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Questions and Answers
What characterizes primary osteoporosis?
What is a common consequence of secondary osteoporosis?
What is a distinguishing feature of osteomalacia?
Which condition is associated with renal osteodystrophy?
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What is the relationship between hyperparathyroidism and calcium levels?
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What is a possible effect of chronic alcoholism on bones?
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In which population is rickets primarily observed?
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Which factor may lead to secondary hyperparathyroidism?
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What is one of the common causes of osteomyelitis?
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Which complication is NOT associated with osteomyelitis?
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Which joints are primarily affected by osteoarthritis?
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What is a defining characteristic of primary osteoarthritis?
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Which of the following is NOT considered a cause of secondary osteoarthritis?
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What is a common clinical feature of arthritis?
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Which of the following conditions can lead to abnormal stresses resulting in osteoarthritis?
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What is the primary pathological change in the joints due to osteoarthritis?
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What is a common histopathological feature found in rheumatoid arthritis?
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Which of the following is considered an extra-articular manifestation of rheumatoid arthritis?
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Which clinical feature is characteristic of rheumatoid arthritis?
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What distinguishes the morphology of rheumatoid arthritis from osteoarthritis?
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Which of the following correctly pertains to the diagnosis of rheumatoid arthritis?
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Which of the following radiologic features is typically absent in osteoarthritis?
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What condition is characterized by periarticular osteophyte formation and morning stiffness?
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In rheumatoid arthritis, the primary cause of the joint inflammation is related to which process?
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Which of the following best describes the typical inflammatory changes seen in the synovium of rheumatoid arthritis?
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What is a common genetic factor associated with increased susceptibility to rheumatoid arthritis?
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What consequence follows the formation of a pannus in rheumatoid arthritis?
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Rice bodies, often found in rheumatoid arthritis synovial fluid, are associated with which type of exudation?
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Which of the following terms refers to the loose bodies that can develop within the synovial fluid of joints affected by inflammatory diseases?
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Study Notes
### Osteoporosis
- Reduction of bone mass per unit of bone volume
- Metabolic bone disease
- Osteoporosis displays a normal ratio of mineral to matrix
- Two types: Primary and Secondary
Primary Osteoporosis
- Most common type
- Uncertain etiology (cause)
- Postmenopausal women are susceptible
- Elderly people (senile) are also susceptible
- Genetic factors contribute to Peak Bone Mass
- Estrogen decline plays a huge role
- Aging is a factor
- Calcium intake is essential (800mg/day)
- Exercise is crucial
- Environmental factors like smoking contribute to lowered estrogen levels.
### Osteopenia
- Decrease in the thickness of the cortex (outer layer of bone)
- Fewer and smaller trabeculae (inner, supporting network of bone)
- Fractures are often the first sign
- Compression fractures of vertebrae are typical
### Secondary Osteoporosis
- Corticosteroids can cause osteoporosis
- Inhibit osteoblastic activity (bone building)
- Impair Vitamin D dependent intestinal calcium absorption (secondary hyperparathyroidism)
- Hematologic malignancies (cancers of blood cells) can lead to osteoporosis
- Malabsorption caused by GI and liver diseases can cause osteoporosis
- Alcoholism can also cause osteoporosis
- Inhibition of osteoblasts
- Decreased calcium absorption
### Osteomalacia and Rickets
- Inadequate mineralization of newly formed bone matrix
- Osteomalacia affects adults, Rickets affects children
- Rickets is marked by open epiphyseal plates (growth plates)
- Rickets also affects cartilage
- Beaded appearance of costochondral junctions
- Pectus carinatum (pigeon chest)
- Dental abnormalities
- Vitamin D deficiency
- Phosphate deficiency
- Defects in the mineralization process
### Osteomalacia and Rickets (cont.)
- Osteopenia (low bone density)
- Exaggeration of osteoid seams ( areas where new bone is formed)
- Poorly localized pain (pain in multiple areas)
- Pain in the femoral neck, pubic ramus, spine, ribs
- Osteomalacia and rickets can lead to secondary hyperparathyroidism
### Hyperparathyroidism
- Caused by parathyroid adenoma (tumor), hyperplasia (overgrowth), or rarely malignancy (cancer)
- Parathyroid hormone:
- Promotes excretion of phosphate in urine
- Stimulates osteoclastic activity (bone breakdown), leading to hypercalcemia (high calcium levels)
