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Pathophysiology Case: Infective Arthritis Clinical Integration Group #5: Peñaflor, Quinto, Ramos, Suaco, Sicat, Valenzuela, Tio Cuison.

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Presentation on theme: "Pathophysiology Case: Infective Arthritis Clinical Integration Group #5: Peñaflor, Quinto, Ramos, Suaco, Sicat, Valenzuela, Tio Cuison."— Presentation transcript:

1 Pathophysiology Case: Infective Arthritis Clinical Integration Group #5: Peñaflor, Quinto, Ramos, Suaco, Sicat, Valenzuela, Tio Cuison

2 Salient Features: Highlights SLE, maintained on prednisone Callous, self-managed with spa therapy (wax and scrub) Intermittent cough, bilateral crackles, harsh breath sounds Febrile Tachycardic Tachypneic Irritable Dizziness Weakness Dry skin Underweight Swelling, erythema, limited mobility, warmth, tenderness of L wrist and pustular lesion on the 5 th digit of the L hand; Swelling, erythema, limited mobility of R elbow

3 Pertinent Positive Findings SLE, maintained on prednisone Callous, self-managed with spa therapy (wax and scrub) Intermittent cough, bilateral crackles, harsh breath sounds Febrile Tachycardic Tachypneic Irritable Dizziness Weakness Dry skin Underweight Swelling, erythema, limited mobility, warmth, tenderness of L wrist and pustular lesion on the 5 th digit of the L hand; Swelling, erythema, limited mobility of R elbow

4 Pertinent Positive Findings, Reclassified Systemic (extra-articular) manifestations – Intermittent cough, bilateral crackles, harsh breath sounds – Febrile – Tachycardic – Tachypneic – Irritable – Dizziness – Weakness – Dry skin – Asthenic, Underweight Musculoskeletal (articular) manifestations – Swelling, erythema, limited mobility, warmth, tenderness of L wrist and pustular lesion on the 5 th digit of the L hand; – Swelling, erythema, limited mobility of R elbow

5 ARTHRITIS

6 Endotoxin elaboration Bacterial entry into synovial joint space Infection | Trauma

7

8 (Inflammatory Cascade) Cytokine production (Endotoxin elaboration)

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10 Macrophages Synovial cells Chondrocytes Recruitment/Chemotaxis/Infiltration of Neutrophils Proteolytic enzymes Elastases

11 [Mechanical factors] Bacterial and inflammatory cell adherence to and invasion of synovium and cartilage Purulent accumulation  increased intraarticular pressure  compromised vascular supply  pressure necrosis Bacterial hyaluronidase  less viscous synovial fluid  less lubrication  friction damage

12 Given these pathologic consequences, what can we conclude? Proteolytic enzymes Infiltration Pressure necrosis Friction damage

13 Proteolytic enzymes Mechanical factors Synovial & Joint cartilage destruction

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15 A combination of proteolytic enzymes and mechanical factors causes synovial and joint cartilage destruction.

16 OTHERS


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