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Musculoskeletal Rheumatology > Intro to rheumatology > Flashcards

Intro to rheumatology Flashcards

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1
Q

What are the functions of connective tissue?

A
  • binds together, supports and strengthens other body tissues
  • protects and insulates internal organs
  • compartmentalises structures such as skeletal muscle
  • the major transport system within the body
  • site of stored energy reserves
  • main site of immune responses
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2
Q

What are the three classes of components for connective tissue?

A
  1. Cells:
    - fibroblast
    - macrophage
    - mast cell
    - plasma cell
    - lymphocytes
    - leukocytes
    - adipose cells
  2. Fibres
    - reticular
    - elastic
    - collagen
  3. Ground substance
    - macromolecules
    - multi-adhesive glycoproteins
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3
Q

What are fibroblasts and what is their function?

A
  • large flat cells with branching processes

- migrate throughout connective tissue secreting the fibres and ground substance

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4
Q

What are mast cells and what is their function?

A
  • alongside blood vessels that supply connective tissue

- produce histamine

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5
Q

What is the function of reticular fibres?

A
  • provide support for the walls of blood vessels

- made of collagen with a glycoprotein covering

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6
Q

What is the ground substance of connective tissues?

A
  • between cells and fibres
  • support cells and bind them together
  • provide a medium through which substances are exchanged e.g hyaluronic acid
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7
Q

What is the most abundant protein in the body?

A

-collagen

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8
Q

What is the main function of connective tissue matrix fibres (collagen, elastin, reticular) ?

A

-provide strength and support to connective tissue

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9
Q

What are the six types of connective tissues ?

A

(-vary by the fibres, ground substance and cells contained in it)

  • loose connective tissue
  • adipose tissue
  • blood
  • fibrous connective tissue
  • cartilage
  • bone
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10
Q

What is connective tissue proper and what is its function?

A
  1. Loose connective tissue:
    - areolar
    - adipose
    - reticular
  2. Dense connective tissue
    - regular
    - irregular
    - elastic

Function:

  • binding tissue
  • resists mechanical stress especially tension
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11
Q

What cells are present in connective tissue proper and in its matrix?

A

Cells:

  • fibroblasts
  • fibrocytes
  • defense cells
  • fat cells

Matrix:

  • gel like ground substance
  • collagen, reticular and elastic collagen
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12
Q

What is the function of cartilage, the cells involved and the matrix composition?

A

-cartilage is avascular and no nerve supply (but perichondrium does)

Function:

  • strengthen and support connective tissue
  • resists compression
  • cushions and support body structures

Cells:

  • chondroblasts- in growing cartilage
  • chondrocytes

Matrix:

  • Gel-like ground substance
  • Fibres: collagen, elastic fibres in some
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13
Q

What is perichondrium?

A

the connective tissue that envelops cartilage where it is not at a joint

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14
Q

What are the three types of cartilage?

A
  1. Hyaline cartilage
  2. Elastic cartilage
  3. Fibrocartilage
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15
Q

What is hyaline cartilage?

A
  • gel like ground substance
  • end of long bones to cushion joints and at epiphyseal plates
  • most abundant cartilage in the body
  • weakest of the 3 types of cartilage
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16
Q

What is fibrocartilage?

A
  • chondrocytes scattered among visible bundles of collagen fibres
  • no perichondrium
  • strongest of the 3 types of cartilage
  • found in the intervertebral discs
  • found in the intervertebral discs
  • collagen fibre in matrix
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17
Q

What is elastic cartilage?

A
  • chondrocytes located in a threadlike network of elastic fibres
  • provides strength, elasticity and maintains the shape of certain structures (like the external ear)
  • elastic fibres in matrix
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18
Q

What is the function of bone tissue, the cells involved and what is the matrix made of?

A

Function:

  • resists compression and tension
  • protect and support

Cells:

  • osteoblasts
  • osteocytes

Matrix:

  • gel-like ground substance
  • calcified with inorganic salts
  • fibres: collagen
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19
Q

What is osseous tissue?

A

-bone tissue

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20
Q

What are the types of bone tissue?

A
  1. Compact:
    - osteon- basic unit of compact bone
    - lamellae- concentric circles of matrix
    - lacunae- spaces in the matrix that house cells
    - osteocytes- mature bone cells
  2. Spongy:
    - trabeculae- columns of bone with spaces filled with red bone marrow
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21
Q

What is in the lacuna of elastic cartilage?

