關(guān)節(jié)炎(英文)--ppt課件

1、“Things may come to those who wait, but only the things left by those who hustle.” 2022/7/22Pathology of ArthritisDr. Venkatesh M. Shashidhar.Associate Professor of PathologyFiji School of Medicine2022/7/22Joints:Mobility - Cranial sutures Shoulder joint.Articular cartilage hyaline friction res.Syno

2、vial fluid lubric/nutri, Type A & B synoviocytes. Hyaluronidase Continuous production and absorption. Affected by Inflammation, immobility.Capsule, ligaments, menisci.Vascular, rich nerve supply Art. Cartilage*2022/7/22Joints - Anatomy2022/7/22Arthritis - IntroductionInflammation of joints - CommonC

3、ommon site for autoimmune injuryHeart valves & Joints - damage Exposure of hidden antigens.Infections.Degeneration Age/Stress/life styleUse it or Loose it.!2022/7/22Arthritis Clinical features:Pain Inflammation - capsule, synovium, periosteum.Swelling: inflammation, effusion, proliferation.Restricte

4、d movement pain, fluid, synovial swelling, damage.Deformity mal-alignment, erosion, ankylosis2022/7/22Arthritis Clinical Classification:Monoarthritis: Local, asymmetric, secondary.Acute: Bacterial, Trauma, Crystal, ReactiveChronic :Tuberculosis, Lyme, Fungal, Trauma, Tumors.Polyarthritis:Chronic, sy

5、mmetric, systemic.Autoimmune, degenerative, Crystal.Rarely infective.2022/7/22Polyarthritis Classification:Autoimmune: Rheumatic, Rheumatoid, Ankylosing spondylitis, Reiter syndrome etc. Degenerative: Osteroarthritis Crystal Deposition: Gout Monosodium urateCPPD - Pseudo GoutInfective - Septic, TB,

6、Lyme etc. rare.2022/7/22Rheumatoid Arthritis2022/7/22Epidemiology of RAPrevalence about 1% of US populationFemale : Male ratio = 2:1Strong association with HLA DR4.Concordance in identical twins only 30%2022/7/22RA - Definition:Chronic Multisystem autoimmune inflammatory disorder primarily affecting

7、 joints producing a proliferative synovitis that often progresses to destruction of the articular cartilage and ankylosis.2022/7/22Etiology:Genetic Susceptibility:HLA DR4, or DR1 in 65% to 80% cases.Microbial inciting agent:Epstein-Barr virus, Borrelia & MycoplasmaAutoimmunity:IGM anti IgG RA Factor

8、.Helper T cell (CD4) against type II collagen & cartilage glycoprotein-392022/7/22Immuno-dysregulation in RAT lymphocytes type II collagen & superantigen releasing cytokines inflammation.B cells IgM Rheumatoid factor anti IgG.Macrophages surround RF factor complex type III injury (immune complex) cy

9、tokine release inflammation damage.2022/7/22Morphology:Proliferative synovitis with lymphocytes (CD4), plasma cell & macrophages Pannus.Organizing fibrin (rice bodies).Neutrophils on the joint surface and fluid.Juxta-articular erosions, cysts & osteoporosisFibrous ankylosis. Skin - Rheumatoid nodule

10、sVasculitis (commonly of digital arteries)2022/7/22Early Destruction in RA:Swan NeckDeformity2022/7/22RA - Clinical Features:Morning stiffness.Arthritis in 3 or more joint areas.Arthritis of small hand joints.Symmetric arthritis.Rheumatoid nodules.Serum rheumatoid factor.Typical radiographic changes

11、At least 4 features for diagnosis.2022/7/22N.Synovium - - R.Arthritis:2022/7/22RA - Pannus:2022/7/22RA - Pannus:Hyperplastic inflammed synovium2022/7/22Extra-Articular RARheumatoid NodulesVasculitisPleuritisPericarditisTendonitis2022/7/22Skin RA Nodule:2022/7/22Skin RA Nodule:2022/7/22Rheumatoid Nod

12、ule (skin):PalisadingMacrophagesCentralFibrinoidNecrosis2022/7/22Joint involvement in RA:2022/7/22Swan Neck Deformity in RA:2022/7/22Joint Destruction in RA:Swan NeckDeformity2022/7/22RA Joint destruction, ankylosis:2022/7/22OsteoarthritisDegenerative arthrosis.(Osteoarthrosis)2022/7/22Osteoarthriti

