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MD1 Locomotor > Joint Pathology > Flashcards

Joint Pathology Flashcards

(54 cards)

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1
Q

What should the bones at synovial joints be like?

A

Fit nicely together with even distribution of pressure

Not touch - separated by cartilage

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2
Q

What type of cartilage is articular cartilage?

A

Hyaline

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3
Q

What attracts water in cartilage?

A

Glycosaminoglycans

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4
Q

How is the collagen arranged in articular cartilage?

A

To hold glycosaminoglycans compressed together

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5
Q

Are there any blood vessels in articular cartilage?

A

No

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6
Q

How is articular cartilage perfused?

A

Compression/decompression of cartilage > pushes water in and out

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7
Q

What do the capsule, tendons, and ligaments at the joint do?

A

Hold everything together

Crucial to joint stability and movement

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8
Q

Where is the synovium?

A

Lines joint space

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9
Q

Where is the synovium attached?

A

Firmly anchored to capsule and bone at edges of cartilage

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10
Q

What is the synovium?

A

Vascular connective tissue with synovial membrane

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11
Q

What are the cell types of the synovium?

A

25% type A “macrophage-like” synoviocytes

75% type B “fibroblast-like” synoviocytes

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12
Q

Why is the synovial membrane not an epithelium?

A

No basement membrane

No junctional complexes

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13
Q

What makes up synovial fluid?

A

Plasma filtrate - easily crosses in and out of joint space
Hyaluronic acid - makes viscous
Lubricin - makes slippery
Etc

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14
Q

How thick is the synovial membrane?

A

1-4 cell layers

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15
Q

Why is osteoarthritis classified as a degenerative disease?

A

Cartilage wears away

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16
Q

Does osteoarthritis present symmetrically?

A

No

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17
Q

When is pain worst in osteoarthritis?

A

At end of day

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18
Q

What is released by the cartilage matrix and synovial cells in osteoarthritis?

A 
Enzymes
- Collagenases
- MMPs
Cytokines
- IL-1
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19
Q

What parts of the joint does osteoarthritis affect?

A

Capsule
Synovium
Bone

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20
Q

What is the pathophysiology of osteoarthritis?

A 
Damage stimulates chondrocyte
- Hypertrophy
- Proliferation
- Enzyme/cytokine secretion
Unravelling of cartilage matrix, release of enzymes, loss of frictionless mechanical function
Changes in bone
- Thickening
- Microfractures
Shedding of cartilage
- Fibrillation
- Erosions
Bone-on-bone
- Eburnation
- Cysts
- Osteophytes
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21
Q

What is the morphology of osteoarthritis?

A 
Remaining cartilage looks rough
Eburnation of bone
Fibrillation of articular cartilage
Subchondral cysts
Non-uniform loss of cartilage
Subchondral thickening
Osteophytes
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22
Q

What is eburnation?

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A

Bone looks like ivory

23
Q

What are osteophytes?

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A

Cartilage growths which become bone through endochondral ossification

24
Q

How can osteophytes affect the joint?

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A

Can impinge on range of movement/nearby structures; eg: in spine, impinge on nerves
Can improve joint stability

