“Life’s battles don’t go

always to the stronger or

faster man,

But sooner or later, The

man who wins is the man
who thinks he can”
Pathology of
Arthritis
Dr. Venkatesh M. Shashidhar.
Senior Lecturer in Pathology
Fiji School of Medicine
Arthritis

Arthritis Clinical Classification:

Monoarthritis
 Acute: Bacterial, Trauma, Crystal, Reactive
 Chronic :Tuberculosis, Lyme, Fungal,
Trauma, Tumors.

Polyarthritis
 Autoimmune, degenerative, Crystal & Septic.
Arthritis

Polyarthritis Classification:
 Autoimmune -
 Rheumatic, Rheumatoid, Ankylosing
spondylitis, Reiter syndrome etc.
 Degenerative – Osteroarthritis
 Crystal Deposition -
 Gout – Monosodium urate
 CPPD - Pseudo Gout
 Infective - Septic, TB, Lyme etc.
Arthritis

Osteoarthritis:
 Degenerative end result - (ageing) >80% in >65y.
 Progressive erosion, fibrillation and cracking of
articular cartilage forms Loose bodies.
 Hardened articular bone – eburnation.
 Subarticular cyst formation in bone.
 Periarticular osteophyte formation.
 Mild inflammation but painful, morning stiffness.
 Limited range of movements Heberden nodes (F)
Arthritis

Femur Head Osteroarthritis:

Normal Osteoarthritis
Arthritis

Femur Osteroarthritis:
Arthritis

Joint Mice or Loose Bodies:

Arthritis

Spine Osteophytes (OA):

Arthritis

Osteoarthritis:
Arthritis

OA Fingers:
Arthritis

OA Hip:
Rheumatoid
Arthritis
Arthritis

RA - Definition:

 Chronic Multisystem autoimmune

inflammatory disorder principally affecting
joints producing a proliferative synovitis
that often progresses to destruction of the
articular cartilage and ankylosis.
Arthritis

Etiology:

 Genetic Susceptibility:
 HLA DR4, or DR1 in 65% to 80% cases.

 Microbial inciting agent:

 Epstein-Barr virus, Borrelia & Mycoplasma

 Autoimmunity:
 IGM anti IgG – RA Factor.
 Helper T cell (CD4) against type II collagen &
cartilage glycoprotein-39
Arthritis

Morphology:
 Proliferative synovitis with lymphocytes (CD4),
plasma cell & macrophages Pannus.
 Organizing fibrin (rice bodies).
 Neutrophils on the joint surface and fluid.
 Juxta-articular erosions, cysts & osteoporosis
 Fibrous ankylosis.
 Skin - Rheumatoid nodules
 Vasculitis (commonly of digital arteries)
Arthritis

RA - Clinical Features:
1. Morning stiffness.
2. Arthritis in 3 or more joint areas.
3. Arthritis of hand joints.
4. Symmetric arthritis.
5. Rheumatoid nodules.
6. Serum rheumatoid factor.
7. Typical radiographic changes
At least 4 features for diagnosis.
Arthritis

Synovium – R.Arthritis:
Arthritis

RA - Pannus:

Hyperplastic
inflammed
synovium
Arthritis

Rheumatoid Nodule (skin):

Palisading
Macrophages

Central
Fibrinoid
Necrosis
Arthritis

Joint Destruction in RA:

Swan Neck
Deformity
Arthritis

Early Destruction in RA:

Swan Neck
Deformity
Arthritis

Skin RA Nodule:
Arthritis

Swan Neck Deformity in RA:

Arthritis

RA hand:
Arthritis
Other
 Other Seronegative
Arthritis

arthropathies
 Ankylosing Spondylitis:
 Adolescent boys, HLA B27, axial joints (sacroiliac)

 Reiter Syndrome:
 Triad of arthritis, urethritis/cervicits & conjuctivitis
 Autoimmune but initiated by bacterial infection.

 Enteropathic Arthritis:
 Secondary to bowel infections (salmonella, shigella)
 HLA B27 positive

 Psoriatic Arthritis:
 5% of patients, starts in DIP joints, similar to RA.
 Septic Arthritis:
ORGANISM PEAK AGE INCIDENCE GRAM STAIN
Hemophilus Gram negative
Children
influenzae coccobacilli
Neisseria Gram negative
Young adults
gonorrheae diplococci
Gram negative
Salmonella young with Sickle Cell An.
rods
Gram positive
Staph. aureus Adults
cocci in clusters
Escherichia Gram negative
Adults
coli rods
Gram negative
Pseudomonas Adults
rods
Arthritis

Gonococcal Arthritis:
Arthritis

Juvenile Rheumatoid Arthritis:

 Before age 16
 Multisystem involement - Spleenomegaly,
 Starts with systemic involvement unlike
RA.
 RA Factor – Seronegative
 ANA positivity is common.
Arthritis

Big Toe in Gout:

Arthritis

Joint Destruction in Gout:

Arthritis

Gout Tophi:
Arthritis

Urate Crystals (Gout):

 CPPD

•Calcium Pyrophosphate Deposition disease

diseas
Arthritis

CPPD – (Chondrocalcinosis)

 Type A – Pseudo gout – Knee, men

 Type B – Pseudo rheumatoid - polyarthritis
 Type C – Pseudo OA + acute attacks, women
 Type D – Pseudo OA - acute attacks, hands
 Type E – Asymptomatic
 Type F – Pseudoneuropathic
Arthritis

CPPD-Arthritis (pseudo gout):

Arthritis

Pseudo Gout – Calcium pyrophoshate

Arthritis

Arthritis Comparison:
Thank you

Dr. Venkatesh M. Shashidhar.

Senior Lecturer in Pathology
Fiji School of Medicine