DISEASES OF
BONES & JOINTS
Dr Manjiri Karandikar
Professor of Pathology
BVDUMC, Pune
Rheumatoid arthritis
• Chronic systemic inflammatory disorder
affects skin, blood vessels, heart, lungs
• But mainly attacks small joints
• Nonsuppurative proliferative and
inflammatory synovitis
• Destruction of the articular cartilage
• Ankylosis of the joints
Rheumatoid arthritis
Clinical Features
• F>>M, 40-70 yrs
• Morning stiffness, joint pains
• Arthritis in more than 3 joint areas
– Bilaterally symmetrical
– Rheumatoid Factor (RA Factor) +ve in 80%
Rheumatoid arthritis
• Etiology/Risk Factors:
• Positive family history (Genetically susceptible host)
• HLA DR4 (chr 6)
• Exposure to some Ag which initiates arthritis
• Autoimmune progression
• Progressive synovitis
Morphology of joint in RA
• Changes in the synovium - Thickened, oedematous
hyperplastic, & shows delicate bulbous folds.
Inflamed hyperplastic synovium is called Pannus
• Dense inflammatory infiltrate & vascularity
• Exudative synovial fluid rich in polymorphs &
Fibrin which forms Rice bodies
Changes in underlying bone Osteoclastic activity ++
Synovium penetrates the bone → Erosion,
subchondral cysts, osteoporosis
Pannus
• Mass of inflamed synovial tissue that grows
over the articular cartilage causes its erosion.
• Eventually cartilage destruction
• Pannus bridges the apposing bones
• Fibrous ankylosis
• Bony ankylosis
Rheumatoid arthritis
Early RA Intermediate RA Late RA
X ray of RA
Different Joint Replacements
Hip Kne
e
Hands
Juvenile idiopathic (Rheumatoid) Arthritis
• Begins before age 16, by definition
• Generally larger joints than RA
• Oligoarticular
• Often positive ANA
Spondylosis
Spondylosis refers to degeneration of the spine.
Seronegative spondyloarthropathies
• Many are associated with the HLA-B27 allele and a
triggering infection but NO specific autoantibodies
• Ankylosing spondylitis
• Reactive arthritis
• Psoriatic arthritis
• Arthritis associated with IBD(ulcerative colitis,
Crohn disease)
Ankylosing Spondylitis
• An inflammatory disease that can cause some
of the vertebrae to fuse together.
• This makes the spine less flexible and can result
in a hunched-forward posture.
• In a severe case, it may be impossible to lift
head high enough to see forward.
• Men >women, Genetic factors
• HLA-B27 positivity
Signs and symptoms
• Typically begin in early adulthood, third decade
• Pain and stiffness in lower back and hips
• The areas most commonly affected are:
• Lumbosacral, SI joint
• The lumbar vertebrae
• Costo-chondral cartilage
• Hip and shoulder joints
Why progressive disease?
• Destruction of articular cartilage
• Persistent inflammation
• New bone forms as part of the body's attempt to
heal.
• This new bone gradually bridges the gap
between vertebrae and eventually fuses
vertebrae together. Ankylosis
• Fusion can also stiffen the rib cage, restricting
lung capacity and function.
Complications
• Eye inflammation (uveitis) Rapid-onset eye
pain, sensitivity to light and blurred vision
• Compression fractures
• Difficulty in breathing
• Cardiac complications e.g.
Aortitis → Aortic regurge
Kyphosis
• Kyphosis is an exaggerated forward rounding
of upper back Hunchback.
• Can occur at any age, most common in older
women
• Osteoporosis weakens spinal bones to the
point that they crack and compress.
Kyphosis
Risk factors
• Adolescent girls with poor posture
• Boys between 10 and 15 yrs of age
Scheuermann's kyphosis
• Older adults with osteoporosis
• People who have connective tissue disorders,
such as Marfan syndrome
Clinical Features
• No noticeable signs or symptoms
• Hunchback
• Back pain and stiffness
• Severe disease
• Inability of lungs to expand fully
(Restrictive lung disease) Breathing difficulty
• Repeated LRTI
Causes of Kyphosis
• Osteoporosis (compression fractures)
• Intervertebral Disk degeneration
• Cancer and cancer treatment Primary or
secondary tumours can weaken vertebrae and
make them more prone to compression fractures,
Also cancer treatments such as chemotherapy
and radiation.
• Scheuermann disease a rare hereditary disorder
• Birth defects
Scoliosis
Lateral curvature
in the normally straight vertical line of the spine.
Scoliosis
Causes of Scoliosis
• Congenital scoliosis
• Neuromuscular scoliosis as in spina bifida or
cerebral palsy
• Degenerative scoliosis traumatic bone
collapse, previous major back surgery, or
osteoporosis
• Idiopathic inherited
Two Types Of Scoliosis
• Nonstructural and structural
• Nonstructural (functional) scoliosis involves a
curve in the spine, without rotation, that is
reversible because it is caused by a condition
such as:
• Pain or a muscle spasm
• A difference in leg length
Structural Scoliosis
Involves a curve in spine, with rotation, Irreversible.
• Causes
• Idiopathic
• Spina Bifida - often gets worse as the child grows,
especially during the teen years.
• Cerebral palsy, Marfan syndrome, muscular
dystrophy
• Injuries, Infections, Tumors
• OA
Symptoms
• One shoulder may appear higher than the other.
• One hip may appear higher than the other.
• One shoulder blade may stick out more than the
other.
• The child's head is not centered over his or her
body.
• The ribs are higher on one side when the child
bends forward from the waist.
• The waistline may be flat on one side.
Lordosis
• Inward curvature of a portion of the lumbar and
cervical vertebral column
• Two segments of the vertebral column, namely
cervical and lumbar, are normally lordotic, that is,
they are set in a curve that has its convexity
anteriorly and concavity posteriorly (behind),
swayback or saddle back
• A major factor of lordosis is anterior pelvic tilt,
when the pelvis tips forward when resting on top
of the femurs.
Causes of Lordosis
• Tight low back muscles
• Excessive visceral fat
• Pregnancy
• Rickets
Hemarthrosis
Definition
Accumulation of blood in the synovial cavity.
Causes:
• Traumatic
• Common in patients of hemophilia
Hemarthrosis
• Causes
• Traumatic
• Hemophilia
• Clinical Features
• Pain and tenderness, Boggy swelling
• Limited movement
Complications
• Loss of degree of movement of the affected
joint if not treated properly
• Joint degeneration
• Cartilage damage that can lead to progressive
degenerative arthritis