25
What are the symptoms of osteoarthritis?
``` Pain - Deep, achy - Worse after activity Onset over years Non systemic symptoms ```
26
What are the signs of osteoarthritis?
Reduced range of movement Crepitus Osteophytes
27
What are Bouchard's nodes?
Osteophytes in proximal interphalangeal joints
28
What are Heberden's nodes?
Osteophytes in distal interphalangeal joints
29
What is the relationship between x-ray and clinical findings in osteoarthritis?
Severity of x-ray findings don't always correlate with severity of clinical findings
30
What is subchondral sclerosis?
Bone thicker under damaged cartilage
31
What are the risk factors for osteoarthritis?
Increasing age Obesity Previous injury/abnormality of joint Repeated heavy use of joint
32
What is the disease classification of rheumatoid arthritis?
Systemic inflammatory disease
33
What is rheumatoid arthritis?
Autoimmune attack on connective tissue
34
What other organs can rheumatoid arthritis affect?
Skin Blood vessels Heart Lungs
35
What is the primary stimulus in rheumatoid arthritis?
Unknown | Triggered in genetically susceptible individuals
36
What is the pathophysiology of rheumatoid arthritis?
``` Self reactive Th1 and Th17 cells activate Secrete cytokines - IL-1 - IL-6 - IL-17 - TNF-alpha Induce - Fibroblasts - Macrophages - Osteoclasts - B cells - T cells - DCs - Mast cells Exuberant granulation tissue-like synovium Collagenases and MMPs Breakdown of cartilage and bone ```
37
What is the morphology of the inflammatory changes in the joints in rheumatoid arthritis?
Neutrophils and fibrin may be found in joint space Mononuclear infiltrate in synovium - Germinal centres Hyperplasia of synovium with villus formation - Pannus Pannus invades and erodes cartilage and bone Weakening and destruction of ligaments
38
What is pannus?
Inflammatory granulation-like tissue in synovium
39
What are the symptoms of rheumatoid arthritis?
``` Symmetrical polyarthritis - Usually starts in hands and feet - Distal interphalangeal joints often spared Morning stiffness - Eases with activity Systemic symptoms - Fever - Weight loss - Anaemia ```
40
What are the signs of rheumatoid arthritis?
Warm, swollen joints Rheumatoid nodules - Common under skin but can get elsewhere - 30-40% of patients - Predicts severe disease Evential destruction and deformity of joints
41
What does a rheumatoid nodule look like histologically?
Evidence of granulomatous inflammation Epithelioid macrophages Lymphocytes and fibrosis Central necrosis
42
What do general inflammatory tests show in rheumatoid arthritis?
CRP, ESR, and FBE all show changes of inflammation
43
What are more specific tests that can be done to diagnose rheumatoid arthritis?
Rheumatoid factor - Not high specificity and sensitivity Anti-cyclic citrullinated peptide (anti-CCP) Abs (ACPAs) - More specific
44
What is the role of x-rays in diagnosing rheumatoid arthritis?
Little role
45
What are the risk factors for rheumatoid arthritis?
Genetic Female Smoking Increasing age from 25-55
46
What is the pathophysiology of gout?
Too much uric acid in body - Asymptomatic at first - Eventually precipitates in cool areas with low pH and nucleating agents - Especially after alcohol/dehydration/dietary indiscretion Crystals can activate inflammatory cells, synovial cells, and complement - Acute inflammatory cascade - IL-1, complement, and chemotaxis > crystals lyse neutrophils
47
What happens if gout remains untreated?
Progresses into chronic, disabling, tophaceous gout
48
What is tophaceous gout?
``` Involvement of multiple joints Recurrent joint inflammation causes damage - Can form pannus Urate deposition in other soft tissue - Forms tophi Gouty neuropathy and kidney stones ```
49
What type of inflammation is a gouty tophus?
Granulomatous inflammation (foreign body type)
50
What are the signs of gout?
Acutely inflamed joint Seldom systemically unwell Tophi if chronic
51
What are the symptoms of gout?
``` Spontaneous onset of - Excruciating pain - Swelling - Heat - Redness Classically in big toe in early morning ```
52
What is the gold standard for diagnosing gout?
Joint/tophus aspiration | - Negatively birefringent crystals with neutrophils
53
Why is measuring serum urate confusing?
Acute gout attack can lower serum urate Urate-lowering therapy can precipitate gout Most people with high urate don't have gout
54
What are the risk factors for gout?
``` Male Increasing age Menopaus Abnormal uric acid metabolism Genetics and ethnicity Obesity Hypertension Metabolic syndrome ```

MD1 Locomotor (17 decks)

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