Issues with Musculoskeletal System

Question 1

Synovial joint structure & pathologies

Answer 1

Hyaline cartilage (articular): wear-and-tear

Bony structure: Osteophytes

Synovial membrane (moveable joint lining): inflammation

Ligaments: tears, inflammation

Tendons: tears inflammation

Bursae (fluid filled sacs): inflammation

Question 2

OSTEOARTHRITIS

Answer 2

“Osteoarthritis is a disease of synovial joints which is characterised by loss of articular cartilage and overgrowth of the underlying bone

Wear and tear of wt-bearing joints (often visible)

Stiffness & Reduced ROM (often visible)

Crepitations (tiny crackes/grating sounds, etc)

Pain

Deformities

Osteophytes (bony protusions formed to protect joins)

Heberden nodes (protrusions of joint margin - nodal osteoarthritis)

Local effusion (body’s attempt to repair)

Decreased joint mobility

Affects DIJs

Question 3

Gout

Answer 3

Gout is a a disease in which defective metabolism of uric acid causes arthritis, especially in the smaller bones of the feet, with episodes of acute pain

The presence of monosodium urate (MSU) crystals in joints, bones, and soft tissues.

Question 4

Carpal Tunnel Syndrome

Answer 4

Carpal tunnel syndrome is caused by compression of the median nerve under the flexor retinaculum of the wrist. It manifests as numbness, tingling, pain and weakness in the hand

Question 5

Osteoporosis

Answer 5

Osteoporosis is a disease characterized by low bone mass and structural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture

Osteoporosis is a metabolic bone disease that, on a cellular level, results from osteoclastic bone resorption not compensated by osteoblastic bone formation

Question 6

Rheumatoid arthritis

Answer 6

Rheumatoid Arthritis is a multisystem inflammatory disorder with persistent synovitis affecting joint structure and function…

Not fully understood.

Synovitis occurs as a consequence of leukocyte infiltration into the synovium.

The interior of the inflamed synovium becomes hypoxic.

Hypoxia, stimulates angiogenesis in the synovium.

T cells cause production of IL-17, a potent cytokine that promotes synovitis (inflammation).

Antigen-activated CD4+ T cells amplify the immune response.

The release of cytokines, especially TNF-α, IL-6 and IL-1, causes further synovial inflammation.

In addition to joint damage, cytokines promote the development of many systemic effects.

Effectively a civil war in the body - the battle takes place in a synovial joint

Question 7

Ankylosing spondylitis

Answer 7

Ankylosing spondylitis is an inflammatory disease that, primarily affects the spine, with progressive fusion of vertebrae leading to rigidity and stooping

Nearly 90% of patients test positive for HLA B27 gene.

8% of general population have the HLA-B27 gene but do not have ankylosing spondylitis.

Chronic inflammation of Entheses (the insertion of a tendon, ligament, capsule, or fascia into bone).

Leading to calcification

Also persistence mild and destructive synovitis

Question 8

Psoriatic arthritis

Answer 8

Psoriatic arthropathy (arthritis) typically causes joints to become swollen, stiff and painful. This is a long-term condition that can get progressively worse leading to bony erosions and other articular manifestations

Immune-mediated, inflammatory arthropathy.

Inflammation at the entheses.

Associated with increased mortality from cardiovascular disease.

Caused by activation of Cytokines, Tumour Necrosis Factor (TNF) and Interleuki

Cascade of immune cells inc. phagocytes cause tissue damage.