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Questions and Answers
What is the main cause of primary osteoarthritis?
Which of the following is a characteristic of osteoarthritis?
What typically increases in the cartilage during the early stages of osteoarthritis?
Which type of arthritis is characterized as being idiopathic and often affects older adults?
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What is a common trigger for secondary osteoarthritis?
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Which of the following changes is NOT associated with osteoarthritis pathology?
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What type of joint condition is classified as metabolic arthritis?
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Which of the following symptoms is commonly associated with inflamed joints in osteoarthritis?
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What progressive change occurs in articular cartilage during osteoarthritis?
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What structural change can occur at the margins of joints in osteoarthritis?
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Which of the following symptoms is commonly associated with osteoarthritis?
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What genetic susceptibility is strongly associated with rheumatoid arthritis?
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Which type of cells are predominantly activated in response to arthritogenic agents in rheumatoid arthritis?
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What type of antibodies are produced during the autoimmune response in rheumatoid arthritis?
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What is a common feature of Herberden nodes in osteoarthritis?
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What is a characteristic histological feature seen in rheumatoid arthritis?
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What may occur as a result of osteophytes impinging on spinal foramina?
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Which of the following describes the composition of the inflammatory infiltrate in the synovial stroma of rheumatoid arthritis?
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What result does the increased activity of osteoclasts in rheumatoid arthritis lead to?
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What is a possible extra-articular manifestation of rheumatoid arthritis?
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Which clinical finding is NOT typically used to diagnose rheumatoid arthritis?
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What is the process that leads to permanent ankylosis in rheumatoid arthritis?
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In patients with rheumatoid arthritis, where do rheumatoid nodules typically form?
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What causes the recurrent episodes of inflammatory arthritis in gout?
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What percentage of primary gout cases are attributed to renal under-excretion of uric acid?
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Which of the following conditions is NOT typically associated with secondary hyperuricemia due to excessive cell breakdown?
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What role do macrophages play in the pathogenesis of gouty arthritis?
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Which factor is NOT known to contribute to the development of symptomatic gout?
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What is the typical morphology of acute arthritis in gout?
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Which of the following is a common cause of secondary hyperuricemia due to renal under-excretion of uric acid?
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At what duration of hyperuricemia does gout typically develop?
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What is a necessary but not sufficient condition for the development of gout?
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What are tophi primarily composed of?
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Which joint is most commonly affected by acute gouty arthritis?
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What is NOT a characteristic feature of chronic tophaceous gout?
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What percentage of gouty subjects may experience gouty nephropathy?
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What is the primary cause of acute suppurative arthritis?
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Which organism is NOT commonly associated with bacterial arthritis?
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What distinguishes intercritical gout from other phases of gout?
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How does a joint typically get infected in acute suppurative arthritis?
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Study Notes
Common Joint Disorders
- Five major categories of joint disorders:
- Arthritis from specific microorganisms (e.g., septic arthritis, Lyme disease).
- Arthritis of unknown etiology (e.g., rheumatoid arthritis).
- Degenerative joint disease (osteoarthritis).
- Metabolic arthritis (e.g., gout).
- Trauma-related arthritis.
Clinical Features
- Pain: Inflammation affecting the capsule, synovium, or periosteum.
- Swelling: Caused by inflammation, effusion, or proliferation.
- Restricted Movement: Due to pain, fluid accumulation, synovial swelling, and cartilage damage.
- Deformity: Results from mal-alignment, erosion, or ankylosis.
Osteoarthritis (OA)
- Most prevalent joint disorder, particularly in individuals over 65 years.
- Typically affects large weight-bearing joints.
- Characterized by:
- Progressive articular cartilage deterioration and loss.
- Formation of bony outgrowths (osteophytes).
- Thickening and sclerosis of subchondral bone.
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Types:
- Primary (idiopathic): Age-related due to wear-and-tear, no initial cause.
- Secondary: Develops in younger people due to trauma or metabolic disorders.
