  Reiter’s Syndrome: Iritis::  Iritis:

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