Bone and Joint

• autoimmune disease
• generalized inflammation of connective tissue
• injury is pricipally a result of vasculitis.
• involves mulitple organs systems (skin, joints, kidneys)

90% of patients are women in the childbearing years, ie 20-30

kidney failure.

glomerulonephritis--> hematuria, proteinuria, HT--> kidney failure

lesions are caused by the deposition of immune complexes and fibrinoid material in tissue and by direct attack of autoantibodies.

• up to 90% of pts have a non-erosive synovitis.
• joint pain is the CC in 40% of pts.

cc joint pain

fever, malaise, anorexia, wt loss, rash( butterfly)

bilateral and symmetrical pain, swellign and sstiffness

arthiritis affects up to 90% of SLE pts

• normal joint space
• reversible deformities
• generalized osteporosis

• +FANA(flourescent antinucleur antibody) 99% of the time
• + LE(leukocyte) cells 70%

corticosteroid tratments

progressive systemic slerosis

fenerilized infrlammation of connective tissue characterized by excesive fibrosis throughout the body.

SKIN, lungs GI trat, MS system, kidneys

• females 3x more than males
• 30-50yrs
• incidence increases with age

• 1. limited skin involvement
• 2. later visceral involvement
• 3. slower progrssion

• c: calcinosis(deposit of calcium)
• r: raynaud's phenomenon( loss of vasculization @ distal extremities)
• e: esophageal dysfunction
• s:scleroderma
• t: telangiectasia-widening of the blood vessels

• 1. Early, widespread skin involvemtn
• 2. early visceral involvement
• 3. rapid progression

• edema, progressive fibrosis of the dermis, thinning of epidermis, atrophy of dermal appendages, autoamputation.
• an increase in melanin
• subcutaneous calcium deposits in 20% of pts
• begins distally and progresses proximally in the upper extremitiy, neck, face
• bilateral and symmetrical

• 70% of PSS pts have pumonary involvement
• impared gas exchanges due to fibrosing alveoli
• most common cuase of death with scleroderma pts.

• Atropy and replacement of teh muscularis layer with fibrotic tissue
• lower 2/3 of the esophagus become narow and rigid-->dysphagia
• small intestine and colon-->malabsorption

• Inflammatory synovitis and fibrosis
• joint destruction is uncommmon
• fingers, knees

• 2/3 of PSS pts have intimal thickening of vessel walls -->renal abn.
• 30% of pts develop HT
• formely the most common cause of death in PSS pts

• in most pts. exposure to cold or stress may initiate raynaud's phen.
• 50% of pts -- dysphasia

• resoprtion fo soft tissue of fingers with retraction of tips
• nomral joint space
• calcinosis of the soft tissue in 20% of pts
• may be disuse osteopenia

• local osteoporosis
• erosions iwth reactive sclerosis
• bony ankylosis

usually bilateral and symmetrical

• lower 2/3 of joint
• iliac sde> scaral side
• loss of join definition (pseudowidening)
• erosions and reactive slcerosis
• bony ankylosis

• 60% of the time, thoracolumbar jxn is first, then lumbosacral
• imflammation invloving the oter annular fibers
• vertical bridging syndesmophytes
• occuring over multiple segments (bamboo spine)
• erosions, sclerosis, decrease jt space at appophyseal and costovertebral jts.
• presevation of the disc space

• chronic skin disorder
• 5-8% of pts have an associated arthropathy

• .2-3% of the pop.
• usually around 27 yrs old

• family clustering suggest genetic factor
• some precipitation event are trauma, infecion, stress

• erythematos patches over covered with silvery scales
• auspitz sign- remove scales-->bleeding
• extensor surface- elboy, knee, scalp, back

• thimble pitting(pathognomic). thickening, discoloration, separation
• found in up to 40% of psoriasis pt
• up to 80-905 of OsA pts

classic presentation- 1 larg jt. and 1-2 interphalangeal jts with dactylitis (sausage digits)

• soft tissue swelling
• erosion and bone proliferation
• pencil in cup defomity
• "fluffy" new bone adjacent to marginal erosions doe to periositis

• SI joints 30-50% involvemtn
• erosions, reactive sclerosi
• bilateral, asymmetrical