13、s:Degenerative end result - (ageing) 80% in 65y.Progressive erosion & fibrillation of articular cartilage forms Loose bodies.Large weight bearing joints.Hardened articular bone eburnation. & Subarticular cyst formation in bone.Periarticular osteophyte formation. Mild inflammation but painful, mornin

14、g stiffness.Limited range of movements Heberden nodes (F)2022/7/22Normal - Femur Head - OANormalOsteoarthritis2022/7/22Femur Osteroarthritis:2022/7/22Joint Mice or Loose Bodies:2022/7/22Spine Osteophytes (OA):2022/7/22Radiologic Features:nonuniform joint space loss, osteophyte formation, cyst format

15、ion subchondral sclerosisSclerosis, ankylosis & deformity.2022/7/22Osteoarthritis:Narrow joint spaceLipping osteophyteDislocationOsteoporosis.2022/7/22Osteophyte formation:2022/7/22Bone cysts in OA:2022/7/22Osteoarthritis: Ankylosisvarus deformity of the knee and collapse of the joint space with des

16、truction of the medial cartilage and the subchondral cortex (open arrowheads). 2022/7/22Osteoarthritis:Lateral view of the left knee shows sclerosis with marked osteophyte formation (arrows). The osteophytes are best seen in this view. 2022/7/22Osteoarthritis:Subchondral cysts (solid arrowhead) 2022

17、/7/22OA Fingers:2022/7/22OA Hip:2022/7/22OA Hip: 1997, bilateral, joint space narrowing (arrows) at the hips that is worse on the left side 2022/7/22OA Hip: Subchondral sclerosis (solid arrowhead) and cyst (arrow) formation are also noted on the left side 2022/7/22OA Hip:left hip arthroplasty 2022/7

18、/22OA - Clinical Features:pain worsens with activity & improves on rest.Instability of joints Knee.Crepitus, limitation of motion. Muscle spasm, and tendon and capsular contractures.Early morning stiffness lasts 1 hour or more.bony overgrowth interphalangeal joints distal(Heberdens) proximal (Boucha

19、rds).2022/7/22Differentiating Features:Rheumatoid Arthritis:Young, small jointsAutoimmune.Synovial Inflammationsynovium CartilageOsteoarthritis:Old, Large jointsDegenerative.Cartilage degeneration.Cartilage Synovium2022/7/22Arthritis Other Infective, traumatic, secondary to systemic diseases. 2022/7

20、/22Seronegative arthropathiesAnkylosing Spondylitis:Adolescent boys, HLA B27, axial joints (sacroiliac)Reiter Syndrome:Triad of arthritis, urethritis/cervicits & conjuctivitisAutoimmune but initiated by bacterial infection.Enteropathic Arthritis:Secondary to bowel infections (salmonella, shigella)HL

21、A B27 positivePsoriatic Arthritis:5% of patients, starts in DIP joints, similar to RA.2022/7/22Septic Arthritis:ORGANISM PEAK AGE INCIDENCE GRAM STAIN Hemophilus influenzae Children Gram negative coccobacilli Neisseria gonorrheae Young adults Gram negative diplococci Salmonella young with Sickle Cel

22、l An. Gram negative rods Staph. aureus Adults Gram positive cocci in clusters Escherichia coli Adults Gram negative rods Pseudomonas Adults Gram negative rods 2022/7/22Gonococcal Arthritis:2022/7/22Juvenile Rheumatoid Arthritis:Before age 16Multisystem involement - Spleenomegaly,Starts with systemic

23、 involvement unlike RA.No serum RA Factor SeronegativeAntinuclear Antibody (ANA) +ve autoimmune.2022/7/22Big Toe in Gout:2022/7/22Joint Destruction in Gout:2022/7/22Gout Tophi:2022/7/22Urate Crystals (Gout):2022/7/22Pseudo GoutCalcium PyroPhosphate Deposition diseaseCPPDChondrocalcinosis.2022/7/22CP

24、PD (Chondrocalcinosis)Type A Pseudo gout Knee, menType B Pseudo rheumatoid - polyarthritisType C Pseudo OA + acute attacks, womenType D Pseudo OA - acute attacks, handsType E AsymptomaticType F Pseudoneuropathic2022/7/22CPPD-Arthritis (pseudo gout):2022/7/22Pseudo Gout Calcium pyrophoshate2022/7/22Ankylosing SpondylitisMarie-Strumpell ArthritisYoung males, 90% HLA B27 +25% have iritis10%