Podcast Beta
Questions and Answers
Which factor is NOT associated with primary osteoporosis?
What may be the first sign of osteoporosis?
Which of the following conditions can lead to secondary osteoporosis?
How does hyperparathyroidism affect phosphate levels in the urine?
Signup and view all the answers
Which symptom is NOT typically associated with rickets?
Signup and view all the answers
What is a common characteristic of osteomalacia?
Signup and view all the answers
What outcome can result from chronic renal failure related to bones?
Signup and view all the answers
What is a potential effect of alcoholism on bone health?
Signup and view all the answers
What is a common characteristic of osteoarthritis as seen in radiologic features?
Signup and view all the answers
What is the primary defect in primary osteoarthritis?
Signup and view all the answers
Which condition is characterized by the formation of Heberden nodes?
Signup and view all the answers
Which of the following is a primary feature of rheumatoid arthritis?
Signup and view all the answers
Which of the following is NOT a complication of osteomyelitis?
Signup and view all the answers
What causes narrowing of joint space in osteoarthritis?
Signup and view all the answers
The presence of which cells is characteristic of the synovium in rheumatoid arthritis?
Signup and view all the answers
What is one of the main genetic factors associated with increased susceptibility to rheumatoid arthritis?
Signup and view all the answers
Which joints are most commonly affected by osteoarthritis?
Signup and view all the answers
Which organism is commonly associated with osteomyelitis due to direct penetration?
Signup and view all the answers
What is a significant outcome of hyperplasia of the synovium in rheumatoid arthritis?
Signup and view all the answers
Which symptom is NOT typically associated with osteoarthritis?
Signup and view all the answers
What is a common feature of chronic osteomyelitis?
Signup and view all the answers
What is the role of osteophytes in osteoarthritis?
Signup and view all the answers
Which of the following is a secondary cause of osteoarthritis?
Signup and view all the answers
What histopathological feature is characterized by organizing fibrin in joint fluid?
Signup and view all the answers
What is the primary morphological characteristic of pannus in rheumatoid arthritis?
Signup and view all the answers
What are 'Rice bodies' in the context of rheumatoid arthritis?
Signup and view all the answers
Which of the following extra-articular manifestations is NOT commonly associated with rheumatoid arthritis?
Signup and view all the answers
Which clinical feature is specifically needed to establish a diagnosis of rheumatoid arthritis?
Signup and view all the answers
Which deformity is associated with rheumatoid arthritis due to joint damage?
Signup and view all the answers
Study Notes
Osteoporosis
- Decrease in bone mass per unit bone volume
- Normal ratio of mineral to matrix
- Classified as primary and secondary types
-
Primary osteoporosis: Most common, uncertain etiology, postmenopausal women, elderly persons
- Genetic factors: Peak bone mass
- Estrogen levels: Decline with age
- Aging: Factors in disease progression
- Calcium intake: 800mg/day recommended
- Exercise: Essential for bone health
- Environmental factors: Smoking lowers estrogen levels
- Osteopenia: Key characteristic of primary Osteoporosis, thinner cortex and reduction in the size and number of trabeculae
- Fractures: Often the first sign of Osteoporosis, compression fractures common in vertebrae
-
Secondary osteoporosis: Corticosteroids, hematologic malignancies, malabsorption (GI and liver disease), alcoholism
- Corticosteroids: Inhibit osteoblastic activity, impair vitamin D dependent intestinal calcium absorption (secondary hyperparathyroidism)
- Hematologic malignancies: Affect bone health
- Malabsorption: Can lead to mineral deficiencies
- Alcoholism: Inhibits osteoblasts, lowers calcium absorption
Osteomalacia and Rickets
- Inadequate mineralization of newly formed bone matrix (osteomalacia)
- Rickets: Occurs in children with open epiphyseal plates
- Cartilage problems contributing to rickets
- Vitamin D deficiency: Main cause of Osteomalacia
- Phosphate deficiency: Can cause "resistant" Osteomalacia
- Clinical features: Beaded appearance of costochondral junctions, Pectus carinatum (pigeon chest), dental abnormalities
- Radiologic features: Osteopenia, exaggerated osteoid seams, poorly localized pain
- Locations of Osteomalacia pain: Femoral neck, pubic ramus, spine, ribs
Hyperparathyroidism
- Characterized by an overactive parathyroid gland, can be caused by adenoma, hyperplasia, or malignancy
- Parathyroid hormone (PTH): Promotes phosphate excretion in urine, stimulates bone resorption (osteoclastic activity), resulting in hypercalcemia
- PTH effects on calcium: Stimulates tubular reabsorption of calcium, excretion of phosphate, and intestinal calcium absorption
- Clinical features: Stones (kidney), bones (brown tumors), psychiatric depression, GI tract irregularities
Secondary Hyperparathyroidism
- Often caused by renal osteodystrophy (chronic renal failure)
- Mechanism: Decreased filtration of phosphate (hyperphosphatemia), effect on active vitamin D, decreased calcium absorption in GI (hypocalcemia), leading to secondary hyperparathyroidism
Osteomyelitis
