UNI 3: THe VASUILIDM > 2. epoLyYARTERITS Wepesh ~ GENERAL PYASCULITIS of WASDiund SIZED VESSELS 1 ANOLVING 6 ole Gil S¥STERt +CAN BE Associated WedeP By, + Deu Reconels * PATHPENSIOLOGEC auo “PMN INVASION oF ALL LAYERS Heeoi Neceosig Puls RESUCHNG } oe PROLIFERATION Leap Te REDUCED ryamtat LUKtINAL A Wi care! ihe Becuees IN (SCHEMIA, INLFARETION, + ANELIEYSEE > CLINICAL FINDHES ONSET INSIDIOUS W. Fever, AAAs t AleIGHT Loss MPAIN IN EXTREMITIES Boo iMALIT BARI CAUSED B) Gna, 7 P MMALEMACpaemoLAg micaLves) i Aerie Menlo NEUE? \AuLmIPLEx Steer Deop Cart tent * Sli FINDINGS *LIVEDO RETWCULARIS *SUBQ NODULE! ‘seitureees S Geeeuecr DEED We DVIS IZE VESSELS 1 DlentAL CrariCreewie + ULCERATION Kee a, +H wwoenenttor peeelk (ABDOMINAL palN— peeuprravedD BY EATING ae NAUSEA /VopAlTi penal | Cntr or appenDtereis a beepers cooprenmes caesar DYSFHM ie a - —> plIaGnlas iC _ nysupecte el SUGHT AnenAla 4 upuiceotes © vier Irie ore HENez . 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SY eremate Gru © Coemeer or crospoeintg ASPIRING Foy Tem AbopHLE RIT 'S ~PATHER GY PHENOL LEN DE ATA THhOP OeRHEUMATOLOGY NOTES Reynold Trowers, M.D. Joint anatomy Synarthrosis (fibrous or immovable joints) Cain Dermete a mes eu) 8 3) syndesmoses (tibiofibular attachment) Rheumatology- science of cea ia ie ye eee ee marked by inflammation, degeneration, Cane coeCer ire meat kies Connective tissue structures of the body (especially the joints and related structures) Amphiarthrosis (Cartilaginous joints) O/C eau oe fibrocartlage ey Sieve Bison Meee © Intervertebral disc @ Epiphyseal plate (growing bone)Synovial Joints (diarthrosis) United by synovial membrane ean Plane or gliding (tarsal, metatarsals) Hinge (interphalangeal) erect ‘Spheroidal (ball and socket) hip, tec alent Synovial joints SIC UM eine Eee secu 8 Well lubricated congruent cartilaginous Rie ee COCs Erne EuUiie ta gratntes st Joint anatomy Pete tee eaten Cra emed iene eee Gene enue Nc} Periosteum specialized connective tissue ise n een Sc Eaeuial Tendon connective tissue muscle to bone Cee een ec to bone or cartilage to cartilageSOME Ue US Gea col kee DM aes sere MectnCc ues Dees ene eet ee Cell secrete fluid (synovium) ‘Synovium nourishes articular cartilage Inflammation GS eee produces arthr itis, Nw ye eee ese ce (ieee NC acy antigen/antibody complexes, chemicals Pree ues Synovial fluid (synovia) NN ee Rene eo ONCens cue Mc Non clotting Inflammation. infection and other pathologic processes change the Cree cine eaa ae CE UCk acy analysis helps with the diagnosis iit tare GC es ene Rear ecg to protect, limit injury, and remove the invader. Unfortunately the inflammatory reaction Mester ue tee limitation of movement, and destruction offissueInflammatory arthritis OER ee eek Uren Geneon CNC e EI Ces ane et Pier tarckae ci etait the articular cartilage, subchondral bone, ligaments, tendons and synovial capsule cools atten tentoMety Loli) Ce oa Ms Eien OU AIee NCI Seen cert Con euCU Rel © * Complement is a specialized series of Proteins which act sequentially to Ge eee a effects including bacterial killing Inflammatory response Antigens (foreign agents) Eunice ta teen) Meee Dna etree eae ae transform into larger round cells (plasma ID) @ Plasma cells produce antibodies specific ae eae tane Wate oag ey kel Vise Met Me uC Caco Cuca ues cells and