骨关节疾病Bone and joint diseases.pptVIP

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When osteoarthritis strikes in youth, there is typically some predisposing condition, such as previous traumatic injury, developmental deformity, or underlying systemic disease such as diabetes or marked obesity. In these settings the disease is called secondary osteoarthritis and often involves one or several predisposed joints. The earliest structural changes in osteoarthritis include enlargement, proliferation, and disorganization of the chondrocytes in the superficial part of the articular cartilage. Subsequently, vertical and horizontal fibrillation and cracking of the matrix occur as the superficial layers of the cartilage are degraded. Gross examination at this stage reveals a soft granular articular cartilage surface. Small fractures can dislodge pieces of cartilage and subchondral bone into the joint, forming loose bodies (joint mice). Morphology Gout Gout is a disorder caused by the tissue accumulation of excessive amounts of uric acid, an end product of purine metabolism. It is marked by recurrent episodes of acute arthritis, sometimes accompanied by the formation of large crystalline aggregates called tophi, and chronic joint deformity. All of these result from precipitation of monosodium urate crystals from supersaturated body fluids. Classification of Gout HGPRT, hypoxanthine guanine phosphoribosyl transferase Clinical Category Metabolic Defect Primary Gout (90% of cases) Enzyme defects unknown (85% to 90% of primary gout) Known enzyme defects—e.g., partial HGPRT deficiency (rare) ? Overproduction of uric acid Normal excretion (majority) Increased excretion (minority) Underexcretion of uric acid with normal production ? Overproduction of uric acid Secondary Gout (10% of cases) Associated with increased nucleic acid turnover--e.g., leukemias Chronic renal disease Inborn errors of metabolism ? Overproduction of uric acid with increased urinary excretion ?? Reduced excretion of uric acid with normal production ?? Overp

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