Joints and Joint Disease Flashcards

Question

Describe Fibrocartilage

Answer 1

* Strongest form of cartilage * Contains thick parallel bundles of **type I collagen** alternating with hyaline cartilage matrix * No perichondrium Found in: * Insertion points of ligaments and tendons to bone * IV discs * Joint capsules * Knee menisci * Pubic sympysis * Temporomandibular joint

Answer 2

* Strong, flexible, resilient * Present in structures requiring **deformation,** then **rapidly return to original shape** * Contain **elastic fibres** and **Type II collagen fibres** * Has a perichondrium Found in: * External ear * Larynx * Epiglottis

Answer 3

A joint that is fixed and does not allow movement e.g. the cranial sutures

Answer 4

A joint which is only slightly moveable such as the pubic symphysis

Answer 5

A joint which is freely moveable such as the shoulder/hip

Answer 6

Bones connected by **dense connective tissue** containing **mainly collagen and no cartilage.** 2 types: * **Sutures** = between flat bones of skull, synarthrodial. * **Syndemoses** = interossus membrane connecting long bones, amphiarthrodial. E.g. between tibia and fibia & radius and ulna

Answer 7

Bones connected **entirely by cartilage** Either hyaline and/or fibrocartilage Can be immoveable or slightly moveable Allow more movement than a fibrous joint but less than highly mobile synovial joint Types: Primary and secondary

Answer 8

Hyaline cartilage only Epiphyseal growth plates, costal cartilage

Answer 9

**Hyaline cartilage** lines the bones with pad of **fibrocartilage** in between **IV discs, pubic symphysis, and manubriosternal joint**

Answer 10

Presence of a joint cavity between the bones that contains **synovial fluid.** **Hyaline Cartilage** Joint is enclosed by a **joint capsule** Contains outer **fibrous membrane and** inner **synovial membrane (synovium)**

Answer 11

Sac made of synovial membrane, containing synovial fluid that reduces friction of one structure moving over another E.g. in the knee

Answer 12

Movements of synovial joints:- - Hinge, e.g. elbow joints – flexion and extension - Ball and socket, e.g. glenohumeral joint – movement in several axes - Plane, e.g. acromioclavicular joint – gliding or sliding movements - Saddle, e.g. metatarsophalangeal joint – consists of concave and convex surfaces - Pivot, e.g. atlantoaxial joint – rotation - Condyloid, e.g. metacarpophalangeal joint – flexion, extension, adduction, abduction and circumduction Synovial joints may also be classified as: - Uniaxial – movement in one plane - Biaxial – movement in two planes - Multiaxial – movement in three planes

Answer 13

Osteoarthritis

Answer 14

Complex interaction between genetic, metabolic, biochemical and biomechanical factors

Answer 15

## Footnote **1. Degradation of cartilage** **2. Fibrillation of cartillage** **3. Chronic synovitis** triggered by cartilage fragments (synovial phagocytes release degradative enzymes)

Answer 16

Risk factors for osteoarthritis include: - Genetic - Increasing age - Female sex - Trauma - Mechanical stress on joints - Obesity - High bone density – increases the risk of developing osteoarthritis - Low bone density – increases the risk of progression of knee and hip osteoarthritis

Answer 17

–Primary - due to genetic factors and occurs in the absence of a precipitating insult –Secondary - occurs as a sequelae of joint pathology, e.g. trauma, infection, joint defects, inflammatory conditions.

Answer 18

knees, hips and small joints of the hands

Answer 19

Change in composition of cartilage -\> reduced shock absorbing abilities Erosion of cartilage in joints -\> fissures (fibrillation) Ulceration of cartilage -\> exposes underlying bone -\> microfractures and subchondral cysts

Answer 20

Inflammation of synovium Thickening of joint capsule -\> stiffness and restricted movement

Answer 21

Joint space narrowing – characteristically asymmetric Subchondral cysts and sclerosis Osteophytes Malalignment

Answer 22

Osteophytes are commonly seen on examination in osteoarthritis of the small joints hand where they present as hard swellings around the distal interphalangeal joints (Herberden nodes) and/or proximal interphalangeal joints (Bouchards nodes) and at the base of the thumb.

Answer 23

Joint stiffness – short-lived morning stiffness and post-inactivity stiffness Joint pain – worse on movement Functional limitation Rest/night pain Examination findings: –Restricted movement –Crepitus –Bony swelling –Joint effusion –Joint instability, deformity and muscle wasting

Answer 24

**Education, advice and information** **Non-pharmacological** –Exercise – build muscle strength, loose weight –Physiotherapy –Aids and devices **Pharmacology** –Pain management – topical and/or oral **Surgical** –Joint replacement (arthroplasty) –Joint fusion –Joint excision –Realignment surgery

Answer 25

1. Rheumatoid arthritis 2. Spondyloarthritis 3. Crystal arthritis e.g. gout

Answer 26

**Rheumatoid arthritis:** * usually begins 25-50yrs * AI response affecting synovial membrane leads to joint destruction * develops in weeks/months * usually symmetrical, affects small joints primarily * signs of inflammation present * morning stiffness often \>1hr * more common in females * no ostephytes * RF frequently present * generalised symptoms present e.g. fatigue, weight loss, anaemia **Osteoarthritis:** * Usually begins after 40 * biomechanical - leads to loss of cartilage matrix * develop slowly over many years * usually affects weight bearing joints * pain associated with joint use, less inflammatory signs * morning stiffness usually \<20mins * no general symptoms * common in males and females * osteophytes may be present * No RF present

Answer 27

An inflammatory response to **urate crystals** deposited in and around joint and synovial fluid Due to **Hyperuricaemia** Crystal formation tends to occur in peripheral areas, e.g. metatarsal-phalangeal joints, especially of big toe

Answer 28

synovitis, cartilage destruction and joint degeneration

Answer 29

–**Primary** (95%) - due to an inherited disorder that causes an overproduction or underexcretion of uric acid –**Secondary** (5%) – other factors causing overproduction of uric acid (e.g. high dietary purine, drugs, or conditions resulting in increased nucleic acid turnover, e.g. lymphoma, psoriasis, haemolysis etc. etc.) or under-excretion (e.g. chronic renal failure, alcohol, drugs etc.)

Answer 30

Urate crystals can also be deposited in the **renal parenchyma**, resulting in **renal failure**, and **urate calculi (kidney stones)** can be formed in the urine

Answer 31

Therefore, important risk factors to remember include: - High serum urate - Family history - Excess alcohol - Renal disease - Chemotherapy for malignancy

Answer 32

Acute gout: –Sudden onset –May be precipitated by excess food or alcohol, dehydration or diuretics –Joint inflammation –Tender, swollen, hot, red joint –Often affects first metatarsophalangeal joint

Answer 33

Chronic tophaceous gout –Often associated with renal impairment and long-term use of diuretics –Tophi – deposits of monosodium urate crystals in bursae, tendons, cartilage or periarticular bone. May ulcerate and discharge –Chronic joint pain –May have superimposed acute gout attacks

Answer 34

Joint effusion “Punched out” bony erosions with sclerotic margins and over-hanging edges Opacities (tophi) in soft tissue Soft tissue swelling Narrowing of joint space in late stages of disease

Answer 35

**General measures:** –Reduce alcohol intake –Avoid purine-rich foods –Loose weight –Review medications including diuretics **Acute attack – NSAIDs or colchicine** Chronic gout –**Allopurinol** (xanthine oxidase inhibitor – reduces synthesis of uric acid) –Uricosuric drugs (increases urinary excretion of uric acid)

Joints and Joint Disease Flashcards

(64 cards)