Pathogenesis of Osteoarthritis
- Intrinsic disease of articular cartilage, involving significant changes in composition and mechanical properties.
- Early degeneration features increased water content, decreased proteoglycans, and weakened collagen networks.
- Elevated levels of inflammatory mediators such as IL-1 and TNF contribute to cartilage damage and increased apoptosis of chondrocytes.
Morphology of Osteoarthritis
- Early stages involve superficial cartilage degradation, leading to granular and softened articular surfaces.
- Fibrillation and erosion can form "joint mice" (loose bodies).
- Subchondral sclerosis leads to ivory-like bone consistency (eburnation) and the formation of fibrous cysts.
Clinical Course of Osteoarthritis
- Often asymptomatic initially but may develop joint pain, movement limitations, and crepitus.
- Osteophytes can cause nerve root compression, leading to radicular pain and spasms.
- Herberden nodes, small osteophytes on distal interphalangeal joints, are common in older females.
Rheumatoid Arthritis (RA)
- Chronic, systemic inflammatory disorder with a prevalence of around 1%, more common in women (3:1 ratio).
- Typically presents in young to middle-aged adults.
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Etiology:
- Genetic susceptibility linked to HLA DR4.
- Possible microbial triggers (e.g., Epstein-Barr virus).
- Autoimmunity involving rheumatoid factor (IgM anti-IgG).
Pathogenesis of Rheumatoid Arthritis
- Initiates in genetically predisposed individuals through T-helper cell activation in response to arthritogenic agents.
- Activated T-helper cells produce cytokines, leading to macrophage and synovial cell proliferation and subsequent synovitis.
- Presence of rheumatoid factor results in inflammation and joint damage.
Morphology of Rheumatoid Arthritis
- Synovium becomes edematous, thickened, and hyperplastic.
- Histology shows synovial hyperplasia, inflammatory infiltrates, increased vascularity, and bone erosion by osteoclast activity.
- Formation of "pannus," which can lead to cartilage and joint destruction.
Clinical Features of Rheumatoid Arthritis
- Diagnosis requires presence of at least four out of seven criteria, including morning stiffness, symmetrical arthritis, and rheumatoid nodules.
Gout and Gouty Arthritis
- Disorder of purine metabolism characterized by long-standing hyperuricemia and recurrent gouty arthritis.
- Often presents monoarticularly, particularly affecting the big toe (metatarsophalangeal joint).
- Family history of gout is present in about 25% of cases.
- Primary Gout: Caused by uric acid overproduction or under-excretion, with the latter being more common.
Pathogenesis of Gouty Arthritis
- Hyperuricemia is necessary for gout development but only affects about 10% of individuals with elevated uric acid.
- Contributing factors include age, genetic predisposition, alcohol consumption, and certain medications.
- Inflammatory response occurs when macrophages ingest urate crystals, leading to further inflammation.
Morphology of Gouty Arthritis
- Acute phase characterized by monosodium urate crystal deposition, causing neutrophilic inflammation.
- Chronic phase features tophi formation, visible as large deposits of urate surrounded by granulomatous inflammation.
Different Phases of Gout
- Phases: Asymptomatic hyperuricemia, acute gouty arthritis, intercritical gout, and chronic tophaceous gout.
- Gouty nephropathy can develop in 10-25% of patients due to crystal deposition in renal tubules.
Suppurative Arthritis (Septic Arthritis)
- Caused by joint infection from pyogenic microorganisms (e.g., Staphylococcus, Streptococcus).
- Typically monoarticular and involves purulent changes in the synovial membrane.
- Often spread hematogenously, leading to potential destruction of articular cartilage if not treated promptly.
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Description
Explore the various categories of joint disorders, including arthritis from microorganisms and trauma-related arthritis. Learn about the clinical features such as pain, swelling, and restricted movement, alongside a focus on osteoarthritis, the most prevalent joint disorder. This quiz will help solidify your understanding of these conditions.