- Inflammation of bone, caused by an infectious organism
- Common pathogens: Staphylococcus, Streptococcus, Escherichia coli, Neisseria gonorrhea, Haemophilus influenza, Salmonella
- Routes of infection: Direct penetration (wounds, fractures, surgery), hematogenous spread (bloodstream, teeth, metaphyses)
- Common locations: Knee, ankle, hip
Complications of Osteomyelitis
- Septicemia (blood poisoning)
- Acute bacterial arthritis
- Pathologic fractures
- Squamous cell carcinoma
- Amyloidosis
- Chronic osteomyelitis
Arthritis: Introduction
- Inflammation of joints – common
- Common site for autoimmune injury
- Heart valves and joints: Damage can result from exposure to hidden antigens, infections, or degeneration
Arthritis: Clinical Features
- Pain: Inflammation of capsule, synovium, and periosteum
- Swelling: Due to inflammation, effusion, and proliferation
- Restricted movement: Caused by pain, fluid, synovial swelling, and damage
- Deformity: Resulting from mal-alignment, erosion, and ankylosis
Osteoarthritis
- Most common joint disease
- Slow progressive degeneration of the articular cartilage
- Affects weight-bearing joints and finger joints
- Primary OA: Defect in cartilage, not an inflammatory disease
- Secondary OA: Trauma, crystal deposits, infection
- Common locations: Interphalangeal joints, knees, hips, cervical and lumbar spine
- Radiographic features: Narrowing of joint space, increased subchondral bone thickness, subchondral bone cysts, osteophytes (Heberden nodes – fingers, distal interphalangeal joints)
Osteoarthritis - Causes
- Primary OA: Unknown cause
- Secondary OA: Intra articular fracture, previous infective arthritis, rheumatoid arthritis, congenital dislocation of hip
- Abnormal stresses: Paget’s disease with deformity, chronic overuse
- Metabolic and endocrine: Hemochromatosis, gout, calcium phosphate deposition
- Neuropathic disorders: Peripheral neuropathy (diabetes mellitus), intraarticular corticosteroid excess
- Degenerative end result: Progressive erosion and fibrillation of articular cartilage, loose bodies, eburnation (hardening of articular bone), subarticular cyst formation, osteophyte formation, mild inflammation, morning stiffness, limited range of motion.
Rheumatoid Arthritis
- Systemic chronic inflammatory disease
- Autoimmune disease, affecting diarthrodial joints bilaterally
- Starts as a synovial disease
- Female predominance (3:1 women)
- Remissions and exacerbations
- Hereditary component, possible role of EBV (Epstein-Barr Virus)
Theory of Pathogenesis for Rheumatoid Arthritis
- Genetically susceptible patient
- Infection (possible trigger)
- Formation of antibodies
- Antibodies act as new antigens
- Production of rheumatoid factor
- Deposition of immune complexes in the synovium
- Activation of complement cascade
- Inflammation
- Activation of macrophages
- Homing of T cells
- Secretion of cytokines
Rheumatoid Arthritis Definition
- Chronic, multisystem, autoimmune, inflammatory disorder primarily affecting joints
- Produces proliferative synovitis that progresses to destruction of articular cartilage
- Leads to ankylosis (joint stiffness and immobility)
Rheumatoid Arthritis - Etiology
- Genetic Susceptibility: HLA DR4 or DR1 in 65-80% of cases
- Microbial inciting agent: 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 - Pathology
- Inflammation of the joint and hyperplasia of the synovium
- Destruction of articular structures
- Synovium infiltrated with lymphocytes, plasma cells
- Fibrin exudation on synovial fluid forms soft, loose bodies (Rice bodies)
- Neutrophil polymorphs also present
Rheumatoid Arthritis - Pathologic progression
- Initial changes are reversible
- As granulation tissue grows over articular cartilage (pannus), it interferes with cartilage nutrition, leading to permanent damage
Rheumatoid Arthritis - Histopathological Features
- Rice bodies
- Hyperplastic synovium
- Pannus
- Allison-Ghormley bodies
- Rheumatoid nodules
Rheumatoid Arthritis - Extra-Articular Manifestation
- Rheumatoid nodules
- Vasculitis
- Cardiac disease
- Pulmonary disease
- Serosal inflammation
- Amyloidosis
- Anemia
- Eye involvement
Rheumatoid Arthritis - Morphology
- Proliferative synovitis with lymphocytes (CD4), plasma cells, and macrophages
- Pannus formation
- Organizing fibrin (rice bodies)
- Neutrophils on the joint surface and fluid
- Juxta-articular erosions, cysts, and osteoporosis
- Fibrous ankylosis
- Rheumatoid nodules in the skin
- Vasculitis (commonly in digital arteries)
Rheumatoid Arthritis - Clinical Features
- Morning stiffness
- Arthritis in 3 or more joint areas
- Small hand joint involvement
- Symmetrical arthritis
- Rheumatoid nodules
- Serum rheumatoid factor
- Typical radiographic changes
- Diagnosis: At least 4 of these clinical features required
Differentiating features between Rheumatoid Arthritis and Osteoarthritis
- Rheumatoid arthritis: Young, small joints, autoimmune, synovial inflammation, synovium, cartilage
- Osteoarthritis: Old, larger joints, degenerative, cartilage degeneration.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Related Documents
Description
Explore the key features of osteoporosis, including its primary and secondary types. Understand the causes, risk factors, and the importance of calcium and exercise for maintaining bone health. This quiz will help you identify the characteristics and implications of osteoporosis.
