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Questions and Answers
Osteomyelitis is an inflammation of bone caused by infectious organisms such as Staphylococcus and Escherichia coli.
True
Calcium absorption in the gastrointestinal tract is increased in cases of hypocalcemia.
False
Primary osteoarthritis is characterized by a defect in cartilage and is not attributed to inflammation.
True
Osteoarthritis is classified as an inflammatory disease affecting joint cartilage.
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Septicemia is a potential complication of osteomyelitis.
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Osteophytes are associated with osteoarthritis and are commonly found in the distal interphalangeal joints of the fingers.
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Weight bearing joints are typically affected during the progression of osteoarthritis.
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Pathologic fractures are not a recognized complication of osteomyelitis.
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The formation of Heberden nodes is indicative of rheumatoid arthritis.
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Rheumatoid nodules are characterized by palisading macrophages and central fibrinoid necrosis.
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Osteoarthritis is characterized by limited range of movements and morning stiffness.
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In rheumatoid arthritis, the disease primarily affects the joints unilaterally.
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Morning stiffness is not considered a clinical feature of rheumatoid arthritis.
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Osteophyte formation is a common radiologic feature of osteoarthritis.
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In rheumatoid arthritis, the synovium is typically hyperplastic and inflamed.
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In rheumatoid arthritis, the presence of Rice bodies indicates irreversible joint damage.
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Swan Neck Deformity is a common physical manifestation of osteoarthritis.
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Bone cysts are a common feature of both osteoarthritis and rheumatoid arthritis.
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Anemia is an extra-articular manifestation that can occur in rheumatoid arthritis.
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The medical condition osteoarthritis leads to uniform joint space loss.
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Rheumatoid arthritis is defined as a chronic multisystem autoimmune inflammatory disorder.
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Primary osteoporosis is primarily caused by a significant increase in bone mass.
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Osteomalacia is related to inadequate mineralization of newly formed bone matrix.
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Vitamin D deficiency can lead to conditions such as osteomalacia.
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Fibrous dysplasia can lead to primary osteoporosis.
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Osteopenia is a condition characterized by thickening of the bone cortex.
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Hyperparathyroidism leads to decreased calcium levels in the body.
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Chronic renal failure can contribute to secondary hyperparathyroidism.
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Corticosteroids enhance osteoblastic activity, promoting bone formation.
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Study Notes
Osteoporosis
- Decrease in bone mass per unit of bone volume
- Metabolic bone disease
- Bone's normal ratio of mineral to matrix remains unchanged
- Primary and secondary types
Primary Osteoporosis
- Most common type
- Etiology is uncertain
- Common in postmenopausal women and elderly people
- Factors that contribute to primary osteoporosis:
- Genetic factors: peak bone mass genetics
- Estrogen: decline in estrogen levels
- Aging
- Calcium intake: less than 800mg/day
- Exercise: lack of exercise
- Environmental factors: smoking reduces estrogen levels
Osteopenia
- Decrease in cortical thickness
- Reduction in trabeculae size and number
- Fractures may be the first sign
- Compression fractures of vertebrae are common
Secondary Osteoporosis
- Corticosteroids:
- Inhibits osteoblastic activity
- Impairs Vitamin D absorption
- Hematologic malignancies (cancers of blood and blood-forming organs)
- Malabsorption:
- Gastrointestinal diseases
- Liver diseases
- Alcoholism:
- Inhibits osteoblasts
- Decreases calcium absorption
Osteomalacia and Rickets
- Inadequate mineralization of newly formed bone matrix (osteomalacia)
- Rickets: affects children with open epiphyseal plates, also a problem with cartilage
- Signs and Symptoms:
- Beading of the costochondral junctions
- Pectus carinatum (protruding breastbone)
- Irregularities in teeth
- Causes:
- Vitamin D deficiency
- Phosphate deficiency
- Defects in the mineralization process
Osteomalacia and Rickets: Pathological Findings
- Osteopenia
- Increased osteoid seams
- Pain that is poorly localized
- Common sites of pain: femoral neck, pubic ramus, spine, ribs
Hyperparathyroidism
- Caused by:
- Parathyroid adenoma
- Parathyroid hyperplasia
- Parathyroid malignancy (rare)
- Parathyroid hormone:
- Promotes phosphate excretion in urine
- Stimulates osteoclastic activity, resulting in hypercalcemia (high blood calcium)
- Stimulates tubular reabsorption of calcium and excretion of phosphate
- Stimulates intestinal calcium absorption
Hyperparathyroidism: Signs and Symptoms
- Kidney stones (renal calculi)
- Bones: Brown tumors
- Psychiatric depression
- Gastrointestinal tract irregularities
Secondary hyperparathyroidism
- Also known as renal osteodystrophy
- Cause: Chronic renal failure
- Complications:
- Decreased filtration of phosphate leads to hyperphosphatemia (high blood phosphate)
- Reduced production of active vitamin D