- Stimulates tubular reabsorption of calcium and excretion of phosphate
- Stimulates intestinal calcium absorption
### Hyperparathyroidism (cont.)
- Stones in kidneys (kidney stones)
- Brown tumors (bone lesions)
- Psychiatric depression
- GI tract irregularities
### Secondary Hyperparathyroidism
- Renal osteodystrophy (bone problems in kidneys)
- Chronic renal failure:
- Decreased filtration of phosphate, leading to hyperphosphatemia (high phosphate levels)
- Affects active Vitamin D, decreases calcium absorption in the GI tract, resulting in hypocalcemia (low calcium levels)
- Secondary hyperparathyroidism is then triggered.
### Osteomyelitis
- Inflammation of bone caused by an infectious organism
- Common infectious organisms include Staphylococcus, Streptococcus, Escherichia coli, Neisseria gonorrhea, Haemophilus influenza, Salmonella
- Two ways in which the infection can occur:
- Direct penetration: wounds, fractures, surgery
- Hematogenous: bloodstream, teeth (metaphyses - area between the ends of long bones and the shaft)
- Common areas affected: knee, ankle, hip
### Complications of Osteomyelitis
- Septicemia (blood poisoning)
- Acute bacterial arthritis (infection of a joint)
- Pathologic fractures
- Squamous cell carcinoma (skin cancer)
- Amyloidosis (build-up of an abnormal protein)
- Chronic osteomyelitis
### Arthritis - Introduction
- Inflammation of joints, common
- Frequent sites for Autoimmune Injury
- Heart valves and joints are susceptible, causing exposure of hidden antigens.
- Infections, Degeneration (caused by age/stress/lifestyle)
- Arthritis can be caused by injury, overuse, and autoimmune disorders
### Arthritis – Clinical Features:
- Pain
- Swelling due to inflammation, effusion (fluid buildup), or proliferation (increase in cell numbers)
- Restricted movement
- Deformity
### Osteoarthritis
- Most common joint disease
- Slow progressive degeneration of articular cartilage (cartilage that covers the ends of bones in joints)
- Affects weight bearing joints - (hips, knees)
- Affects fingers
- Primary: defect in cartilage (non-inflammatory)
- Secondary: trauma, crystal deposits, infection
- Interphalangeal joints, knees, hips, cervical and lumbar spine are most commonly affected.
### Osteoarthritis (cont.)
- Narrowing of joint space (loss of disk)
- Increased thickness of subchondral bone (bone below cartilage)
- Eburnated bone (hard, polished bone)
- Subchondral bone cysts
- Osteophytes (Haberden nodes)
- Fingers, distal interphalangeal joints (joints at the tips of fingers)
### Causes of Osteoarthritis
- Primary
-
Secondary:
- Intra articular fracture (fracture within the joint)
- Previous infective arthritis
- Rheumatoid arthritis
- Congenital dislocation of the hip
-
Abnormal stresses:
- Paget's disease with deformity
- Chronic overuse
-
Metabolic and endocrine:
- Hemochromatosis (iron overload)
- Gout (excess uric acid)
- Calcium phosphate deposition
-
Neuropathic disorders:
- Peripheral neuropathy as in diabetes mellitus
- Intraarticular corticosteroid in excess
### Osteoarthritis: Degenerative End Result
- Ageing: more than 80% of those over 65 years old suffer from osteoarthritis
- Progressive erosion and fibrillation (splitting) of articular cartilage
- Loose bodies form within the joint
- Large weight-bearing joints are most affected
- Hardened articular bone (eburnation)
- Subarticular cyst formation in bone
- Periarticular osteophyte formation (bone spurs)
- Mild inflammation but painful
- Morning stiffness
- Limited range of movements
- Heberden nodes (common in finger OA)
### Rheumatoid arthritis
- Systemic chronic inflammatory disease
- Autoimmune disease (body's immune system attacks its own tissues)
- Affects diarthrodial joints (freely-moving joints) bilaterally (both sides)
- Starts as a synovial disease
- Affects women more than men (3:1)
- Periods of remission (no symptoms) and exacerbations (flareups) are common
- Hereditary factors contribute
- Epstein-Barr Virus (EBV) suspected as a cause
- Rheumatoid arthritis can affect the heart, lungs, and other organs due to inflammation
- Rheumatoid arthritis is characterized by inflammation in the synovium (lining of the joints) and the surrounding tissues.