A

-chondrocytes

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22
Q

What is in the lacuna of fibrocartilage?

A

-chondrocytes

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23
Q

What is an osteon?

A

-basic unit of compact bone

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24
Q

What is lamellae?

A

-concentric circles of matrix

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25
What is the function of blood, the cells involved and the components of the matrix?
-complex cell formation and differentiation Function: -transport oxygen, carbon dioxide, nutrients, wastes and other substances Cells: - erythrocytes (RBC)- transport oxygen - leukocytes (WBC)- function in immunity - platelets- blood clotting Matrix: - liquid - plasma - no fibres
26
What are the two main types of connective tissue proper?
-loose and dense
27
Which type of cartilage are you most likely to find at the epiphyseal (growth) plate?
-hyaline cartilage
28
Which of the three types of cartilage is the strongest?
-fibrocartilage
29
Which substance is house in the trabecular of spongy bone?
-red bone marrow
30
What are the three rheumatological disorders?
- rheumatoid arthritis RA - systemic lupus erythematosus SLE - vasculitis
31
What is rheumatoid arthritis?
- autoimmune disorder primarily affecting joints resulting in warm swollen painful joints - symptoms are worse following rest
32
What is systemic lupus erythematous?
- autoimmune disorder of connective tissue | - affects multiple organ systems and joints
33
Which is vasculitis?
-a group of disorders that destroy blood vessels by inflammation
34
What are the general macroscopic and microscopic changes in rheumatoid?
Macroscopic: - synovitis - bone - cartilage - erosion - angiogenesis diagram Microscopic: - cells - IL - ANF - synoviocytes - osteoclasts - proteases - CD4 cells - plasma cells - neutrophils
35
What are the joint changes in rheumatoid?
- bone erosion - swollen inflamed synovial membrane - cartilage wears away - reduced joint space
36
What causes inflammation in RA?
- Th17 cells produce IL-17 - IL-17 acts on synovial lining cells, these release IL-6, IL-8, MCP-1, GRO-alpha, GM-CSF =inflammation -IL-17 acts on macrophages, these release IL-1, TNF-alpha, IL-6 =inflammation
37
What causes cartilage destruction in RA?
- Th17 cells produce IL-17 - IL-17 acts on chondrocytes, these release NO = cartilage destruction - IL-17 action macrophages, these release MMPs = cartilage destruction
38
What causes bone destruction in RA?
- Th17 cells produce IL-17 | - IL-17 acts on osteoblasts, these release RANKL = bone destruction
39
( What are the three key symptoms of RA? )
- joint pain - stiffness - swelling
40
What are the key features of RA?
1. symptoms last > 6 weeks - often lasts the remainder of patients' life 2. inflammatory synovitis: - palpable synovial swelling - morning stiffness > 1hr, fatigue 3. symmetrical and polyarticular (>3 joints): - typically involves wrists, MCP, PIP joints - typically spares certain joints; thoracolumbar spine, DIPs of the fingers and IPs of the toes 4. may have nodules: subcutaneous or periosteal at pressure points 5. marginal erosions and joint space narrowing on x-ray - ulnar deviation
41
Compare and contrast rheumatoid versus osteoarthritis?
Rheumatoid: - inflammatory - autoantibodies - small joints affected - rapid onset - bilateral, symmetrical pattern - morning stiffness - ESR Osteoarthritis: - degenerative - no antibodes - large weight bearing joints affected - slow onset - asymmetric - uncommon stiffness in morning
42
What is ESR?
-erythrocyte sedimentation rate
43
What is CRP?
-C-reactive protein
44
What is PIP?
-proximal interphalangeal joint
45
What is MCP?
-metacarpophalangeal joint
46
What is DIP?
-distal interphalangeal joint
47
What is CMC?
-carpometacarpal joint
48
What is RF?
-rheumatoid factor
49
What happened to ESR and CRP levels in RA?
-elevated
50
What happened to ESR and CRP levels in OA?
-normal
51
Tell me about finger PIP swelling in RA?
- swelling is confined to the area of the joint capsule | - synovial thickening feels like a firm sponge
52
What are you looking for in x-rays of RA?