- Reduced calcium absorption in the gastrointestinal tract leading to hypocalcemia (low blood calcium)
- Secondary hyperparathyroidism (increased parathyroid hormone)
Osteomyelitis
- Inflammation of bone caused by infectious organisms
- Common organisms involved:
- Staphylococcus
- Streptococcus
- Escherichia coli
- Neisseria gonorrhea
- Haemophilus influenza
- Salmonella
- Routes of Infection:
- Direct penetration of wounds, fractures, surgery
- Hematogenous (through bloodstream)
- Teeth
- Metaphyses (ends of long bones)
- Knee, ankle, hip
Complications of Osteomyelitis
- Septicemia (blood poisoning)
- Acute bacterial arthritis
- Pathological fractures
- Squamous cell carcinoma
- Amyloidosis
- Chronic osteomyelitis
Arthritis - Introduction
- Inflammation of joints
- Common site for autoimmune injury:
- Heart valves and joints are susceptible to damage
- Hidden antigens are exposed by the damage
- Infections, Degeneration (age, stress, lifestyle)
Arthritis - Clinical Features
- Pain: inflammation of the capsule, synovium, periosteum
- Swelling: inflammation, effusion (fluid buildup), proliferation
- Restricted movement: pain, fluid (effusion), synovial swelling, damage
- Deformity: mal-alignment, erosion, ankylosis (stiffening)
Osteoarthritis (OA)
- Most common joint disease
- Slow, degenerative disease that involves articular cartilage
- Weight-bearing joints are commonly affected
- Fingers are commonly involved
- Types:
- Primary: Defect in cartilage, not inflammatory in nature
- Secondary: Trauma, crystal deposits, infection
- Commonly affected joints:
- Interphalangeal joints
- Knees
- Hips
- Cervical and lumbar spine
Osteoarthritis (OA): Pathological Features
- Narrowing of the joint space (loss of articular cartilage)
- Increased thickness of subchondral bone (eburnation)
- Subchondral bone cysts
- Osteophytes (bone spurs):
- Commonly found in the fingers, distal interphalangeal joints (Heberden nodes)
Osteoarthritis (OA): Causes
- Primary: Unknown cause
- Secondary:
- Intraarticular fracture
- Previous infective arthritis
- Rheumatoid arthritis
- Congenital dislocation of the hip
- Abnormal stresses
- Paget's disease
- Chronic overuse
- Metabolic and endocrine disorders
- Hemochromatosis
- Gout
- Calcium phosphate deposition disease
- Neuropathic disorders
- Peripheral neuropathy as in diabetes mellitus
- Excessive intraarticular corticosteroid injections
Osteoarthritis (OA): Summary
- Degenerative end result of aging
- Affects more than 80% of those over 65 years old
- Progressive erosion and fibrillation of the articular cartilage
- Large weight-bearing joints are commonly involved
- Hardened articular bone (eburnation)
- Subarticular cyst formation in bone
- Periarticular osteophyte formation
- Mild inflammation but painful
- Morning stiffness is common
- Limited range of motion
- Heberden nodes (osteophytes on the fingers)
Rheumatoid Arthritis (RA)
- Systemic, chronic, inflammatory disease
- Autoimmune disease
- Affects diarthrodial (synovial) joints bilaterally
- Begins as a synovial disease
- Affects women 3 times more than men
- Characterized by remissions and exacerbations
- Heredity and Epstein-Barr virus (EBV) are possible factors
Rheumatoid Arthritis (RA): Theory of Pathogenesis
- Genetically susceptible patient
- Infection (possible trigger)
- Formation of antibodies
- Antibodies act as new antigens
- Production of rheumatoid factor
- Deposits of immune complexes in the synovium (joint lining)
- Activation of the complement cascade
- Inflammation
- Activation of macrophages
- Influx of T cells
- Secretion of cytokines
Rheumatoid Arthritis (RA): Definition
- Chronic, multisystem, autoimmune inflammatory disorder that primarily affects the joints
- Produces a proliferative synovitis (inflammation of synovium)
- Progresses to destruction of the articular cartilage
- May lead to ankylosis (stiffening) of the joint
Rheumatoid Arthritis (RA): Etiology
- Genetic susceptibility
- HLA-DR4 or DR1 present in 65% - 80% of cases
- Microbial inciting agents
- Epstein-Barr virus, Borrelia, Mycoplasma
- Autoimmunity
- IgM anti-IgG (rheumatoid factor)
- Helper T cells (CD4) against type II collagen and cartilage glycoprotein-39
Rheumatoid Arthritis (RA): Pathology
- Inflammation of the joint and hyperplasia of the synovium
- Destruction of the articular structures
- Synovium infiltrated with lymphocytes, plasma cells, and macrophages
- Fibrin exudation (leakage) into the synovial fluid
- Formation of soft, loose bodies called Rice bodies
- Neutrophil polymorphs are present
Rheumatoid Arthritis (RA): Pathology - Reversibility
- Earlier changes are reversible
- When granulation tissue grows over the articular cartilage, it forms pannus
- Pannus interferes with cartilage nutrition, leading to permanent joint damage
Rheumatoid Arthritis (RA): Histopathological Features
- Rice bodies
- Hyperplastic synovium (overgrowth of joint lining)
- Pannus (inflamed granulation tissue)
- Allison-Ghormley bodies
- Rheumatoid nodules
Rheumatoid Arthritis (RA): Extra-articular Manifestations
- Rheumatoid nodules
- Vasculitis
- Cardiac disease
- Pulmonary disease
- Serosal inflammation
- Amyloidosis
- Anemia
- Eye involvement
Rheumatoid Arthritis (RA): Morphology
- Proliferative synovitis with lymphocytes (CD4), plasma cells and macrophages (pannus)
- Organizing fibrin (Rice bodies)
- Neutrophils on the joint surface and fluid
- Juxta-articular erosions, cysts, and osteoporosis
- Fibrous ankylosis (stiffening of joint)
- Skin: Rheumatoid nodules, vasculitis
Differentiating Features Between Rheumatoid Arthritis and Osteoarthritis
-
Rheumatoid Arthritis
- Affects younger individuals
- Affects small joints
- Primarily an autoimmune disease
- Synovial inflammation occurs first, which then damages the cartilage
-
Osteoarthritis
- Affects older individuals
- Affects large joints
- Primarily a degenerative disease
- Cartilage degeneration occurs first
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Description
Test your knowledge on conditions like osteomyelitis and osteoarthritis. This quiz covers essential concepts such as the causes, complications, and characteristics of these bone and joint diseases. Dive into specifics such as infectious organisms and arthritis types.
