Common Joint Disorders Overview
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Questions and Answers

What is the main cause of primary osteoarthritis?

  • Trauma to the joint
  • An autoimmune response
  • Infection by microorganisms
  • Wear-and-tear over time (correct)

    • Which of the following is a characteristic of osteoarthritis?

  • Formation of bony outgrowths known as osteophytes (correct)
  • Formation of rheumatoid nodules
  • Classic morning stiffness lasting more than 30 minutes
  • Inflammatory synovitis

    • What typically increases in the cartilage during the early stages of osteoarthritis?

  • Level of collagen type II
  • Water content (correct)
  • Chondrocyte proliferation
  • Proteoglycan concentration

    • Which type of arthritis is characterized as being idiopathic and often affects older adults?

    <p>Primary osteoarthritis</p> Signup and view all the answers

    What is a common trigger for secondary osteoarthritis?

    <p>Joint trauma</p> Signup and view all the answers

    Which of the following changes is NOT associated with osteoarthritis pathology?

    <p>Increased synthesis of type II collagen</p> Signup and view all the answers

    What type of joint condition is classified as metabolic arthritis?

    <p>Gout</p> Signup and view all the answers

    Which of the following symptoms is commonly associated with inflamed joints in osteoarthritis?

    <p>Swelling and restricted movement</p> Signup and view all the answers

    What progressive change occurs in articular cartilage during osteoarthritis?

    <p>Granular and softer surfaces with small tears</p> Signup and view all the answers

    What structural change can occur at the margins of joints in osteoarthritis?

    <p>Bone outgrowths known as osteophytes</p> Signup and view all the answers

    Which of the following symptoms is commonly associated with osteoarthritis?

    <p>Crepitus during joint movement</p> Signup and view all the answers

    What genetic susceptibility is strongly associated with rheumatoid arthritis?

    <p>HLA DR4</p> Signup and view all the answers

    Which type of cells are predominantly activated in response to arthritogenic agents in rheumatoid arthritis?

    <p>T-helper cells</p> Signup and view all the answers

    What type of antibodies are produced during the autoimmune response in rheumatoid arthritis?

    <p>IgM anti-IgG rheumatoid factor</p> Signup and view all the answers

    What is a common feature of Herberden nodes in osteoarthritis?

    <p>They occur on the distal interphalangeal joints</p> Signup and view all the answers

    What is a characteristic histological feature seen in rheumatoid arthritis?

    <p>Synovial cell hyperplasia</p> Signup and view all the answers

    What may occur as a result of osteophytes impinging on spinal foramina?

    <p>Cervical and lumbar nerve root compression</p> Signup and view all the answers

    Which of the following describes the composition of the inflammatory infiltrate in the synovial stroma of rheumatoid arthritis?

    <p>Plasma cells and macrophages</p> Signup and view all the answers

    What result does the increased activity of osteoclasts in rheumatoid arthritis lead to?

    <p>Bone erosion</p> Signup and view all the answers

    What is a possible extra-articular manifestation of rheumatoid arthritis?

    <p>Rheumatoid nodules</p> Signup and view all the answers

    Which clinical finding is NOT typically used to diagnose rheumatoid arthritis?

    <p>Arthritis in one joint</p> Signup and view all the answers

    What is the process that leads to permanent ankylosis in rheumatoid arthritis?

    <p>Pannus formation and calcification</p> Signup and view all the answers

    In patients with rheumatoid arthritis, where do rheumatoid nodules typically form?

    <p>On extensor surfaces of the forearm</p> Signup and view all the answers

    What causes the recurrent episodes of inflammatory arthritis in gout?

    <p>Monosodium urate crystal precipitation</p> Signup and view all the answers

    What percentage of primary gout cases are attributed to renal under-excretion of uric acid?

    <p>90%</p> Signup and view all the answers

    Which of the following conditions is NOT typically associated with secondary hyperuricemia due to excessive cell breakdown?

    <p>Chronic renal disease</p> Signup and view all the answers

    What role do macrophages play in the pathogenesis of gouty arthritis?

    <p>They phagocytose monosodium urate crystals and recruit leukocytes.</p> Signup and view all the answers

    Which factor is NOT known to contribute to the development of symptomatic gout?

    <p>Chronic renal disease</p> Signup and view all the answers

    What is the typical morphology of acute arthritis in gout?

    <p>Pale, elongated, needle-like monosodium urate crystals with neutrophilic infiltrate</p> Signup and view all the answers

    Which of the following is a common cause of secondary hyperuricemia due to renal under-excretion of uric acid?

    <p>Ethanol consumption</p> Signup and view all the answers

    At what duration of hyperuricemia does gout typically develop?

    <p>After 20 to 30 years</p> Signup and view all the answers

    What is a necessary but not sufficient condition for the development of gout?

    <p>Hyperuricemia</p> Signup and view all the answers

    What are tophi primarily composed of?

    <p>Sodium urate</p> Signup and view all the answers

    Which joint is most commonly affected by acute gouty arthritis?

    <p>Metatarsophalangeal joint of the big toe</p> Signup and view all the answers

    What is NOT a characteristic feature of chronic tophaceous gout?

    <p>Sudden onset of joint pain</p> Signup and view all the answers

    What percentage of gouty subjects may experience gouty nephropathy?

    <p>10-25%</p> Signup and view all the answers

    What is the primary cause of acute suppurative arthritis?

    <p>Joint infection with pyogenic microorganisms</p> Signup and view all the answers

    Which organism is NOT commonly associated with bacterial arthritis?

    <p>Lactobacillus</p> Signup and view all the answers

    What distinguishes intercritical gout from other phases of gout?

    <p>It presents an asymptomatic interval.</p> Signup and view all the answers

    How does a joint typically get infected in acute suppurative arthritis?

    <p>Hematogenous spread</p> Signup and view all the answers

    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.
    • 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.
    • 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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    Common Joint Disorders PDF

    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.

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