Flashcards in Joint Pathology Deck (45):
what is the function of collagen in cartilage?
Holds GAGs together
because cartilage is avascular where does it receives its nutrients from?
Articular: Synovial fluid
what is synovial fluid?
ultra filtrate of blood with added substances such as hyaluronic acid
What are the main types of cells that make up the synovium?
Type A synoviocytes (macrophage like)
Type B synoviocyte (fibroblast like)
Arthritis is an umbrella term relating to?
damage to joints
osteoarthritis is an example of
Rheumatoid Arthritis is an example of
Gout (crystal induced) is an example of
Acute inflammation arthritis
Osteoarthritis is more common in
hard working joints (knee and hands)
first symptoms to be noticed in Rheumatoid Arthritis is
oligoarthritis (1-4) or polyarthritis (>5)
one diagnostic characteristics of Rheumatoid Arthritis is
Gout is described as
incredibly painful inflammation in a single joint due to the accumulation of crystals of uric acid
what is podagra?
inflammation of the articulation of the hallux of the foot in the context of gout
in Osteoarthritis what parts of the joint are affecteD?
the caspsule, synovium, cartilage and bone
in Osteoarthritis, explain why there is hypertrophy and hyperplasia of the cartilage
because as part of the pathological disease there is a reduction in the amount of matrix present in the cartilage decreasing its shock absorbent properties. proliferation is a deficient savaging mechanism
what is fibrillation of the cartilage?
destruction of the cartilage with the formation of gaps or clefts
what is eburnation?
It is an ivory-like reaction of bone occurring at the site of cartilage erosion. The bone tissue now becomes the outer most layer and there is the formation of subchondral cysts
in the context of Osteoarthritis what is the changes observed in Bone and Cartilage
B --> Eburnation and osteophytes
C --> Erosion and Fibrillation
What are osteophytes?
out pouches of bone caused by the proliferation of bone tissue
what are some of the signs observed in Osteoarthritis?
Crepitus, osteophytes, painful [slow onset] worst after activity [end of day]
how is diagnosis of Osteoarthritis performed?
mostly clinical [diagnosis of exclusion]
X rays do not correlate with the symptoms of the patient
if an X-ray is performed on a patient with Osteoarthritis what will be seen?
loss of joint space
subchondral sclerosis --> thickening of the bone
in Osteoarthritis how doe subchondral cysts form?
the lack of articular cartilage and the destruction of the bone allows for synovial fluid to enter the the bone
What are the risk factors for the development of Osteoarthritis?
Repeated heavy use
[all that relate to damage to cartilage]
Rheumatoid Arthritis needs to be treated with medication because
Rapidly progressive, patient disabled in 10 years
in Rheumatoid Arthritis there is the formation of granulation tissue in the synovium, which is known as
what cells and cytokines are central to Rheumatoid Arthritis
what are some of the histological features of Rheumatoid Arthritis
Villus Formation form the synovium
Development of germinal centres
deposition of fibrin and neutrophils into the joint space
erosion of the cartilage and bone due to the pannus
destruction of bone, cartilage and ligaments
scarring and LORM [if untreated]
what are some of the signs of Rheumatoid Arthritis?
Warm, swollen joints (rubbery)
Systemic Symptoms present (LOW, fever)
if the joint gets better with use it is more likely to be ---1---- if not ---2---
1 Rheumatoid Arthritis
What is a rheumatoid nodule?
Granulomatous Inflammation with central necrosis
Diagnosis for Rheumatoid Arthritis
Inflammatory Tests (ESR, CRP, FBE)
more specific Tests (rheumatoid factor--> autoantibody)
Xray indicators of Rheumatoid Arthritis
Uniform loss of joint space*
Erosion of bone surrounding the synovium
Risk factors for the development of Rheumatoid Arthritis
Genetic (some HLA haplotypes, ~50%)
Increasing age (up to 55)
what is the main cause of Gout
too much uric acid in the body
Hyperuricaemia is a strong indicator of Gout
Necessary for the development of the condition but not determinant
Create levels change and not accordingly with the condition
what is the cause of pain in gout?
the immune reaction and activation of the inflammasome due to the uric acid crystals
Why is there lysis of neutrophils in the gouty joint?
because the crystals are filamentous and penetrate the cell membrane causing leaking and death
what are tophi and where do they form?
accumulation of uric acid in soft tissue
some of the events that can trigger gout are?
alcohol, dehydration, trauma and dietary indiscretion
what type of inflammation occur in the tophi?
what are some of the signs in gout?
acutely inflamed joint
rarely systematic signs
tophi if chronic and uncontrolled
Pain, redness, swelling, heat in joint
what is the gold standard for the diagnosis of gout?
Joint or tophi Aspiration (negatively birefringent crystals with neutrophils)
in x rays what is the main finding?
No loss of joint space