then destroyed by the Deeeueeceorc lait the cellsInflammatory arthritis eM emcelg utr) asco ene ua ae or Inflammation in joints triggers cells to seem to lose the ability to distinguish Ca euch Re ku CA UC! Pannus is pathologic thickened synovial Eeeeiiuciicst eRe Ct eee OT eWIU Sen ue ete cue Seu saa Ca fie ele Ueto a etaecsaes Ee ea Peat icaeesteete te Inflammatory arthritis ifflammation (manifestations) & Destruction of cartilage attra: Heat (calor) phagocytic cells with more release of Renee crea) Cramster tint sts Renee) IE Mennece ean , Con Pain (dolor) May result in significant joint damage EU Ucn ag aed eee en Mee ae eesGet Guetta encores Eee Om Mit mene en) Crore) ete eck ok a TORS ueaue eeu hd Medical care. Range of Motion Pe taca icon Ram ao Reet Cine estado eeesaerc) Swelling (edema) ie eee ae eee Cea ot, aggravating or alleviating factors, Sao & Restriction and or discomfort at the Cee uate rest or inactivityWeakness Eien game geo) @ Attimes difficult to distinguish muscular strength from decrease effort related to cel Eye hteet Screed Physical examination of the joints Oates. cae cee Re cana (ONG SC Stolle Titoli) & Check for swelling, ROM, temperature Cre Neate ic cam testing BS Aitelnnl ren ker eed Ea Maries ue eae iekek a) eeu ene Maes ReGioerteceetaine enemas joints Vise ei ewe Mer cee "A Alignment _ (of axis of conjoined bones) Cygne sas a ee Eee eco eine) Pion cekeri ny 3 'C° Cartilage _ (normally radi Denese aa)Rheumatoid Arthritis Eye eue eeu Crary Qiareaie es) ese uC Mar Cee eS 2A extra articular findings Geto niet est cou) Peco) NeCenicy Net y Episcleritis and scleritis Gere ie ceae cay Bean Rheumatoid arthritis Er inienane ener ecea exacerbations and remi @ [fot controlled will generally result in Progressive joint destruction and Cece RNa ese Geocities ere auitatesyy) & Worldwide distribution Allracial and ethnic groups Eau kei ke aC Gea Ebro eet et ea typically onset is 20-30 year oldEtiology (idiopathic) Investigations have looked to endocrine, metabolic, nutritional factors No particular geographic prediliion Bacterial viral and mycoplasmal etiologies investigated, without clear its Rheumatoid factors Ee mcN Rode We ea ference 9 Results given as titers (the higher the titer the more activity is evident) Die ree tact cuca’ since the itis a larger and easier to detect molecule Immunologic disease & Serum and joint fluid of patients with RA Ciemeiss|-s © These antibodies are often specific for Cigaiccuad (crue CAMO MEU) eV eey SO unc econo Penne cartilage, (esp. at the junction at Cnieree ae eines) & As inflammation continues, joint capsule Peete raat eco Joint destruction, muscle atrophy (uel Rogue atc) Genes Mee uCRn COAV Colina nen lant Can affect any diarthroidal joint Most common small joints of the hands, Raa Ouch Cle shoulder, hips, ankles and cervical spine) Generally bilateral, symmetric and Peveienrts Shiela Morning stiffness Ses Le eee ened Guia Reg ieucce kal Praesens ra ec OER Ce inactivity Tau CMe colo keke Bcc meat synovium and thickening of joint capsule Sen ea enced with increase in volume of effusion Eee eeu as Rie oeankylosis EMIS eur keneee Coma a Eiger eec ies ei won) ankylosis (fusion of bone to bone). Swan neck deformities Sy eseen cued eee ec DIP See ew ROht Cnn a Cane ace Ciena) RA typical findings Swelling at the PIPAs with