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Risk Factors Genetic (HLA-DR4 on the short arm of chromosome 6) More common in women Age 35-50 y/o Viral Infections Smoking
Prostaglandin Release
Macrophages are stimulated Stimulation of B and T cell proliferation in the subintimal area
Synoviocytes exposure to IL-1 Produces IL-6, PGE2 and MMPs which causes proteoglycan degradation
New blood vessel growth (angiogenesis) Early pannus invation and chondrocyte activation
secrete proteolytic enzymes contributing to the dissolution of their own cartilage matrix. Progressive narrowing of joint spaces
IL-6 suppresses albumin synthesis by the liver and stimulates acute phase protein synthesis thus, Swelling in small joints contributes assoc. With pain, significantly to stiffness and fatigue high ESR elevation. Warm swollen effusions, pain and decreased motion with possible rheumatoid nodules Erosion of contiguous bone and cartilage and laxity of ligaments
oxygen-derived free radicals that depolymerize hyaluronic acid and inactivate endogenous inhibitors of proteases are released
Proteoglycan degradation is further compounded by IL1 and TNF by inducing synthesis of proteases and preventing its repair.
RHEUMATOID ARTHRITIS
SEPTIC ARTHRITIS RISK FACTORS Use of prosthetic joint N. gonorrhoea infection S. Aureus Osteomyelitis Use of Immunosuppressive agents Diabetic patients Lyme disease
Reactive
Local Infection
S. aureus promotes tropism in the synovium by binding to specific tissue adhesion factors
oxygen-derived free radicals that depolymerize hyaluronic acid are released Hosts polymorphnuclear leukocyte response is activated
Autoimmune response
Implanted hardware becomes less susceptible to infections by haematogenous spread as the pseudocapsule develops around it
Altered host response in regard to enhanced invasion of microbes in the GUT facilitating persistent state of Chlamydia
Hydrolysis of essential collagen and proteoglycans Synovial hyperaemia with exudation of fluid Fluid has high fibrin content Rapid consumption of nutrients due to bacterial proliferation
Biofilm coagulase negative S. Aureus protects the pathogen from host defenses
Impairment of blood supply and may cause aseptic necrosis of the bone
References: Medical Surgical Nursing: clinical Management for Positive Outcomes by Black and Hawks Brunner and Suddarths Textbook of Medical Surgical Nursing www.emedicine.medscape.com/article/23699-overview#ao156 www.hoopkins-arthritis.org/arthritis-info/rheumatoid-arthritis/rheum_clin_path.html Rheumatoid arthritis by William et. al