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| solid joints, provide structural integrity and allow for minimal movement - Cranial sutures and bonds b/w roots of teeth and jawbones = ? - Symphyses = ? | Synarthroses
- Fibrous synarthroses
- Synchondroses (Cartilaginous synarthroses)
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| Joints with joint space that allows for wide range of motion | Synovial joints
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| Most common type of joint disease. progressive erosion of articular cartilage, dislodged pieces of cartilage/bone form loose bods (joint mice) in joint space, bone eburnation. knees and hands affected in women and hips in men. worse w use, morning stiff. | Osteoarthritis
- Heberden nodes at DIP joints in women
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| Chronic systemic inflamm affects many tissues/organs, principally attacks joints->inflamm synovitis->destroy articular cartilage and ankylosing joints. Women 40-70 y/o. Pannus bridge apposing bones, form fibrous ankylosis. nodules, HLA-DRB1, anti-CCP, TNF | Rheumatoid Arthritis
- symmetrical and small joints affected first
- joints are swollen, warm, painful, morning stiff
- Radial wrist deviation, Ulnar finger deviation, Swan Neck/Boutonniere finger deformities
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| Arthritis <16 y/o and persists for 6 wks. Oligoarthritis more common, systemic disease more freq (spiking fever, rash, hepatosplenomega, serositis), large joints affected, no nodules, ANA positive. | Juvenile Idiopathic Arthritis (JIA)
- Oligoarthritis=4 or less joints w/o psoriasis, HLA-B27, asymm, <6 y/o w iridocylitis
- Rheumat factor-pos polyarth=teenage girls
- Rheumat factor-neg polyarth= >5 joints
- Enthesitis-related=male <6 y/o, HLA-B
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| Destroy articular cartilage and resulting bony ankylosis (sacroiliac and apophyseal joints). Squaring/Fusion of vertebral bods w bony outgrowths-> spinal immobility. HLA-B27. men 10-29 | Ankylosing Spondyloarthritis (Marie-Strumpell)
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| triad of arthritis, nongonococcal urethritis or cervicitis, and conjunctivitis, d/t prior GI/GU infx. Ankles, knees, feet affected w sausage fingers/toes. men 20s and 30s. HLA-B27, inc risk w HIV. | Reiter Syndrome
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| Arthritis d/t GI infx by Yersinia, Salmonella, Shigella, Campylobacter | Enteritis-Associated Arthritis
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| Sudden painful, swollen joint w restricted ROM and fever, suppurative arthritis mostly d/t gonococcus (late teens, young adult), Staph (mainly), Strep, H. influ (<2 y/o), gram neg bacilli, Salmonella (Sickle cell). Most nongonococcals involve 1 knee only | Bacterial Arthritis
- Axial joint involvement w drug addicts
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| Arthritis caused by Borrelia burgdorferi, transmitted by Ixodes ticks. Large joints (knees, shoulders, elbows, ankles). Papillary synovitis w synoviocyte hyperplasia, fibrin deposit, CD4 T cell infiltrate, and onion-skin thickening of arterial walls. | Lyme Arthritis
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| X-linked lack of HGPRT w hyperuricemia, neuro deficits w mental retardation, self mutilation, and gouty arthritis. | Lesch-Nyhan syndrome
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| Precipitation of long, needle-like, NEGATIVELY BIREFRINGENT Monosodium Urate crystals into the joint space causing Tophi (urate crystals surrounded by inflamm rxn of macrophages, lymphocytes, giant cells). most first attacks occur in 1st MTP joint | Gout
- Risk factors for hyperuricemia:
Age (gout rare b4 20-30)
HGPRT and other familial links
Heavy alcohol
Obesity
Drugs like Thiazides that reduce urate excretion
Lead toxicity
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| Precipitation of blue-purple, geometric (rhomboid), WEAKLY BIREFRINGENT Calcium Pyrophosphate crystals first into articular matrix, menisci, and IV discs. Hereditary variant caused by mut ANKH gene. freq asymptomatic. Knees most commonly affected | Pseudo-Gout
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| Small cyst almost always located near a joint capsule or tendon sheath (esp. wrist). firm, fluctuant, pea-sized translucent nodule. | Ganglion
- Synovial cyst: herniation of synovium through joint capsule or massive enlargement of bursa. In popliteal space w Rheumatoid arthritis = Baker cyst
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| Benign neoplasms that develop in synovial lining of joint, tendon sheaths, bursae. Chromo translocation t(1;2) (fuses CSF1 to promoter of collagen VI alpha-3 gene-> overexpress CSF1 [chemoattractant for macrophages]). | Tenosynovial Giant-cell Tumor
- Diffuse: Red-brown tangled mat of synovium w projections and nodules. pain, locking, swelling of knee
- Localized: well circumscribed, resemble a small walnut
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| Most common soft-tissue tumor of adults. Benign | Lipoma
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| Amplification of MDM2 oncogene inhibits p53-> lipoblasts that mimic fetal fat cells and contain round clear cytoplasmic vacuoles of lipid that scallop nuclei. t(12;16). 40-60s in the deep soft-tissue of prox extremities and retroperitoneum | Liposarcoma
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| Most common reactive pseudosarcoma, often occurs in adults on the volar forearm. W plump, randomly oriented spindle cells surrounded by myxoid stroma | Nodular Fasciitis
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| Can be palmar, plantar, or penile, nodular or poorly defined broad fasicles of fibroblasts and myofibroblasts surrounded by abundant dense collagen. | Fibromatoses
- Palmar: Dupuytren contracture, nodular thickening of palmar fascia w puckering and dimpling and flex contracture of 4th and 5th digits
- Penile: Peyronie disease, curvature of shaft, constrict uretha
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| Large, infiltrative masses that freq recur after incomplete excision and are composed of banal well-differentiated fibroblasts that don't metastasize. teens to 30s. Mut APC or Beta-catenin. asso w Gardner synd (familial adenomatous polyposis). | Deep-seated Fibromatosis
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| commonly in the deep soft tissue of the extremities. unencapsulated, infiltrative, soft, Fish-Flesh, spindled cell masses in Herringbone pattern to architectural disarray (pleomorphism, freq mitoses, necrosis). aggressive | Fibrosarcoma
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| Most common soft-tissue sarcoma of kids/teens. most in head and neck or GU tract. tadpole or strap cells (rhabdomyoblasts: have abundant eosinophilic cytoplasm). | Rhabdomyosarcoma
- Embryonal type: most common, includes sarcoma botryoides. <10 y/o, nasal cavity, orbit, ear, prostate. cambium layer.
- Alveolar type: teens, deep muscles of extremities. fibrous septae divide tumor into clusters that resemble alveo
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| Uterine these are the most common neoplasm of women. benign smooth muscle tumor. loss of func mut in Fumarate Hydratase. Blunt-ended, elongated nuclei w minimal atypia and few mitotic figs | Leiomyoma
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| Malignant spindle cells w Cigar-shaped nuclei arranged in interweaving fascicles. in skin (small) and deep soft tissue of extremities and retroperitoneum (large). | Leiomyosarcoma
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| Deep-seated mass noted for yrs, often in deep-soft tissue of LE around knee/thigh. Biphasic has dual lines of differentiation (epithel like and mesenchymal like). positive rxns w keratin and epithel memb antigen differentiates from other sarcomas. t(X;18) | Synovial Sarcomas
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