-soft tissue swelling -erosions -joint space loss -subluxation-partial dislocation -
53
What is the typical course of RA?
- damage occurs early in most patients - lowered life expectancy: - women 10 years less, men 4 years
54
What is the typical pattern of pain and stiffness in RA?
Inflammatory pattern: | -worse when resting (therefore moving stiffness) and improves with activity
55
What are the key x-ray changes found in rheumatoid arthritis?
- loss of joint space - juxta-articular bone erosions - soft tissue swellings - osteopenia - subluxations
56
What are the treatment principles for RA?
1. Diagnosis 2. Severity 3. Treatment: - when damage begins early, start aggressive treatment - use the safest treatment plan that matches the aggressiveness of the disease 4. Monitor: - treatment for adverse effects - disease activity, revise Rx (prescription) as needed
57
What are the elements of the assessment for RA?
Assess current activity: -morning stiffness, synovitis, fatigue, ESR Document the degree of damage - ROM and deformities - joint space narrowing and erosions on x-ray - functional status Document extra-articular manifestations -nodules, pulmonary fibrosis, vasculitis Asess prior Rx responses and side effects
58
What are the critical elements of therapy for RA?
1. Education: - build a cooperative long-term relationship - use materials from the arthritis foundation and the ACR - assistive devices 2. Exercise: - ROM, conditions, strengthening exercises 3. Medications: - analgesic and/or anti-inflammatory - immunosuppressive, cytotoxic, biologic - balance efficacy and safety with activity
59
What are the drug treatment options for RA?
1. NSAID: - symptomatic relief, improved function - no change in disease progression 2. Low-dose prednisone (<10mg QD): - may substitute for NSAID - used as bridge therapy - if used long term, consider prophylactic treatment for osteoporosis 3. Intra-articular steroids: - useful for flares 4. DMARDs- disease modifying drugs - minocycline- modest effect, may work best early - sulfasalazine, hydroxychloroquine- moderate effect, low cost - intramuscular gold- slow onset, decreases progression, rare remission, requires close monitoring 5. Immunosuppressive drugs: - methotrexate- most effective single DMARD, good benefit to risk ratio - Azathioprine- slow onset, reasonably effective - Cyclophosphamide- effective for vasculitis, less so for arthritis - Cyclosporin- superior to placebo, renal toxicity 6. New DMARDs a) Leflunomide: - pyrimidine inhibitor - effect and side effects similar to those of MTX b) Ethanercept: - soluble TNF receptor, blocks TNF - rapid onset, quite effective in refractory patients in short-term trials and in combinations with MTX - injection site reactions, long-term effects unknown, expensive
60
What is monitoring of treatment with DMARDs?
- these drugs need frequent monitoring - blood, liver, lung, and kidney are frequent sites of adverse effects - interval of laboratory testing varies with the drug (4-8 week interval commonly needed) - most patients need to bee seen 3-6 times a year
61
What are the extraarticular manifestations of RA?
- liver - cardiovascular - neurological - musculoskeletal - bone marrow - spleen
62
What are the manifestations of SLE?
- alopecia - malar rash - arthralgia - oral ulcers - photosensitivity
63
What is UCTD?
-undifferentiated connective tissue disease
64
What is scleroderma and what are its manifestations?
-chronic autoimmune disease that affects the skin, connective tissue and internal organs - reflux - Raynaud's - digital ulcerations
65
What are sicca symptoms?
-dryness of exocrine glands, e.g dry eyes, skin, mouth
66
lecture slides
https://d3c33hcgiwev3.cloudfront.net/6a4GAB1BTdGuBgAdQW3RGw_2d8c3a2535d34867862b89587fc10744_SV_Final_MSK_LE07_Introduction_to_Rheumatology.pdf?Expires=1580860800&Signature=CXo0ClidAKZ9p~Hc3z39BALYKQ6FxWvAQwr1q0J1J~OMdy2S1GxR3dhnkiUNhzU5D4E1~XHakXeZ9dNHuQl3j0IC1Fmh6aCy6Vi-tjib60ZR9Fcj-LYW6KfrwYsA-pUOenWzrxmY6fb7Lmb4DOIMxoSUjhfXVA5NqHOpfxFJLRI_&Key-Pair-Id=APKAJLTNE6QMUY6HBC5A

Musculoskeletal Rheumatology (6 decks)

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