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Flashcards in Joint Pathology Deck (45):
1

what is the function of collagen in cartilage?

Holds GAGs together

2

because cartilage is avascular where does it receives its nutrients from?

NON-articular: Perichondrium
Articular: Synovial fluid

3

what is synovial fluid?

ultra filtrate of blood with added substances such as hyaluronic acid

4

What are the main types of cells that make up the synovium?

Type A synoviocytes (macrophage like)
Type B synoviocyte (fibroblast like)

5

Arthritis is an umbrella term relating to?

damage to joints

6

osteoarthritis is an example of

Degenerative Disease

7

Rheumatoid Arthritis is an example of

Autoimmune Arthritis

8

Gout (crystal induced) is an example of

Acute inflammation arthritis

9

Osteoarthritis is more common in

hard working joints (knee and hands)

10

first symptoms to be noticed in Rheumatoid Arthritis is

oligoarthritis (1-4) or polyarthritis (>5)

11

one diagnostic characteristics of Rheumatoid Arthritis is

Morning Stiffness

12

Gout is described as

incredibly painful inflammation in a single joint due to the accumulation of crystals of uric acid

13

what is podagra?

inflammation of the articulation of the hallux of the foot in the context of gout

14

in Osteoarthritis what parts of the joint are affecteD?

the caspsule, synovium, cartilage and bone

15

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

16

what is fibrillation of the cartilage?

destruction of the cartilage with the formation of gaps or clefts

17

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

18

in the context of Osteoarthritis what is the changes observed in Bone and Cartilage

B --> Eburnation and osteophytes
C --> Erosion and Fibrillation

19

What are osteophytes?

out pouches of bone caused by the proliferation of bone tissue

20

what are some of the signs observed in Osteoarthritis?

Crepitus, osteophytes, painful [slow onset] worst after activity [end of day]
NO FEVER

21

how is diagnosis of Osteoarthritis performed?

mostly clinical [diagnosis of exclusion]
X rays do not correlate with the symptoms of the patient

22

if an X-ray is performed on a patient with Osteoarthritis what will be seen?

loss of joint space
subchondral cysts
subchondral sclerosis --> thickening of the bone
osteophytes

23

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

24

What are the risk factors for the development of Osteoarthritis?

Ageing
Obesity
Previous Injury
Repeated heavy use
[all that relate to damage to cartilage]

25

Rheumatoid Arthritis needs to be treated with medication because

Rapidly progressive, patient disabled in 10 years

26

in Rheumatoid Arthritis there is the formation of granulation tissue in the synovium, which is known as

Pannus

27

what cells and cytokines are central to Rheumatoid Arthritis

Th17
Th1
TNF-alpha

28

what are some of the histological features of Rheumatoid Arthritis

Villus Formation form the synovium
Synovial Hperplasia
Mononuclear Infiltration
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]

29

what are some of the signs of Rheumatoid Arthritis?

Warm, swollen joints (rubbery)
Systemic Symptoms present (LOW, fever)
Morning Stiffness

30

if the joint gets better with use it is more likely to be ---1---- if not ---2---

1 Rheumatoid Arthritis
2 Osteoarthritis

31

What is a rheumatoid nodule?

Granulomatous Inflammation with central necrosis

32

Diagnosis for Rheumatoid Arthritis

Inflammatory Tests (ESR, CRP, FBE)
more specific Tests (rheumatoid factor--> autoantibody)

33

Xray indicators of Rheumatoid Arthritis

Osteopenia
Uniform loss of joint space*
Erosion of bone surrounding the synovium

34

Risk factors for the development of Rheumatoid Arthritis

Genetic (some HLA haplotypes, ~50%)
Female
Increasing age (up to 55)
Smoking

35

what is the main cause of Gout

too much uric acid in the body

36

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

37

what is the cause of pain in gout?

the immune reaction and activation of the inflammasome due to the uric acid crystals

38

Why is there lysis of neutrophils in the gouty joint?

because the crystals are filamentous and penetrate the cell membrane causing leaking and death

39

what are tophi and where do they form?

accumulation of uric acid in soft tissue

40

some of the events that can trigger gout are?

alcohol, dehydration, trauma and dietary indiscretion

41

what type of inflammation occur in the tophi?

Granulomatous Inflammation

42

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

43

what is the gold standard for the diagnosis of gout?

Joint or tophi Aspiration (negatively birefringent crystals with neutrophils)

44

in x rays what is the main finding?

Tophi
No loss of joint space

45

what are the risk factor for gout?

Male
Obese
Age
Defects in uric acid metabolism
Genetic