关节炎(英文)-ppt课件.ppt

1、“Things may come to those who wait,but only the things left by those who hustle.”2022-7-31Dr.Venkatesh M.Shashidhar.Associate Professor of PathologyFiji School of Medicine2022-7-31Joints:YMobility-Cranial sutures Shoulder joint.YArticular cartilage hyaline friction res.YSynovial fluid lubric/nutri,T

2、ype A&B synoviocytes.Hyaluronidase YContinuous production and absorption.Affected by Inflammation,immobility.YCapsule,ligaments,menisci.YVascular,rich nerve supply Y Art.Cartilage*2022-7-31Joints-Anatomy2022-7-31Arthritis-IntroductionYInflammation of joints-CommonYCommon site for autoimmune injury H

3、eart valves&Joints-damage Exposure of hidden antigens.YInfections.YDegeneration Age/Stress/life styleYUse it or Loose it.!2022-7-31Arthritis Clinical features:YPain Inflammation-capsule,synovium,periosteum.YSwelling:inflammation,effusion,proliferation.YRestricted movement pain,fluid,synovial swellin

4、g,damage.YDeformity mal-alignment,erosion,ankylosis2022-7-31Arthritis Clinical Classification:YMonoarthritis:Local,asymmetric,secondary.Acute:Bacterial,Trauma,Crystal,Reactive Chronic:Tuberculosis,Lyme,Fungal,Trauma,Tumors.YPolyarthritis:Chronic,symmetric,systemic.Autoimmune,degenerative,Crystal.Rar

5、ely infective.2022-7-31Polyarthritis Classification:YAutoimmune:Rheumatic,Rheumatoid,Ankylosing spondylitis,Reiter syndrome etc.YDegenerative:OsteroarthritisY Crystal Deposition:Gout Monosodium urate CPPD-Pseudo GoutYInfective-Septic,TB,Lyme etc.rare.2022-7-31Rheumatoid Arthritis2022-7-31Epidemiolog

6、y of RAYPrevalence about 1%of US populationYFemale:Male ratio=2:1YStrong association with HLA DR4.YConcordance in identical twins only 30%2022-7-31RA-Definition:YChronic Multisystem autoimmune inflammatory disorder primarily affecting joints producing a proliferative synovitis that often progresses

7、to destruction of the articular cartilage and ankylosis.2022-7-31Etiology:YGenetic Susceptibility:HLA DR4,or DR1 in 65%to 80%cases.YMicrobial inciting agent:Epstein-Barr virus,Borrelia&MycoplasmaYAutoimmunity:IGM anti IgG RA Factor.Helper T cell(CD4)against type II collagen&cartilage glycoprotein-39

8、2022-7-31Immuno-dysregulation in RAYT lymphocytes type II collagen&superantigen releasing cytokines inflammation.YB cells IgM Rheumatoid factor anti IgG.YMacrophages surround RF factor complex type III injury(immune complex)cytokine release inflammation damage.2022-7-31Morphology:YProliferative syno

9、vitis with lymphocytes(CD4),plasma cell¯ophages Pannus.YOrganizing fibrin(rice bodies).YNeutrophils on the joint surface and fluid.YJuxta-articular erosions,cysts&osteoporosisYFibrous ankylosis.YSkin-Rheumatoid nodulesYVasculitis(commonly of digital arteries)2022-7-31Early Destruction in RA:Swan

10、 NeckDeformity2022-7-31RA-Clinical Features:1.Morning stiffness.2.Arthritis in 3 or more joint areas.3.Arthritis of small hand joints.4.Symmetric arthritis.5.Rheumatoid nodules.6.Serum rheumatoid factor.7.Typical radiographic changesAt least 4 features for diagnosis.2022-7-31N.Synovium-R.Arthritis:2

11、022-7-31RA-Pannus:2022-7-31Extra-Articular RAYRheumatoid NodulesYVasculitisYPleuritisYPericarditisYTendonitis2022-7-31Skin RA Nodule:2022-7-31Skin RA Nodule:2022-7-31Rheumatoid Nodule(skin):2022-7-31Joint involvement in RA:2022-7-31Swan Neck Deformity in RA:2022-7-31Joint Destruction in RA:Swan Neck

12、Deformity2022-7-31RA Joint destruction,ankylosis:2022-7-31OsteoarthritisDegenerative arthrosis.(Osteoarthrosis)2022-7-31Osteoarthritis:YDegenerative end result-(ageing)80%in 65y.YProgressive erosion&fibrillation of articular cartilage forms Loose bodies.YLarge weight bearing joints.YHardened articul

13、ar bone eburnation.&Subarticular cyst formation in bone.YPeriarticular osteophyte formation.YMild inflammation but painful,morning stiffness.YLimited range of movements Heberden nodes(F)2022-7-31Normal-Femur Head-OANormalOsteoarthritis2022-7-31Femur Osteroarthritis:2022-7-31Joint Mice or Loose Bodie

