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Rheumatoid arthritis and osteoarthritis: Pathology review

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Musculoskeletal system pathology review

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Rheumatoid arthritis and osteoarthritis: Pathology review

Questions

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Questions

USMLE® Step 1 style questions USMLE

15 questions
Preview

A 65-year-old man comes to his primary care provider for evaluation of pain in both knees. His symptoms worsen with activity and improve with rest and ibuprofen. The patient had previously been an avid runner but had to stop due to the joint pain. Past medical history is notable for hypertension and a right fibular fracture, which occurred after a biking accident. Vitals are within normal limits. Examination of the affected joints reveals crepitus and mildly reduced range of motion. The remainder of the patient’s physical examination is noncontributory. Knee imaging is ordered, and the results are as follows:




Reproduced from: Radiopedia

Which of the following additional findings, if present, would best support the patient’s diagnosis?

Transcript

Jody is a 55 year old woman who presents with a 6 month history of bilateral hand and wrist stiffness.

She mentions that the stiffness lasts for more than an hour a day but tends to improve as she uses the affected joints.

Examination shows swelling, limited range of movement, and subcutaneous nodules over the proximal interphalangeal joints, but no redness.

Then you see Kerry, a 60 year old woman who comes in with a 1 year history of pain in the right knee that has gotten progressively worse.

The pain is worse in the evening or with use of the affected limb and is associated with stiffness, which typically occurs at rest and lasts around 10 to 15 minutes.

Examination reveals Kerry is obese, has bowing of the right knee, and that the affected joint has a limited range of motion.

Blood tests are ordered in both cases, showing in Jody’s case high levels of rheumatoid factor (RF) and anti-citrullinated peptide antibody (ACPA), whereas in Kerry’s case both antibodies were absent.

Both people have arthritis.

Now, a healthy joint usually consists of two bones, each with its own layer of articular cartilage.

Articular cartilage is a type of connective tissue with a lubricated surface that acts like a protective cushion for bones to smoothly glide against.

Now, there are many types of joints, including fibrous, cartilaginous, and synovial joints, which have additional components depending on their function.