Pathology Final

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xdiabx
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Pathology Final
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2011-12-12 20:55:28
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Pathology Final
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  1. Osteoarthritis (Degenerative Joint Dissorder)
    • Most common joint disorder affecting more than 40 million people in US
    • the overall prevalence is expected to continue to grow significantly in the coming years (we are heavier w/ increased activity & older life expectancy)
    • Most commonly involved the weight bearing joints (hip & knee), also includes shoulder and joints of the neck & hands (cervical spine)
  2. Etiology of Osteoarthritis
    • Weight
    • Genetics
    • Biomechanics (expecially ligamentous laxity--pigon toes, locked knees, ect)
    • High impact sports (increased risk w/ increased age)
    • Occupational activities w/ repeated kneeling, squatting, or repetitive use of heavy equipment
    • Historically considered localized disease focused on ARTICULAR CARTILAGE
    • Now, likely a broader etiology more active w/ joint detruction being "cellular" rather than "wear" cause
    • Once articular cartilage begins to break down, the destruction of accompanying structure becomes progressive more quickly
  3. Signs & Symptoms of OSTEOARTHRITIS
    • Aching pain w/ weight bearing and movement
    • Joint movement is limited
    • Recreational and social activities become limited due to pain
    • Difficulty walking
    • Predisposition to falls
    • Mastication and speaking difficulty w/ TMJ
    • Heberden's Nodes: Bony enlargement of DIP
    • Bouchard's Nodes: Bony enlargement PIP
    • X rays aften reveal changes in the joint space (narrowed joint space)
    • Bone Sclerosis
    • Bone Cysts (fluid filled sac)--Baker's cyst, common w/ knee replacement on the posterior portion of the knee. May be drained. These are very painful.
    • Osteophytes (bone spurs)
  4. Treatment of Osteoarthritis
    • Stress on joint minimized by use of adaptive devices (cane)
    • Pacing activity
    • Mild exercise program to maintain fitness and joint function
    • Supports such as hand brace to facilitate movement
    • Orthotic inserts in shoes
    • Massage Therapy
    • Physiotherapy
    • Acupuncture
    • Occupational Therapy
    • Glucosamine-chondrotin Supplements
    • Injection of synthetic synovial fluid (hyaluronic acid)--SYNVISC
    • NSAIDs
    • Analgesics
    • Surgical Joint Replacement
  5. Rheumatoid Arthritis
    • Autoimmune Disorder
    • Systemic in nature
    • Characterized by period of exacerbation and remission
    • Causes chronic systemic inflammatory disease
    • Higher incidence in women
    • Affects all ages w/ peak onset b/t 20-50yr/olds
    • Often extends beyond the muskuloskeletal system w/ the systemic finding impacting cardiovascular and pulmonary systems
    • More than 2 million ppl in US w/ RA
    • Women who have had children and those who use oral contriceptives have a lower incidence of the diease than other similarly aged women
    • May be associated w/ other auto immune dieases particularly thyroid conditions
    • Characterized by a massive infiltration of T-Lymphocytes into the synovium
  6. Pathophysiology of Rheumatoid Arthritis (RA)
    • 1) Synovitis: Marked inflammation, cell proliferation
    • 2)Pannus Formation: Grannulation tissue spreads
    • 3)Cartilage Erosion: Creates unstable joint
    • 4)Fibrosis: Calcifies and obliterates joint space-->
    • -->Ankylosis: Joint fixation and deformity develop if untreated
    • Muscle atrophy
    • Bone alignment shifts
    • Muscle spasms due to inflammation/pain
    • Contracture and deformity develop
  7. Synovitis
    • Inflammation of the synovial membrane
    • Painful during motion
    • Accumulation of fluid in the synovial membrane
  8. Pannus Formation
    • Membrane of granulation tissue composed of mesenchyme and bone-marrow derived cells.
    • Causes cartilage destruction & bone errosion
  9. Cartilage Erosion
    Results in loss of joint function due to instability
  10. Fibrosis
    Calcifies and obliterates joint space
  11. Ankylosis
    • Joint fixation and deformity develop if untreated
    • (stiffness/fusion of a joint)
  12. Systemic Effects of Rheumatoid Arthritis
    • Marked Fatigue
    • Depression
    • Malaise
    • Anorexia
    • Low-grade Fever
    • Iron deficiency anemia that is resistant to iron therapy
    • Generalized aching
    • Generalized lymphadenopathy
  13. Etiology of Rheumatoid Arthritis
    • Exact cause not known
    • Genetic factor is present
    • Familian predisposition
    • Some links to viral infections
  14. Signs & Simptoms of Rheumatoid Arthritis
    • Affected joints are extremely painful
    • Stiffnes of joints
    • Redness and swelling of joints
    • Joint involvement includes small joints and is often bilateral
    • Joint movement impaired
    • Eventually joint becomes fixed and deformed
  15. Treatment for Rheumatoid Arthritis
    • Balance b/t rest & moderate activity
    • Heat and cold applications
    • Physical and occupational therapy
    • NSAIDs
    • Glucocorticoids for severe inflammation
    • Analgesia for pain
    • Disease-modifying anti-rheumatic drugs-e.g. gold salts, methotrexate, hydroxychloroquine
    • Biologic response (modifying agents): Infliximad, Rituximad, & Anakinra
  16. Juvenile Rheumatoid Arthritis
    • Several different types
    • Onset more acute than adults form
    • Large joints frequently affected
    • Still disease (systemic form): fever, rash, lymphadenopathy, hepatomegaly, joint involvement
    • Second form of JRA causes polyarticular inflammation
    • Third form of JRA involves 4 or fewer joints but causes uveitis (inflammation of iris, ciliary body, and choroid of eye)
  17. Infectious Arthritis
    • Also known as septic arthritis
    • Develops in single joint
    • Joint red, swollen, painful decreased movement
    • Direct Cause: Introduction of bacteria into joint (trauma, non-sterile, injection or surgery)
    • Secondary Cause: Infection due to bacteremia
    • Treated w/ antimicrobials over sustained period; often requires IV administration
  18. Gout
    • Also know as gouty arthritis
    • Results from deposits of uric acid and crystals in the joint, causing inflammtion
    • Formation of tophus (large, hard nodule of urate crystals)
    • Tophi cause local inflammation and occur after the first attack of gout
    • Uric acid and crystal formation resulting from inadequate renal excretion, chemotherapy, metabolic abnormality, and/or genetic factor
    • Inflammation causes redness, swelling & pain
    • Treated by reducing uric acid levels by drugs and dietary changes
    • Diagnosed by examination of synovial fluid and blood tests (use of NSAIDs produce a false negative)
  19. Ankylosing Spondylitis
    • Chronic, progressive inflammatory condition
    • Affects sacroiliac joints, intervertebral spaces, costovertebral spaces
    • More common in men age 20-40
    • Cause has not yet been determined (deemed an autoimmune disorder w/ genetic basis)
  20. Progression of Ankylosing Spondylitis
    • Vertebral joints inflamed
    • Fusion of joint (loss of mobility)
    • Inflammation in lower back, then up spine
    • Kyphosis develops
    • Osteoporosis common
    • Lung expansion limited
  21. Signs, Systemic Signs & Treatment of Ankylosing Spondylitis
    • Signs: LBP (low back pain)/ morning stiffness, pain when lying down, spine becomes rigid
    • Systemic Signs: Fatigue, fever, weight loss, uveitis
    • Treatment: drugs to relieve pain, daily exercise, physiotherapy, and occupational therapy

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