关节炎(英文).ppt

Thingsmaycometothosewhowait butonlythethingsleftbythosewhohustle AbrahamLincoln PathologyofArthritis Dr VenkateshM Shashidhar AssociateProfessorofPathologyFijiSchoolofMedicine Joints Mobility Cranialsutures Shoulderjoint Articularcartilage hyaline frictionres Synovialfluid lubric nutri TypeA Bsynoviocytes HyaluronidaseContinuousproductionandabsorption AffectedbyInflammation immobility Capsule ligaments menisci Vascular richnervesupply Art Cartilage Joints Anatomy Arthritis Introduction Inflammationofjoints CommonCommonsiteforautoimmuneinjuryHeartvalves Joints damage Exposureofhiddenantigens Infections Degeneration Age Stress lifestyleUseitorLooseit Arthritis Clinicalfeatures Pain Inflammation capsule synovium periosteum Swelling inflammation effusion proliferation Restrictedmovement pain fluid synovialswelling damage Deformity mal alignment erosion ankylosis ArthritisClinicalClassification Monoarthritis Local asymmetric secondary Acute Bacterial Trauma Crystal ReactiveChronic Tuberculosis Lyme Fungal Trauma Tumors Polyarthritis Chronic symmetric systemic Autoimmune degenerative Crystal Rarelyinfective PolyarthritisClassification Autoimmune Rheumatic Rheumatoid Ankylosingspondylitis Reitersyndromeetc Degenerative OsteroarthritisCrystalDeposition Gout MonosodiumurateCPPD PseudoGoutInfective Septic TB Lymeetc rare RheumatoidArthritis EpidemiologyofRA Prevalenceabout1 ofUSpopulationFemale Maleratio 2 1StrongassociationwithHLADR4 Concordanceinidenticaltwinsonly30 RA Definition ChronicMultisystemautoimmuneinflammatorydisorderprimarilyaffectingjointsproducingaproliferativesynovitisthatoftenprogressestodestructionofthearticularcartilageandankylosis Etiology GeneticSusceptibility HLADR4 orDR1in65 to80 cases Microbialincitingagent Epstein Barrvirus Borrelia MycoplasmaAutoimmunity IGMantiIgG RAFactor HelperTcell CD4 againsttypeIIcollagen cartilageglycoprotein 39 Immuno dysregulationinRA Tlymphocytes typeIIcollagen superantigen releasingcytokines inflammation Bcells IgMRheumatoidfactor antiIgG MacrophagessurroundRFfactorcomplex typeIIIinjury immunecomplex cytokinerelease inflammationdamage Morphology Proliferativesynovitiswithlymphocytes CD4 plasmacell macrophagesPannus Organizingfibrin ricebodies Neutrophilsonthejointsurfaceandfluid Juxta articularerosions cysts osteoporosisFibrousankylosis Skin RheumatoidnodulesVasculitis commonlyofdigitalarteries EarlyDestructioninRA SwanNeckDeformity RA ClinicalFeatures Morningstiffness Arthritisin3ormorejointareas Arthritisofsmallhandjoints Symmetricarthritis Rheumatoidnodules Serumrheumatoidfactor Typicalradiographicchanges Atleast4featuresfordiagnosis N Synovium R Arthritis RA Pannus RA Pannus Hyperplasticinflammedsynovium Extra ArticularRA RheumatoidNodulesVasculitisPleuritisPericarditisTendonitis SkinRANodule SkinRANodule RheumatoidNodule skin PalisadingMacrophages CentralFibrinoidNecrosis JointinvolvementinRA SwanNeckDeformityinRA JointDestructioninRA SwanNeckDeformity RAJointdestruction ankylosis Osteoarthritis Degenerativearthrosis Osteoarthrosis Osteoarthritis Degenerativeendresult ageing 80 in 65y Progressiveerosion fibrillationofarticularcartilage formsLoosebodies Largeweightbearingjoints Hardenedarticularbone eburnation Subarticularcystformationinbone Periarticularosteophyteformation Mildinflammationbutpainful morningstiffness LimitedrangeofmovementsHeberdennodes F Normal FemurHead OA Normal Osteoarthritis FemurOsteroarthritis JointMiceorLooseBodies SpineOsteophytes OA RadiologicFeatures nonuniformjointspaceloss osteophyteformation cystformationsubchondralsclerosisSclerosis ankylosis deformity Osteoarthritis NarrowjointspaceLipping osteophyteDislocationOsteoporosis Osteophyteformation BonecystsinOA Osteoarthritis Ankylosis varusdeformityofthekneeandcollapseofthejointspacewithdestructionofthemedialcartilageandthesubchondralcortex openarrowheads Osteoarthritis Lateralviewoftheleftkneeshowssclerosiswithmarkedosteophyteformation arrows Theosteophytesarebestseeninthisview Osteoarthritis Subchondralcysts solidarrowhead OAFingers OAHip OAHip 1997 bilateral jointspacenarrowing arrows atthehipsthatisworseontheleftside OAHip Subchondralsclerosis solidarrowhead andcyst arrow formationarealsonotedontheleftside OAHip lefthiparthroplasty OA ClinicalFeatures painworsenswithactivity improvesonrest Instabilityofjoints Knee Crepitus limitationofmotion Musclespasm andtendonandcapsularcontractures Earlymorningstiffnesslasts1hourormore bonyovergrowth interphalangealjointsdistal Heberden s proximal Bouchard s DifferentiatingFeatures RheumatoidArthritis Young smalljointsAutoimmune SynovialInflammationsynovium CartilageOsteoarthritis Old LargejointsDegenerative Cartilagedegeneration Cartilage Synovium ArthritisOther Infective traumatic secondarytosystemicdiseases Seronegativearthropathies AnkylosingSpondylitis Adolescentboys HLAB27 axialjoints sacroiliac ReiterSyndrome Triadofarthritis urethritis cervicits conjuctivitisAutoimmunebutinitiatedbybacterialinfection EnteropathicArthritis Secondarytobowelinfections salmonella shigella HLAB27positivePsoriaticArthritis 5 ofpatients startsinDIPjoints similartoRA SepticArthritis GonococcalArthritis JuvenileRheumatoidArthritis Beforeage16Multisysteminvolement Spleenomegaly StartswithsystemicinvolvementunlikeRA NoserumRAFactor SeronegativeAntinuclearAntibody ANA ve autoimmune BigToeinGout JointDestructioninGout GoutTophi UrateCrystals Gout PseudoGout CalciumPyroPhosphateDepositiondiseaseCPPDChondrocalcinosis CPPD Chondrocalcinosis TypeA Pseudogout Knee menTypeB Pseudorheumatoid polyarthritisTypeC PseudoOA acuteattacks womenTypeD PseudoOA acuteattacks handsTypeE AsymptomaticTypeF Pseudoneuropathic CPPD Arthritis pseudogout PseudoGout Calciumpyrophoshate AnkylosingSpondylitis Marie StrumpellArthritisYoungmales 90 HLAB27 25 haveiritis10 AorticinsufficiencyS