Osteoarthritis and Rheumatoid Arthritis Overview

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Questions and Answers

Which characteristic of the crystals formed in pseudogout can be observed histologically?

Round, smooth aggregates

Long needle-like shapes

Irregular, jagged forms

Ovoid blue-purple aggregates (correct)

What triggers the crystallization process in Calcium Pyrophosphate Crystal Deposition Disease?

Increased mineralization of cartilage

Degradation of articular cartilage proteoglycans (correct)

Inhibition of chondrocyte activity

Inflammation of synovial fluid

Which joints are most commonly affected by pseudogout?

Hips and wrists

Elbows and shoulders

Knees and ankles (correct)

Fingers and toes

What is the typical duration of joint involvement in pseudogout?

Several days to weeks Signup and view all the answers

What is the main therapeutic approach for managing pseudogout?

Supportive therapy Signup and view all the answers

What is the main clinical symptom of primary osteoarthritis?

Morning stiffness Signup and view all the answers

Which factor is NOT associated with the development of rheumatoid arthritis?

Vitamin D deficiency Signup and view all the answers

What is the estimated prevalence of rheumatoid arthritis in the United States?

Around 1% Signup and view all the answers

What is the primary pathologic feature of rheumatoid arthritis?

Destruction of articular cartilage Signup and view all the answers

In which demographic is rheumatoid arthritis most prevalent?

Women in their 30s to 50s Signup and view all the answers

Which of the following is a common treatment for osteoarthritis?

Intra-articular corticosteroids Signup and view all the answers

What autoimmune mechanism is suggested to trigger rheumatoid arthritis?

Citrullination of self-proteins Signup and view all the answers

Which joint symptom is NOT typically associated with primary osteoarthritis?

Electrical shock sensation Signup and view all the answers

What is pathognomonic of gout?

Tophi in various tissues Signup and view all the answers

Which joint is most commonly affected during the first acute attack of gout?

First metatarsophalangeal joint Signup and view all the answers

What is a common characteristic of the chronic phase of gout?

Development of tophi Signup and view all the answers

Which factor is NOT associated with the development of gout?

High physical activity Signup and view all the answers

In calcium pyrophosphate crystal deposition disease (pseudogout), which demographic is primarily affected?

Equal distribution among genders and races Signup and view all the answers

What treatment strategy is commonly employed to manage gout?

Lifestyle modifications and NSAIDs Signup and view all the answers

Which condition is associated with secondary calcium pyrophosphate crystal deposition disease?

Hyperparathyroidism Signup and view all the answers

What physiological change occurs in the synovium during gout?

Hyperplasia and fibrosis Signup and view all the answers

What symptom is most characteristic of reactive arthritis within several weeks of infection?

Low back pain Signup and view all the answers

What is the typical age range for the onset of symptoms in psoriatic arthritis?

30 to 50 years Signup and view all the answers

Which joint is predominantly affected in patients with psoriatic arthritis?

Distal interphalangeal joints Signup and view all the answers

What is the most common form of gout?

Primary gout Signup and view all the answers

What is the necessary plasma urate level for the development of gout?

Over 6.8 mg/dL Signup and view all the answers

What typically occurs in the kidneys during uric acid metabolism?

Resorption and secretion of uric acid Signup and view all the answers

Which of the following is a common feature of psoriatic arthritis compared to rheumatoid arthritis?

More frequent remissions Signup and view all the answers

What genetic markers are associated with susceptibility to psoriatic arthritis?

HLA-B27 and HLA-Cw6 Signup and view all the answers

What histologic feature is primarily associated with rheumatoid arthritis morphology?

Synovial cell hyperplasia and proliferation Signup and view all the answers

Which cell type is predominantly found in the dense inflammatory infiltrate of rheumatoid arthritis?

B cells Signup and view all the answers

What is a potential complication of untreated advanced rheumatoid arthritis?

Bony ankylosis Signup and view all the answers

In which locations are rheumatoid nodules most commonly found?

Forearm and elbows Signup and view all the answers

How can rheumatoid arthritis be distinguished from other types of inflammatory arthritis?

Presence of anticitrullinated protein antibodies Signup and view all the answers

Which joints are most frequently involved in rheumatoid arthritis?

Metacarpophalangeal and proximal interphalangeal joints Signup and view all the answers

What is the pattern of joint involvement in rheumatoid arthritis?

Symmetrical joint involvement Signup and view all the answers

What initial symptoms might indicate the onset of rheumatoid arthritis?

Malaise, fatigue, and generalized musculoskeletal pain Signup and view all the answers

Study Notes

Osteoarthritis

Typically affects individuals in their 50s, but a search for underlying causes is crucial in younger patients.
Symptoms: Joint pain worsening with use, morning stiffness, crepitus (crackling sound), and limited range of movement.
Can cause cervical and lumbar nerve root compression due to osteophytes, leading to radicular pain, muscle spasms, atrophy, and neurological deficits.
Treatment involves pain management, non-steroidal anti-inflammatory drugs (NSAIDs), intra-articular corticosteroids, activity modification, and arthroplasty (joint replacement) for severe cases.

Rheumatoid Arthritis

Chronic inflammatory autoimmune disorder primarily targeting joints.
Leads to non-suppurative, proliferative, and inflammatory synovitis, often causing articular cartilage destruction, and potentially joint ankylosis (fusion).
Affects skin, heart, blood vessels, and lungs.
Prevalence in the US is about 1%, with women three times more likely affected than men.
Peak incidence occurs in the third through fifth decades of life.