### Theory of Pathogenesis (Development) of Rheumatoid Arthritis
- Genetically susceptible patient
- Infection (EBV or other)
- Formation of antibodies
- Antibodies act as new antigens
- Production of rheumatoid factor (antibodies that react with other antibodies)
- Deposits of immune complexes in the synovium
- Activation of the complement cascade (a series of proteins involved in inflammation)
- Inflammation
- Activation of macrophages (immune cells)
- Homing of T cells (immune cells)
- Secretion of cytokines (chemicals that promote inflammation)
### Rheumatoid Arthritis - Definition:
- Chronic, multisystem (affecting multiple organs), autoimmune, inflammatory disorder
- Primarily affects joints
- Causes proliferative synovitis (inflammation and thickening of the synovium)
- Often progresses to destruction of the articular cartilage and ankylosis (stiffening of a joint)
### Etiology (Causes) of Rheumatoid Arthritis:
- Genetic Susceptibility:
- HLA DR4, or DR1 present in 65% to 80% of cases
- Microbial inciting agent:
- Epstein-Barr virus, Borrelia (Lyme disease bacterium), and Mycoplasma (bacteria)
- Autoimmunity:
- IGM anti-IgG (rheumatoid factor)
- Helper T cells (CD4) against type II collagen and cartilage glycoprotein-39
### Pathology of Rheumatoid Arthritis
- Inflammation of the joint
- Hyperplasia of the synovium (thickening of the synovium)
- Destruction of the articular structures
- Synovium is infiltrated with lymphocytes, plasma cells, and macrophages
- Fibrin exudation (leakage of fibrin, a protein involved in blood clotting) on the synovial fluid
- Soft loose bodies called Rice bodies can form
- Neutrophil polymorphs (white blood cells) are present
- These early changes can be reversed before permanent damage occurs.
### Permanent Joint Damage
- When granulation tissue grows over the surface of the articular cartilage called Pannus
- Panus interferes with the nutrition of the cartilage leading to permanent joint damage
### Rheumatoid Arthritis Histopathological Features
- Rice bodies
- Hyperplastic synovium
- Pannus
- Allison-Ghormley bodies (small masses of debris in the joint fluid)
- Rheumatoid nodules (lumps of tissue that can form under the skin)
### Extra Articular Manifestations (Outside of Joints) of Rheumatoid Arthritis
- Rheumatoid nodules
- Vasculitis (inflammation of blood vessels)
- Cardiac disease
- Pulmonary disease
- Serosal inflammation (inflammation of the lining of body cavities)
- Amyloidosis (build-up of an abnormal protein)
- Anemia
- Eye involvement
### Rheumatoid Arthritis 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 (erosion near the joints)
- Cysts
- Osteoporosis
- Fibrous ankylosis (stiffening of a joint)
- Skin: Rheumatoid nodules
- Vasculitis (commonly of digital arteries)
### Early Destruction in Rheumatoid Arthritis
- Swan Neck Deformity
### Rheumatoid Arthritis - Clinical Features
- Morning stiffness
- Arthritis in 3 or more joint areas
- Arthritis of small hand joints
- Symmetrical arthritis
- Rheumatoid nodules
- Serum rheumatoid factor
- Typical radiographic changes
### Rheumatoid Arthritis Diagnosis
- At least 4 features are required for diagnosis
### Rheumatoid Arthritis - Pannus
- Hyperplastic (overgrowth), inflamed synovium
### Extra-Articular Rheumatoid Arthritis
- Rheumatoid Nodules
- Vasculitis
- Pleuritis (inflammation of the pleura, lining of the lungs)
- Pericarditis (inflammation of the pericardium, lining of the heart)
- Tendonitis (inflammation of a tendon)
### Rheumatoid Nodules
- Found in the skin
- Consist of palisading macrophages (arranged like a fence)
- Central fibrinoi necrosis (death of tissue)
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Description
This quiz covers the fundamentals of osteoporosis, including its definition, types (primary and secondary), and conditions like osteopenia. It explores risk factors, underlying causes, and the biological importance of calcium and exercise in bone health.
