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MS Pathologies

Overview for Pathopharm
by

Ben Rieke

on 18 October 2013

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Transcript of MS Pathologies

The Musculoskeletal System
Pathologies of the Bones & Muscles
Humana Osseus
The Skeletal System
DISLOCATION AND SUBLUXATION
RHEUMATOID ARTHRITIS
OSTEOARTHRITIS
BURSITIS
GOUT
OSTEOPOROSIS
TENDINOPATHY & STRAINS
SPRAINS
OSTEOMYELITIS
FRACTURES
Humana Lacerti
The Musculature
RHABDOMYOLYSIS
FIBROMYALGIA
MYOGLOBINEMIA
CHRONIC FATIGUE SYNDROME
MALIGNANT HYPERTHERMIA
Dislocation:
When the articular surfaces of a joint are no longer in aligned contact with each other. Presents with loss of ROM of the joint, and may compress surrounding nerves and vasculature (potentially medical emergency)
Subluxation:
When the articular surfaces of a joint are partially out of alignment with each other. Inhibits normal ROM of the joint, but usually is not as disruptive to surrounding tissues as dislocation
Inflammatory joint disease caused by an autoimmune response to the synovium. Presentation includes bilateral redness, warmth, edema, and pain of effected joints. May limit ROM. Will eventually lead to loss of bone integrity, joint cartilage erosion, joint deformity,and loss of normal ROM in chronically effected joints.
NSAIDS
Steroids
Immunosupressants
GOLD!
Biologic Response
Modifiers
TREATMENTS FOR
R.A.
Celebrex
Ibuprofen
Naproxen
Prednisone
Dexamethasone
Azathioprine
Methotrexate
Gold sodium thiomalate
adalimumab (Humira)
certolizumab (Cimzia)
infliximab (Remicade)
abatacept (Orencia)
etanercept (Enbrel)
Nice to know...
The bones lose mineral density (calcium and phosphorous) causing porous, soft regions of bone. Affected bones are less able to perform their supportive and weight-bearing duties, and are prone to fracture and compression.
Women, people of Asian and Caucasain descent, the aged, and those with severe nutritional deficiencies are most at risk for developing this condition. Mineral deposition in the bones takes place mainly prior to age 30, so nutritional status must be strongly maintained during this period to promote strong skeletal density.
Hairline fracture of R. humerus
14 y/o male
Pathologic Transverse Fracture
68 y/o female
Tendinopathy:
Strains:
may refer to a tendonitis (destructive inflammatory process) or a tendinosis (non-inflammatory damage). Tennis elbow, or lateral epicondylitis, is a repetitive motion injury of the tendons overlying the lateral epicondyle of the humerus. Tendinitis and tendinosis are common atheletic injuries.
involve overstretching, or exceed the load bearing capacity of a tendon. This can cause the tendon to lose tension, tear, or (in extreme instances) separate completely. This can lead to pain, stiffness, decrease or loss of ROM of affected muscle group, eccyhmosis, and deformity
Inflammation of one or more bursae (small sacs) of synovial fluid in the body that cushion the joints. May occur in the elbows, knees, shoulders, or other bursae.
May be caused by overuse of joints, improper exercise mechanics, or long periods of standing or weight bearing.
An infection which infects the periosteum and bone. May be chronic or acute in etiology. Presentation is similar to other types of infection, but severe regional pain over infected bone and local redness may also be present.
Typically difficult to treat, and may require long-term parenteral antibiotic therapy as well as surgical intervention.
Osteomyelitis may occur following a fracture, especially an open fracture when bone is exposed to air. It may also set on if infectious microbes are present in the blood and colonize the bone.
The articular surfaces of bones in a joint are typically padded from direct impact by cartilage. When this cartilage thins from pressure, excessive use, or the process of aging, areas of bone may grind against one another, causing inflammation, crepitus, pain, stiffness, and decreased ROM of the affected joint. Usually occurs in the fingers, shoulders, hips, and knees.
Bouchard's Nodes
Heberden's Nodes
Sprains involve ligaments, but is
similar in nature to strains. Over
stretching ligaments may lead to tearing, pain and reduction or loss of ROM.
When serum levels of uric acid, or urates, exceed normal levels, it may precipitate as crystals.
Uric acid crystals may accumulate in
the joint, leading to severe pain and
joint tenderness. This can also lead to
characteristic nodules that form in the small joints of the body, like the toes and knuckles, called tophi. A tophus is a large accumulation of uric acid, and can lead to gross deformity. Pain and deformity related to tophi and urate crystals in the joint is called gouty arthritis.
Chonic fatigue syndrome is characterized by somnolence, insomnia, fatigue that is not relieved by rest, depression, and irritability. It may be associated with physiologic changes regarding hormones, or long lasting effects of certain viral infections. Patients suffering chronic fatigue syndrome are often misdiagnosed as having a psychiatric disorder, and end up inappropriately treated or undertreated.
Women in their 40s and 50s
are the most commonly afflicted
population with CFS
Epstein-Barr virus has been
implicated as a causative agent
in CFS
Rhabdomyolysis is characterized by the mass breakdown of muscle cells, leading to the release of intracellular components into the bloodstream. These include myoglobin, potassium, and other unusual proteins and electrolytes.
Rhabdomyolysis may be the result of trauma, especially crush injuries, as well as hyperthermia, prolonged exertion, disruption of blood supply to muscles, and response to severe infection. Rhabdomyolysis may also be caused by exposure to certain medications and toxins.
Myoglobin is an oxygen carrying protein present in muscle cells. It is a porphyrin-type pigment, and has a heme group like its molecular cousin hemoglobin. Usually, this protein is sequestered in muscle tissue, but when muscle cells are damaged or rupture, it is freely released into the bloodstream.
Myoglobin can obstruct the renal tubules, causing acute kidney injury. Myoglobin excreted in the urine give the urine a characteristic cola-brown color (myoglobinuria).
Fibromyalgia is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues. Women are much more likely to develop fibromyalgia than are men.
Diagnosis is in part determined by chronic, deep pain at 11 of 18 characteristic sites of fibromyalgia pain.
While there is no cure for fibromyalgia, a variety of medications can help control symptoms. Exercise, relaxation and stress-reduction measures also may help.
Myoglobin!


1.)Morning stiffness in and around the joints for at least one hour.
2.)Swelling or fluid around three or more joints simultaneously.
3.)At least one swollen area in the wrist, hand, or finger joints.
4.)Arthritis involving the same joint on both sides of the body (symmetric arthritis).
5.)Rheumatoid nodules, which are firm lumps in the skin of people with rheumatoid arthritis. These nodules are usually in pressure points of the body, most commonly the elbows.
6.)Abnormal amounts of rheumatoid factor in the blood.
7.)X-ray changes in the hands and wrists typical of rheumatoid arthritis, with destruction of bone around the involved joints. However, these changes are typical of later-stage disease.
To be diagnosed with R.A., patients must exhibit four of the following:
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