Rheumatoid Arthritis: Pathogenesis

Genetic predisposition and environmental factors play a role.
50% of the risk is linked to inherited genetic susceptibility, particularly associated with HLA class II locus.
Environmental factors, such as infection and smoking, may promote citrullination of self-proteins, creating new epitopes that trigger autoimmune responses.

Rheumatoid Arthritis: Morphology

Histological features include synovial cell hyperplasia and proliferation, dense inflammatory infiltrates of CD4+ helper T cells, B cells, plasma cells, and macrophages, increased vascularity, neutrophils, fibrin aggregates, and osteoclastic activity in bone.
These changes produce a pannus: a mass of edematous synovium, inflammatory cells, granulation tissue, and fibroblasts that grows over the articular cartilage and causes erosion.
In advanced cases, the pannus can bridge bones, forming fibrous, and later bony ankylosis.
Rheumatoid nodules, representing necrotizing granulomas, can occur in subcutaneous tissue.

Rheumatoid Arthritis: Clinical Course

Distinguished from other polyarticular inflammatory arthritis by anticitrullinated protein antibodies and characteristic radiographic findings.
Often begins gradually with malaise, fatigue, and generalized musculoskeletal pain, progressing to joint involvement after weeks or months.
Joint involvement is typically symmetrical, most commonly affecting hands, feet, wrists, ankles, elbows, and knees, particularly metacarpophalangeal and proximal interphalangeal joints.

Reactive Arthritis

Develops within weeks of an initial infection, presenting with low back pain.
Most commonly affects ankles, knees, and feet asymmetrically.
Severe chronic cases can mimic ankylosing spondylitis affecting the spine.

Seronegative Spondyloarthropathies: Psoriatic Arthritis

Chronic inflammatory arthropathy associated with psoriasis involving peripheral and axial joints, ligaments, tendons.
Affects over 10% of psoriatic individuals.
Susceptibility is genetically determined, linked to HLA-B27 and HLA-Cw6.
Symptoms manifest between ages 30 and 50.

Psoriatic Arthritis: Clinical Course

Sacroiliac joints affected in 20%, but primarily a peripheral arthritis of hands and feet.
Distal interphalangeal joints are often the first to be affected in an asymmetric distribution, leading to the "pencil in cup" deformity.
Usually less severe than rheumatoid arthritis, with more frequent remissions and less joint destruction.

Gout

Marked by transient attacks of acute arthritis caused by monosodium urate (MSU) crystal deposition.
Primary (90% of cases): Gout is the primary manifestation, with an unknown cause.

Gout: Pathogenesis

Hyperuricemia (urate levels over 6.8 mg/dL) is necessary but not sufficient for gout development.
Uric acid is the end product of purine catabolism.
Uric acid is filtered by the glomerulus and resorbed by the proximal renal tubule.
A small fraction of resorbed uric acid is secreted by the distal nephron and excreted in urine.
Crystals on the articular surface and chalky deposits in the synovium trigger inflammation, hyperplasia, fibrosis, and thickening of the synovium, forming a pannus that destroys cartilage.

Gout: Morphology

Tophi, formed by urate crystal aggregations surrounded by foreign body giant cell reaction, are pathognomonic of gout, affecting articular cartilage, ligaments, tendons, and bursae.

Gout: Clinical Course

Affects males, obese individuals, those with metabolic syndrome, excessive alcohol consumption, renal failure, and those over 30 years old.
Clinical stages:
- Asymptomatic hyperuricemia: Starts around puberty in males and after menopause in females.
- Acute arthritis: After several years, sudden onset of excruciating joint pain, localized hyperemia, and warmth. Most initial attacks are monoarticular, with 50% affecting the first metatarsophalangeal joint.
- Asymptomatic intercritical period: Resolution of acute arthritis leading to a symptom-free interval.
- Chronic tophaceous gout: Develops on average 12 years after the initial attack.

Gout: Treatment

Lifestyle modification and medication are used.
NSAIDs reduce symptoms, and xanthine oxidase inhibitors lower urate levels.

Calcium Pyrophosphate Crystal Deposition Disease (Pseudogout)

Usually affects individuals over 50 and becomes more common with age.
Equally affects genders and races.
Can be sporadic (idiopathic), hereditary, or secondary.
Hereditary form is autosomal dominant, caused by germline mutations in the pyrophosphate transport channel, leading to early crystal deposition and arthritis.
Secondary forms are associated with conditions like previous joint damage, hyperparathyroidism, hemochromatosis, and diabetes mellitus.

Calcium Pyrophosphate Crystal Deposition Disease (Pseudogout): Pathogenesis

Proteoglycans in articular cartilage, normally inhibiting mineralization, are degraded, allowing crystallization around chondrocytes.

Calcium Pyrophosphate Crystal Deposition Disease (Pseudogout): Morphology

Crystals initially develop in the articular cartilage, menisci, and intervertebral discs.
Crystals form chalky, white friable deposits, appearing as oval blue-purple aggregates in H&E sections.
Individual crystals are rhomboid, 0.5 to 5 µm in size, and positively birefringent.
Inflammation is generally milder than in gout.

Pseudogout: Clinical Course

Often asymptomatic.
Can cause acute, subacute, or chronic arthritis lasting days to weeks, potentially affecting one or multiple joints, most commonly knees, then wrists, elbows, shoulders, and ankles.
Significant joint damage occurs in approximately 50% of affected individuals.
Treatment is supportive, with no known prevention of crystal formation.

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Description

This quiz covers essential information about Osteoarthritis and Rheumatoid Arthritis, including their symptoms, underlying causes, and treatment options. Understand the differences between these two prevalent types of arthritis, their impact on patients, and management strategies for effective care.