“Life’s battles don’t go always to the stronger or faster man, But sooner or later, The man who wins

is the man who thinks he can”

Pathology of Arthritis
Dr. Venkatesh M. Shashidhar.
Senior Lecturer in Pathology Fiji School of Medicine

Arthritis

Arthritis Clinical Classification:
Monoarthritis
 Acute: Bacterial, Trauma, Crystal, Reactive  Chronic :Tuberculosis, Lyme, Fungal, Trauma, Tumors.

Polyarthritis
 Autoimmune, degenerative, Crystal & Septic.

Arthritis

Polyarthritis Classification:
 Autoimmune  Rheumatic, Rheumatoid, Ankylosing spondylitis, Reiter syndrome etc.

 Degenerative – Osteroarthritis

Crystal Deposition  Gout – Monosodium urate  CPPD - Pseudo Gout

 Infective - Septic, TB, Lyme etc.

Arthritis

Osteoarthritis:
 Degenerative end result - (ageing) >80% in >65y.  Progressive erosion, fibrillation and cracking of articular cartilage forms Loose bodies.  Hardened articular bone – eburnation.  Subarticular cyst formation in bone.  Periarticular osteophyte formation.  Mild inflammation but painful, morning stiffness.  Limited range of movements Heberden nodes (F)

Arthritis

Femur Head Osteroarthritis:

Normal

Osteoarthritis

Arthritis

Femur Osteroarthritis:

Arthritis

Joint Mice or Loose Bodies:

Arthritis

Spine Osteophytes (OA):

Arthritis

Osteoarthritis:

Arthritis

OA Fingers:

Arthritis

OA Hip:

Rheumatoid Arthritis

Arthritis

RA - Definition:
 Chronic Multisystem autoimmune inflammatory disorder principally affecting joints producing a proliferative synovitis that often progresses to destruction of the articular cartilage and ankylosis.

Arthritis

Etiology:
 Genetic Susceptibility:
 HLA DR4, or DR1 in 65% to 80% cases.

 Microbial inciting agent:
 Epstein-Barr virus, Borrelia & Mycoplasma

 Autoimmunity:
 IGM anti IgG – RA Factor.  Helper T cell (CD4) against type II collagen & cartilage glycoprotein-39

Arthritis

Morphology:
 Proliferative synovitis with lymphocytes (CD4), plasma cell & macrophages Pannus.  Organizing fibrin (rice bodies).  Neutrophils on the joint surface and fluid.  Juxta-articular erosions, cysts & osteoporosis  Fibrous ankylosis.  Skin - Rheumatoid nodules  Vasculitis (commonly of digital arteries)

Arthritis

RA - Clinical Features:
1. Morning stiffness. 2. Arthritis in 3 or more joint areas. 3. Arthritis of hand joints. 4. Symmetric arthritis. 5. Rheumatoid nodules. 6. Serum rheumatoid factor. 7. Typical radiographic changes

At least 4 features for diagnosis.

Arthritis

Synovium – R.Arthritis:

Arthritis

RA - Pannus:
Hyperplastic inflammed synovium

Arthritis

Rheumatoid Nodule (skin):

Palisading Macrophages

Central Fibrinoid Necrosis

Arthritis

Joint Destruction in RA:

Swan Neck Deformity

Arthritis

Early Destruction in RA:

Swan Neck Deformity

Arthritis

Skin RA Nodule:

Arthritis

Swan Neck Deformity in RA:

Arthritis

RA hand:

Arthritis Other

Arthritis

Other Seronegative arthropathies

 Ankylosing Spondylitis:
 Adolescent boys, HLA B27, axial joints (sacroiliac)

 Reiter Syndrome:
 Triad of arthritis, urethritis/cervicits & conjuctivitis  Autoimmune but initiated by bacterial infection.

 Enteropathic Arthritis:
 Secondary to bowel infections (salmonella, shigella)  HLA B27 positive

 Psoriatic Arthritis:
 5% of patients, starts in DIP joints, similar to RA.

Septic Arthritis:
ORGANISM PEAK AGE INCIDENCE Hemophilus influenzae Neisseria gonorrheae Salmonella Staph. aureus Escherichia coli Pseudomonas Children Young adults young with Sickle Cell An. Adults Adults Adults GRAM STAIN Gram negative coccobacilli Gram negative diplococci Gram negative rods Gram positive cocci in clusters Gram negative rods Gram negative rods

Arthritis

Gonococcal Arthritis:

Arthritis

Juvenile Rheumatoid Arthritis:
 Before age 16  Multisystem involement - Spleenomegaly,  Starts with systemic involvement unlike RA.  RA Factor – Seronegative  ANA positivity is common.

Arthritis

Big Toe in Gout:

Arthritis

Joint Destruction in Gout:

Arthritis

Gout Tophi:

Arthritis

Urate Crystals (Gout):

CPPD

•Calcium Pyrophosphate Deposition disease diseas

Arthritis

CPPD – (Chondrocalcinosis)
 Type A – Pseudo gout – Knee, men  Type B – Pseudo rheumatoid - polyarthritis  Type C – Pseudo OA + acute attacks, women  Type D – Pseudo OA - acute attacks, hands  Type E – Asymptomatic  Type F – Pseudoneuropathic

Arthritis

CPPD-Arthritis (pseudo gout):

Arthritis

Pseudo Gout – Calcium pyrophoshate

Arthritis

Arthritis Comparison:

Thank you
Dr. Venkatesh M. Shashidhar.
Senior Lecturer in Pathology Fiji School of Medicine

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