ARTHRITIS

An inflammation of one or more joints. It is Manifested

by joint pain, swelling, warmth, erythema, and limited
range of motion.
THE TWO MAIN TYPES OF ARTHRITIS —
OSTEOARTHRITIS AND RHEUMATOID ARTHRITIS —
DAMAGE JOINTS IN DIFFERENT WAYS.
Osteoarthritis Rheumatoid Arthritis
Modifiable risk factors  Idiopathic inflammatory
• Obesity autoimmune disorder of
• Excessive joint loading or unknown etiology
overuse (mechanical stress)
Nonmodifiable risk factors  Riskfactors include: [Genetic
• Age (> 55 years) disposition: associated with 
• Family history HLA-DR4 and HLA-DR1 [6]
• History of joint injury or trauma Environmental factors
(e.g., smoking)

• Anatomic factors causing • Infection

asymmetrical joint stress  • Obesity
• Hemophilic hemarthroses and • Family history of RA
deposition diseases that stiffen 
cartilage
RHEUMATOID ARTHRITIS PATHOLOGY

 Synovial pannus formation and bone invasion: pathological layer

of proliferative granulation tissue, mononuclear inflammatory cells,
and fibroblast-like mesenchymal cells, releasing cytokines and
enzymes, which, in turn, damage and invade the surrounding
connective tissue
 Synovial lining hyperplasia with mononuclear cell infiltrate
 Perivascular inflammatory infiltrates
 Angiogenesis
 Fibrin deposition on synovial surfaces
 Rheumatoid nodules: central fibrinoid necrosis with palisading
histiocytes (epithelioid cells
 Fibrinoid necrosis is
visible as an
accumulation of fibrin
(green overlay).
Histiocytes (epithelioid
cells) surround the
necrotic area (white
overlay). The outermost
granuloma layer shows
fibrosis (gray overlay)
and an abundance of
lymphocytes (blue
overlay).
Rheumatoid nodules are
a typical finding in
patients with rheumatoid
arthritis.

RHEUMATOID NODULE
GROSS DESCRIPTION
JOINTS HAVE EDEMATOUS, THICK, HYPERPLASTIC SYNOVIUM, COVERED BY DELICATE AND BULBOUS FRONDS

Microscopic (histologic) description

 Dense perivascular inflammatory infiltrate of T lymphocytes, plasma cells (often with

eosinophilic cytoplasmic inclusions called Russell bodies), macrophages;
inflammation extends to subchondral bone (relatively specific for rheumatoid
arthritis)
 Proliferative synovitis with synovial cell hyperplasia and hypertrophy
 Lymphoplasmacytic infiltrate with variable germinal centers, necrobiotic nodules and
fibrosis
 Increased vascularity with hemosiderin deposition
 Organizing fibrin floating in joint space as rice bodies
 Neutrophils present on synovial surface; osteoclasts present in bone forming cysts
COMPLICATIONS
 Untreated and/or severe cases can result in permanent damage to
the joints with stiffening and deformity.

 Complications in the upper limbs: rheumatoid hand deformities  

 Complications in the lower limbs:-

 Baker cyst due to inflammatory joint effusion 
 Foot impairment: pes plano‑valgus (flat feet)  Other
complications
 Muscle weakness 
 Vasculitis involving the kidneys 
 Amyloid A amyloidosis (AA amyloidosis)
 Septic arthritis  [42]
 Osteopenia, osteoporosis, and bone fractures
PROGNOSIS:-
 The average life span of the patients with RA,
revealing 65.8 years in male and 63.7 years in female,
were much shorter than of general population. The
causes of all deaths were investigated by ourselves
and/or autopsy. The autopsy was performed in 56.6%.
OSTEOARTHRITIS PATHOGENESIS
MICROSCOPIC DESCRIPTION
 Ghost chondrocytes (no nuclei) or
necrotic chondrocytes, marked
irregularity of tidemark
 Irregular thinning, fragmentation
and fibrillation of thinned cartilage
 Subchondral cysts with mucoid
fluid surrounded by sclerotic bone
 Usually no significant inflammatory
component although advanced cases
have synovial hyperplasia with
lymphoid follicles
COMPLICATIONS:-
 Rapid, complete breakdown of cartilage resulting in
loose tissue material in the joint (chondrolysis).
 Bone death (osteonecrosis).

 Stress fractures (hairline crack in the bone that develops

gradually in response to repeated injury or stress).
 Bleeding inside the joint.
Osteoarthritis Prognosis as follows:

 Most osteoarthritis cases do stabilize.

 Some osteoarthritis cases progress.

 A small number of osteoarthritis patients

improve spontaneously.