14、s:2022-7-31Spine Osteophytes(OA):2022-7-31Radiologic Features:Ynonuniform joint space loss,Yosteophyte formation,Ycyst formation Ysubchondral sclerosisYSclerosis,ankylosis&deformity.Osteoarthritis:Narrow joint space Lipping osteophyte Dislocation Osteoporosis.Osteophyte formation:Bone cysts in OA:20

15、22-7-31Osteoarthritis:AnkylosisYvarus deformity of the knee and collapse of the joint space with destruction of the medial cartilage and the subchondral cortex(open arrowheads).2022-7-31Osteoarthritis:YLateral view of the left knee shows sclerosis with marked osteophyte formation(arrows).The osteoph

16、ytes are best seen in this view.2022-7-31Osteoarthritis:YSubchondral cysts(solid arrowhead)2022-7-31OA Fingers:2022-7-31OA Hip:OA Hip:1997,bilateral,joint space narrowing(arrows)at the hips that is worse on the left side OA Hip:Subchondral sclerosis(solid arrowhead)and cyst(arrow)formation are also

17、noted on the left side OA Hip:left hip arthroplasty 2022-7-31OA-Clinical Features:Ypain worsens with activity&improves on rest.YInstability of joints Knee.YCrepitus,limitation of motion.Muscle spasm,and tendon and capsular contractures.YEarly morning stiffness lasts 1 hour or more.Ybony overgrowth i

18、nterphalangeal joints distal(Heberdens)proximal(Bouchards).2022-7-31Differentiating Features:YYoung,small jointsYAutoimmune.YSynovial InflammationYsynovium CartilageYOld,Large jointsYDegenerative.YCartilage degeneration.YCartilage Synovium2022-7-31Arthritis Other Infective,traumatic,secondary to sys

19、temic diseases.2022-7-31Seronegative arthropathiesYAnkylosing Spondylitis:Adolescent boys,HLA B27,axial joints(sacroiliac)YReiter Syndrome:Triad of arthritis,urethritis/cervicits&conjuctivitis Autoimmune but initiated by bacterial infection.YEnteropathic Arthritis:Secondary to bowel infections(salmo

20、nella,shigella)HLA B27 positiveYPsoriatic Arthritis:5%of patients,starts in DIP joints,similar to RA.2022-7-31Septic Arthritis:ORGANISM PEAK AGE INCIDENCE GRAM STAIN Hemophilus influenzae Children Gram negative coccobacilli Neisseria gonorrheae Young adults Gram negative diplococci Salmonella young

21、with Sickle Cell An.Gram negative rods Staph.aureus Adults Gram positive cocci in clusters Escherichia coli Adults Gram negative rods Pseudomonas Adults Gram negative rods 2022-7-31Gonococcal Arthritis:2022-7-31Juvenile Rheumatoid Arthritis:YBefore age 16YMultisystem involement-Spleenomegaly,YStarts

22、 with systemic involvement unlike RA.YNo serum RA Factor SeronegativeYAntinuclear Antibody(ANA)+ve autoimmune.2022-7-31Big Toe in Gout:2022-7-31Joint Destruction in Gout:2022-7-31Gout Tophi:2022-7-31Urate Crystals(Gout):2022-7-312022-7-31CPPD (Chondrocalcinosis)YType A Pseudo gout Knee,menYType B Ps

23、eudo rheumatoid-polyarthritisYType C Pseudo OA+acute attacks,womenYType D Pseudo OA-acute attacks,handsYType E AsymptomaticYType F Pseudoneuropathic2022-7-31CPPD-Arthritis(pseudo gout):2022-7-31Pseudo Gout Calcium pyrophoshate2022-7-31Ankylosing SpondylitisYMarie-Strumpell ArthritisYYoung males,90%H

24、LA B27+Y25%have iritisY10%Aortic insufficiencyYStrongly familial,100%concordance in monozygotic twins.AS-fusion of vertebral bodies due to bridging syndesmophytes.2022-7-31Scoliosis in Ankylosing Spondylitis2022-7-31Organisms in Reiters YShigella FlexneriYSalmonellaYS.typimurium othersYYersinia ente

25、rocoliticaYCampylobacter JejuniYChlamydia trachomatisYUreaplasma urealyticum2022-7-31Arthritis Comparison:The gem cannot be polished without friction,nor man perfected without trials or problems(or exams)!.-Chinese proverb2022-7-31Pathology of Reiters SyndromeYAcute SynovitisYChronic changes(in some)YUnilateral SacroilitisYAscending arthropathyYOssification&enthesopathyYIleal,colonic or urethral-non specific mucosal inflammation2022-7-31Reiters Syndrome:2022-7-31Iritis:2022-7-31