Joint Pathology

Question 1

bony congruence allows?

Answer 1

even distribution of pressure

Question 2

3 layers of articular cartilage

Answer 2

superficial: parallel fibers
middle: random fibers
deep: perpendicular fiberes

Question 3

what do GAGs do in articular cartilage?

Answer 3

draws in water

Question 4

what does collagen and chondrocytes and GAGs do in articular cartilage?

Answer 4

water drawn in by GAGs, held together by collagen II, and maintained by chondrocytes

Question 5

blood vessels in aritcular cartilage?

Answer 5

Nope

Question 6

capsule, tendons, ligaments purpose?

Answer 6

stability and movement

Question 7

synovial fluid contains?

Answer 7

• plasma filtrate

- extra slippery hyaluronic acid

Question 8

2 cells in synovium ?

Answer 8

Type A: macrophage-like

Type B: fibroblast-like (make hyaluronic acid)

Question 9

OA presentation?

Answer 9

1. Chronic, few joint
2. weight bearing or prev. injured
3. worse with use

Question 10

RA presentation?

Answer 10

1. inflamm, systemic
2. symmetrical, small joints
3. morning stiffness
4. better with use

Question 11

Gout presentation?

Answer 11

1. paroxysmal acute inflammation

2. uric acid crystallisation

Question 12

what is gout in big toe called?

Answer 12

Podagra

Question 13

Damage precipitates what 3 things in OA?

Answer 13

1. chondrocyte proliferation
2. cytokine release
3. matrix depletion

Question 14

matrix depletion or unravelling releases what things?

Answer 14

enzymes (collagenases, MMPs)

Question 15

what bony changes in OA?

Answer 15

thickening and microfractures,

Question 16

what is shedding of cartilage called?

Answer 16

fibrillation “shredded appearance”

Question 17

bone on bone causes 3 things:

Answer 17

1. eburnation
2. cysts
3. osteophytes

Question 18

3 big things in morphology of OA?

Answer 18

1. non-uniform less of cartilage
2. subchondral thickening
3. osteophytes

Question 19

signs of OA: 3

Answer 19

1. reduced ROM
2. crepitus
3. osteophytes

Question 20

onset of OA?

Answer 20

insidious

Question 21

pain type in OA?

Answer 21

deep achey

worse after use

Question 22

Heberden’s Nodes?

Answer 22

DIP

Question 23

Bouchard Nodes?

Answer 23

PIP

Question 24

X-rays dx OA?

Answer 24

Nope, little correlation

Question 25

5 OA risk factors:

Answer 25

1. age 2. obesity 3. prev. injury 4. heavy use of joint 5. genetic

Question 26

OA not common in which joint?

Answer 26

shoulder | elbow

Question 27

RA affects not just joint but:

Answer 27

skin blood vessels heart lungs

Question 28

RA pathogenesis which t-helper cells?

Answer 28

Th1, Th17

Question 29

RA pathogenesis which cytokines releases? 4:

Answer 29

IL-1,6,17 | TNF-a

Question 30

RA pathogenesis T-cells activate what 4 things?

Answer 30

fibroblasts macros osteoclasts B-cells

Question 31

RA pathogenesis what is formed in joint?

Answer 31

granulation tissues-like pannus due to breakdown of cartilage and bone

Question 32

what happens in synovium of RA pathogenesis ?

Answer 32

1. germinal centres 2. mononuclear infiltrate 3. hyperplasia with villus formation = pannus

Question 33

what does pannus lead to eventually in RA pathogenesis ?

Answer 33

fibrosis and bony union of joints

Question 34

signs of RA?

Answer 34

1. warm swollen joints | 2. rheumatoid nodules

Question 35

symptoms of RA?

Answer 35

1. morning stiffness - eases with activity | 2. symmetric polyarthritis -starts at hands then feet

Question 36

what is a rheumatoid nodule?

Answer 36

granulomatous inflammation | with central necrosis

Question 37

how is joint space loss in RA?

Answer 37

uniform loss

Question 38

Risk factors for RA? 4 things:

Answer 38

1. genetic 2. women 3. age: 25-55 4. smoking

Question 39

When do you get systemic gout?

Answer 39

after 20-30 years of increasing uric acid levels, then precipitates into crystals

Question 40

uric acid crystals like to precipitate where?

Answer 40

in cool areas with low pH and nucleating agents: eg. big toe

Question 41

uric acid crystals do what do cause pain?

Answer 41

activate inflammation, synovial cells complement neutrophil lysis

Question 42

what are tophi?

Answer 42

uric acid crystal deposition in soft tissue: articular cartilage and capsule

Question 43

gout and kidneys?

Answer 43

kidney stones | gouty nephropathy

Question 44

what is a gouty tophi?

Answer 44

granulomatous inflammation (foreign type body)

Question 45

gold standard for gout test?

Answer 45

joint aspiration: crystals

Question 46

serum urate in gout?

Answer 46

not reliable

Question 47

x-ray findings for gout?

Answer 47

1. punched out erosions | 2. overhanging edges

Question 48

gout risk factors: 4

Answer 48

1. male 2. uric acid metabolism 3. genetics 4. metabolic syndrome

Question 49

high uric acid is related to what things that would help upright human evolutionarily:

Answer 49

1. Na+ retention 2. hypertension 3. insulin resistance