关节炎(英文)

“Thingsmaycometothosewhowait,butonlythethingsleftbythosewhohustle.”AbrahamLincoln,PathologyofArthritis,Dr.VenkateshM.Shashidhar.AssociateProfessorofPathologyFijiSchoolofMedicine,Joints:,Mobility-CranialsuturesShoulderjoint.Articularcartilagehyalinefrictionres.Synovialfluidlubric/nutri,TypeA&Bsynoviocytes.HyaluronidaseContinuousproductionandabsorption.AffectedbyInflammation,immobility.Capsule,ligaments,menisci.Vascular,richnervesupplyArt.Cartilage*,Joints-Anatomy,Arthritis-Introduction,Inflammationofjoints-CommonCommonsiteforautoimmuneinjuryHeartvalves&Joints-damageExposureofhiddenantigens.Infections.DegenerationAge/Stress/lifestyleUseitorLooseit.!,ArthritisClinicalfeatures:,PainInflammation-capsule,synovium,periosteum.Swelling:inflammation,effusion,proliferation.Restrictedmovementpain,fluid,synovialswelling,damage.Deformitymal-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:GoutMonosodiumurateCPPD-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:IGMantiIgGRAFactor.HelperTcell(CD4)againsttypeIIcollagen&cartilageglycoprotein-39,Immuno-dysregulationinRA,TlymphocytestypeIIcollagen&superantigenreleasingcytokinesinflammation.BcellsIgMRheumatoidfactorantiIgG.MacrophagessurroundRFfactorcomplextypeIIIinjury(immunecomplex)cytokinereleaseinflammationdamage.,Morphology:,Proliferativesynovitiswithlymphocytes(CD4),plasmacell¯ophagesPannus.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%in65y.Progressiveerosion&fibrillationofarticularcartilageformsLoosebodies.Largeweightbearingjoints.Hardenedarticularboneeburnation.&Subarticularcystformationinbone.Periarticularosteophyteformation.Mildinflammationbutpainful,morningstiffness.LimitedrangeofmovementsHeberdennodes(F),Normal-FemurHead-OA,Normal,Osteoarthritis,FemurOsteroarthritis:,JointMiceorLooseBodies:,SpineOsteophytes(OA):,RadiologicFeatures:,nonuniformjointspaceloss,osteophyteformation,cystformationsubchondralsclerosisSclerosis,ankylosis&deformity.,Osteoarthritis:,NarrowjointspaceLippingosteophyteDislocationOsteoporosis.,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.InstabilityofjointsKnee.Crepitus,limitationofmotion.Musclespasm,andtendonandcapsularcontractures.Earlymorningstiffnesslasts1hourormore.bonyovergrowthinterphalangealjointsdistal(Heberdens)proximal(Bouchards).,DifferentiatingFeatures:,RheumatoidArthritis:Young,smalljointsAutoimmune.SynovialInflammationsynoviumCartilageOsteoarthritis:Old,LargejointsDegenerative.Cartilagedegeneration.CartilageSynovium,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.NoserumRAFactorSeronegativeAntinuclearAntibody(ANA)+veautoimmune.,BigToeinGout:,JointDestructioninGout:,GoutTophi:,UrateCrystals(Gout):,PseudoGout,CalciumPyroPhosphateDepositiondiseaseCPPDChondrocalcinosis.,CPPD(Chondrocalcinosis),TypeAPseudogoutKnee,menTypeBPseudorheumatoid-polyarthritisTypeCPseudoOA+acuteattacks,womenTypeDPseudoOA-acuteattacks,handsTypeEAsymptomaticTypeFPseudoneuropathic,CPPD-Arthritis(pseudogout):,PseudoGoutCalciumpyrophoshate,AnkylosingSpondylitis,Marie-StrumpellArthritisYoungmales,90%HLAB27+25%have