fusiform ‘appearance (BouchardAs nodes) MC-P joint involvment that can progress fo ulnar deviation subluxations eee aa) RICCOBoutonniere deformity Secunia gen ec ine kuc} pire Tendon rupture Garpal tunnel syndrome Me ed eet ec ae nucw cede fingers would be indicative of a acute Beer heer ae Ce a CaS Co eee CMe cc Contac) GE auehe eels remastered Eee eee ey ees peeve eumeuea eaKnee involvement Sais a tuany Chronic effusions Beles eee) BakerAs cyst (pathologie enlargement of CES nents RA joint involvement Bee ekeuiec ts Sen eens ul Neck not very common involvement, may SMC detrei mains Perea eto tee ucas Foot and ankle involvement Geico) GS neice clu Gy SMtec Cueto eRe Cues (eeeimestet meus traarticular manifestations Gree Renee tery @ Vasculitis Note tny Reames lease tS Pericarditis eee accu eng eeeRheumatoid nodules Olean SMa aes OU Ane seat ey SN auune ase cu Citucereueclacctiy SSC ieede en eat aa} Ore IeCay Baca soar Sco Re Pericarditis Eeiunucts Physical findings? EKG changes? TT Cu eal Ie oui Seed Neurologic complications COVEY ieee WRC ened Ciesueas eer Te Rec Oca aN neues wasting Cus Vasculitis (inflammation of blood vessels) Oy ereo Neue cues Paina Cue Manne a necrosis, ulceration, digital gangrene and Cea eeu ad cout ManetOcular complications EUCr etree) Bescon mcr iS ieoecy Scleritis Felty syndrome Sexi tn ecu eons Gaeta) yc uc cum accra Enum MKS aS) Ce-To] Eno Mitelnelits Rheumatoid pneumoconiosis RA. @ Multiple pulmonary nodules (theumatoid Ceuticuco) First described in Welsh coal miners but Ceci secur ea) Since Laboratory studies = CBC espa elo Net ec Cette he ncry ENNSynovial fluid analysis (RA) eter) Turbid Tyee MLC cy Mucin clot test Gram stain and bacterial culture negative JRA GiGi Tee Ce ene rane cum k oe} © Up to 100,000 children in the US have eee eek Sem ee nek od Ried eon Juvenile Rheumatoid Arthritis esteem Meee ue na ‘One of the most common childhood Cteniece sc Clinical course and immunologic test different from adult RA SOR A nag have a early manifestation of the adult Cees Diagnostic criteria ature mmER etd SRS cn Ct hems for at least six weeks & Exclusion of other types of arthritis,JRA heterogeneous group of lett Cee cuis & Polyarticular Cugtcewtenes sJRA Exes Amur CeCe ed blanching) eet CSc RneC tes Cry Systemic JRA ere ites kane SQer ees im eta ceca the 1-6 year old age range SEO Reue reece Ric tia Za (eSeminar a Pees seueu ee Aca EReuE eters ee OMe ee Pee etCn escent ENaC) Oncava Polyarticular arthritis & Patients may develop pericardial Bywater eu cet em Sete nnl) Ponce ec ® Long term prognosis variable depending Cel Cassa tee) ‘on severity of arthritis and other BCLs poJRA Pauciarticular JRA (paJRA) a ae 8 Child with arthritis of four or fewer joints Later onset disease (older than 8) ExCcaec Nei Me en ‘Symmetric small joint involvement Cue TICE Pea ee Greatly resembles adult onset RA See ee eee erepaJRA early onset Young children 1-4 year old CNet cee uur INT eee Bea Seana ci Cream) een ogee JRA treatment © Multidisciplinary approach Must address chronic illness in a child, ieee aeese ace est Can effect growth @ Must address and control inflammation, Ele eee nue Recomm) Bea isos) eee ea akon en Pai oe ced EVM melita (eee ey EOLA ela acy rae Often have tendonitis and enthesitis Adthritis often involves large joints of the EXC C es outa SiS ta)