Bone and Joint
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Bone and Joint
Define Systemic Lupus Erythematosis
generalized inflammation of connective tissue
injury is pricipally a result of vasculitis.
involves mulitple organs systems (skin, joints, kidneys)
Most effected with SLE?
90% of patients are women in the childbearing years, ie 20-30
What is the most common cause of death in SLE?
glomerulonephritis--> hematuria, proteinuria, HT--> kidney failure
Lesions of SLE are caused by?
lesions are caused by the deposition of immune complexes and fibrinoid material in tissue and by direct attack of autoantibodies.
up to 90% of pts have a non-erosive synovitis.
joint pain is the CC in 40% of pts.
cc joint pain
Initial Signs and Symptoms of SLE
fever, malaise, anorexia, wt loss, rash( butterfly)
SLE and arthritis
bilateral and symmetrical pain, swellign and sstiffness
arthiritis affects up to 90% of SLE pts
X-ray and SLE
normal joint space
Lab presentation for SLE
+FANA(flourescent antinucleur antibody) 99% of the time
+ LE(leukocyte) cells 70%
Treatment for SLE
Scleroderma aka is?
progressive systemic slerosis
fenerilized infrlammation of connective tissue characterized by excesive fibrosis throughout the body.
SKIN, lungs GI trat, MS system, kidneys
most commonly affected by scleroderma
females 3x more than males
incidence increases with age
CREST phenom. :
1. limited skin involvement
2. later visceral involvement
3. slower progrssion
What does CREST stand for?
: calcinosis(deposit of calcium)
: raynaud's phenomenon( loss of vasculization @ distal extremities)
: esophageal dysfunction
: telangiectasia-widening of the blood vessels
1. Early, widespread skin involvemtn
2. early visceral involvement
3. rapid progression
Skin and Scleroderma
edema, progressive fibrosis of the dermis, thinning of epidermis, atrophy of dermal appendages, autoamputation.
an increase in melanin
subcutaneous calcium deposits in 20% of pts
begins distally and progresses proximally in the upper extremitiy, neck, face
bilateral and symmetrical
scleroderma and lungs
70% of PSS pts have pumonary involvement
impared gas exchanges due to fibrosing alveoli
most common cuase of death with scleroderma pts.
GI Tract and Scleroderma
Atropy and replacement of teh muscularis layer with fibrotic tissue
lower 2/3 of the esophagus become narow and rigid-->dysphagia
small intestine and colon-->malabsorption
MS Systems and scleroderma
Inflammatory synovitis and fibrosis
joint destruction is uncommmon
Kidnesy and Scleroderma
2/3 of PSS pts have intimal thickening of vessel walls -->renal abn.
30% of pts develop HT
formely the most common cause of death in PSS pts
Clincal findings and scleroderma
in most pts. exposure to cold or stress may initiate raynaud's phen.
50% of pts -- dysphasia
xray finding of sclerodema
resoprtion fo soft tissue of fingers with retraction of tips
nomral joint space
calcinosis of the soft tissue in 20% of pts
may be disuse osteopenia
Ankylosing Spondylitis x-ray findings:
erosions iwth reactive sclerosis
usually bilateral and symmetrical
SI joints and Ankylosing spondylitis
lower 2/3 of joint
iliac sde> scaral side
loss of join definition (pseudowidening)
erosions and reactive slcerosis
Spine and Ankylosing spondylitis
60% of the time, thoracolumbar jxn is first, then lumbosacral
imflammation invloving the oter annular fibers
vertical bridging syndesmophytes
occuring over multiple segments (bamboo spine)
erosions, sclerosis, decrease jt space at appophyseal and costovertebral jts.
presevation of the disc space
psoriatic arthritis definition:
chronic skin disorder
5-8% of pts have an associated arthropathy
Who is affected by Psoriatic arthritis?
.2-3% of the pop.
usually around 27 yrs old
How does one get psoriatic arthritis
family clustering suggest genetic factor
some precipitation event are trauma, infecion, stress
Clinical effects of psoriatic arthritis on skin:
erythematos patches over covered with silvery scales
auspitz sign- remove scales-->bleeding
extensor surface- elboy, knee, scalp, back
clinc of psoriatic arthritis on nails:
thimble pitting(pathognomic). thickening, discoloration, separation
found in up to 40% of psoriasis pt
up to 80-905 of OsA pts
athritis adn psoriatic arthritis
classic presentation- 1 larg jt. and 1-2 interphalangeal jts with dactylitis (sausage digits)
Psoriatic arthritis and xray
soft tissue swelling
erosion and bone proliferation
pencil in cup defomity
"fluffy" new bone adjacent to marginal erosions doe to periositis
SI joints 30-50% involvemtn
erosions, reactive sclerosi