PATHOLOGY OF JOINTS &

RELATED STRUCTURE

Dody Novrial
Department of Pathology, JSU
INFECTIVE ARTHRITIS

 PYOGENIC ARTHRITIS
 TUBERCULOUS ARTHRITIS
 LYME ARTHRITIS
 VIRAL ARTHRITIS
 PYOGENIC ARTHRITIS

 Haematogenious dissemination from a

distant focus of infection.
 In children the most common organism is
Haemophilus influenzae,while in adult the
organism are more (staphylococci,
pneumococci, streptococci, gonococci)
PYOGENIC ARTHRITIS
 Usually monoarticular,involves one of
the larger joints i.e hip, knee, ankle,
shoulder, elbow, wrist.
 Clinically:
redness,swelling,pain,tenderness.
 If it is not effectively treated, it may
become chronic and destructive
TUBERCULOUS ARTHRITIS
 May occur with tuberculous osteomyelitis
of spine (Pott’s disease) which extend
into intervertebral discs
 Hematogenous dissemination from
visceral, usually pulmonary
 It may also occur as monoarticular form
within large joints.
TUBERCULOUS ARTHRITIS

 Confluent granulomas with central

caseous necrosis
 Early diagnosis and treatment is
necessary to prevent the destructive
consequences of this chronic disorder.
LYME ARTHRITIS
 Spirochete infection (Borrelia
burgdorferi)
 Initial infection from the skin
 Involve large joints: knees, shoulders,
elbows and ankles
 Usually one or two joints are affected at
a time
LYME ARTHRITIS

 Morphology : Chronic papillary synovitis

with synoviocyte hyperplasia, and onion
skinning of arterial walls
 The morphology in severe cases can
closely resemble that of RA
VIRAL ARTHRITIS
 Variety of viral infections (parvovirus
B19, rubella, hepatitis C virus)
 Acute to subacute symptoms
 Direct infection or autoimmune reaction
??
 Also develop in HIV infected patient
(similar pathogenesis to that RA)
OSTEOARTHRITIS
Degenerative joint disease
 Most common disease of joint
 It is degenerative rather than inflammatory
disorder
 Associated with aging, but may occur after
trauma or infection of the joint
 The joints affected are commonly the weight-
bearing joints (vertebral, femoral) and distal
interphalangeal
 Common pathologic change is degeneration of
articular cartilage
OSTEOARTHRITIS
Degenerative joint disease(2)
 Clinically:slowly progressive joint stiffness.
Spur formation in distal interphalageal joints of
fingers  nodular swelling called
HEBERDEN’S NODE.
 Involvement of the spine may cause
compression of nerve root  radicular pain,
spasme,atrophy of skeletal muscle
 Bony spur may project from the margin of the
jointspace  limiting motion & pain.
 Bone spur or fragments of articular cartilarge
may break off to create osteocartilaginous
loose foreign bodies (joint mice)
RHEUMATOID ARTHRITIS
 Idiopathic, chronic systemic inflamatory
(autoimmune) disease which may affect skin,
skeletal muscle,bone, eyes, heart, blood
vessel, lung and other organs.
 Classical feature is progressively deforming
arthritis which usually affect multiple joints,
 The onset at fourth or third decade, with
prodrome of fatigue, malaise, low grade fever.
 Prodromal symptoms are followed by
appearance of joint stiffness, most apparent in
the morning upon waking
RHEUMATOID ARTHRITIS (2)
 Any joint may be involve, but the classic
presentation is bilateral symetric involvement
of proximal interphalangeal and
metacarpophalangeal joint which may be
enlarged, tender, painful, warm, and reddened.
 As the disease progress  progressive joint
induration and stiffness to the point of
permanent and disabling ankylosis.
 Atrophy of related skeletal muscle follows
RHEUMATOID ARTHRITIS (3)
 The hand may assume a clawlike
appearance with characteristic ulnar
deviation of ankylosed fingers
 The overlying skin is shiny, erytematous
and atrophic.
 Anti-IgG antibody (Rheumatoid factor) is
found nearly all patients
RHEUMATOID ARTHRITIS (4)
 Early lesions show an acute nonspecific
synovitis with edema and mixed inflammatory
infiltrate of the synovia.
 As the disease progresses  diffuse
proliferative synovitis with replacement of
synovial lining by a highly vascularized,
polypoid mass of inflammatory tissue infiltrated
by chronic inflammation cells  PANNUS
formation
 Advanced lesion show erosion of the entire of
articular surface with obliteration of the joint
space  followed by fibrous adhesion of bony
ankylosis between opposing joint surfaces
 GOUT ARTHRITIS

 Characterized by recurrent attacks of acute

arthritis due to precipitation of monosodium
urate crystals in the synovial space
 May developed in anyone with elevated uric
acid blood levels
 Genetic disorder of purine metabolism
 Predominantly affect adult males
GOUT ARTHRITIS
 Excessive cellular turnover such as
leukemia and renal disease
 Disposisition of urate crystals in other
tissue (joint capsules, perichondrial
tissue, burse, heart valves,kidney)
inflammatory foci, known as TOPHI
 Recurrent attack of acute gouty arthritis
 chronic disabling disorder
TUMOR AND TUMOR-LIKE
CONDITIONS

 GANGLION
 TENDOSYNOVIAL GIANT CELL TUMOR
 PIGMENTED VILLONODULAR SYNOVITIS &
BURSITIS
 SYNOVIAL OSTEOCHONDROMATOSIS
SYNOVIAL SARCOMA
GANGLION
 Ganglion is commonly small cystic, non-
neoplastic lesion found within the
connective tissue of a joint capsule or
tendon sheath.
 It consist of central area of myxoid
degeneration, surrounded by
collagenous capsule.
 Excission is usually curative
TENDOSYNOVIAL GIANT CELL
TUMOR
 More frequently in women than men
 At young and middle age
 Most cases in the wrist-finger tips; ankle
and toe tips
 Nearly always benign
 Histo: closely packed medium sized
polyhedral cells with a variable
admixture of giant cells containing fat
and hemosiderin
PIGMENTED VILLONODULAR
SYNOVITIS & BURSITIS
 Closely related to TSGCT
 Tends to occur in young adults
 Usual site : knee ankle
 Usually only one articulation is affected
 Histo : cellular component is simillar to that of
TSGCT, in addition there are papillary
projections made up of foamy cells and
hemosiderin laden macrophage
 Recurrent, complete removal is impossible
SYNOVIAL
OSTEOCHONDROMATOSIS
 Characterized by the formation of
osteocartilaginous bodies in the synovial
membrane
 Most often monoarticular, knee or hip
and communicating bursa
 Histo : the chondrocytes may show
some degree of atypia and even
binucleated
SYNOVIAL SARCOMA
 Uncommon lesion that tend to arise in
the deep soft tissue of lower and upper
extremities from synovial cells, usually of
bursa.
 They tend to be highly aggressive, and
frequently metastasize to the lung and
pleura.
Referrences
 Robbins and Cotran. Pathologic basis of
disease. 7th ed. Elsevier. 2005.
 Rosai and Ackerman’s. Surgical pathology.9Th
ed. Mosby. 2004.
 Rubin's Pathology : Clinicopathologic
Foundations of Medicine, 5th Edition. Lippincott
Williams & Wilkins.2008.
 www.pathconsult.com
 www.webpath.com
 www.pathblog.net
THANK YOU