Lecture 3: Joint Disorders

Question 1

______________ is a process of rapid cartilage degeneration resulting in narrowing of the joint space and loss of motion

Answer 1

chondrolysis

Question 2

Where does the most common chondrolysis occur?

Answer 2

in hip (slipped capital femoral epiphysis)

Question 3

What is one way that chondrolysis can be diagnosed?

Answer 3

imaging studies (radiographs / MRI’s) OR signs of joint narrowing

Question 4

What is the difference between primary and secondary OA?

Answer 4

• Primary has an unknown cause
• secondary OA is caused by trauma, infection, hemarthrosis, osteonecrosis, or another condition

Question 5

________________ is a slowly evolving articular disease that appears to originate in cartilage and effects the underlying bone, soft tissues, and synovial fluid

Answer 5

OA

Question 6

What is the most common joint disease?

Answer 6

OA

Question 7

Name 2 risk factors of osteoarthritis

Answer 7

• generalized ligamentous laxity
• muscle weakness (due to prolonged immobilization, polymyositis, MS, or myopathies)

Question 8

With osteoarthritis, the synovial lining of the joint undergoes hyperplasia, secreting excess synovial fluid, The extra fluid creates a joint _________ that activateds joint mechanoreceptors that through a spinal reflect inhibit muscles crossing the joint and affecting joint _________________

Answer 8

effusion; nociceptors

Question 9

With the loss of cartilage there is now excessive mechanical load on the bone which causes new bone to be formed at the joint margin (______________)

Answer 9

osteophytes

Question 10

T/F: people with OA experience pain that is better with activity and worse with rest

Answer 10

false: they experience a deep ache that is worse with activity and better at rest

Question 11

how long does morning stiffness usually last for patients with OA? how do you dissipate this?

Answer 11

it lasts 5 to 10 mins and it dissipates with movement and activity

Question 12

____________ is audible crackling or grating sensation produced when roughened articular or extraarticular surfaces rub together during movement

Answer 12

crepitus

Question 13

Definite osteophytes; possibly narrowing of the joint space indicates a ________ on the Kellgren and Lawrence grading system

Answer 13

2

Question 14

Large osteophytes; definite joint space narrowing; some slcerosis and possible deformity of bone ends indicates a ________ on the Kellgren and Lawrence grading system

Answer 14

4

Question 15

What types of symptoms do we see with rheumatic diseases that we do not normally see with joint or muscle condition brought on by trauma or overuse?

Answer 15

• affects all body systems so fever, rash, diarrhea, scleritis, or neuritis symptoms

Question 16

What is the second most prevalant form of arthritis after OA?

Answer 16

rheumatoid arthritis

Question 17

What are the two primary risk factors for RA?

Answer 17

age and female gender

Question 18

____________________ are antibodies that react with immunoglobin antibodies found in the blood. The reaction between ________________ (same as first blank) and the immunoglobin triggers events that initiate an inflammatory reaction.

Answer 18

rheumatoid factors

Question 19

In RA, the cells of the synovial lining multiply and there is an influx of ______________ (what type of cell?)

Answer 19

leukocytes

Question 20

• What is the name of the destructive vascular granulation tissue that can develop in RA and disrupt the two main functions of the synovium?
• what are the two main functions of the synovium?

Answer 20

pannus
- lubricate the joint
- provide nutrients to avascular articular cartilage

Question 21

T/F: elevated cytokine levels in RA induce bone formation by directly or indirectly activating osteoblasts

Answer 21

false; INHIBIT bone formation by directly or indirectly activating OSTEOCLASTS

Question 22

What is ankylosis of a joint?

Answer 22

adhesions and fibrous or bony fusions of the joint

Question 23

What is the swan neck deformity?

Answer 23

flexion at the DIP and hyperextension at the PIP

Question 24

What is the boutonniere deformity?

Answer 24

flexion of the PIP

Question 25

The longer a person has RA, the greater the likelihood of having _________ (what spinal segment?) spine disease.

Answer 25

cervical

Question 26

Why is the upper cervical spine most effected in someone with RA?

Answer 26

- joints are purely synovial C1-C2 facets have no bony interlocking

Question 27

Where are common places for nodulosis to occur in someone with RA? ("pump bumps"

Answer 27

olecranon, proximal ulna, extensor surfaces of fingers, achilles tendon

Question 28

______________________ secondary to RA can cause stocking-glove peripheral neuropathy and small brown infarcts in the palm and fingers.

Answer 28

small vessel vasculitis

Question 29

Why might it be harder to diagnose RA in the early stages?

Answer 29

symptoms fluctuate which delay visits to a physician's office

Question 30

which 3 lab values should be looked at when diagnosing RA?

Answer 30

WBC count in synovial fluid, synovial fluid volume, c-reactive protein (an acute phase reactant)

Question 31

What type of imaging enables the visualization of small superficial structures and can reveal synovial inflammation, tenosynovitis, effusions, and bone erosions?

Answer 31

ultrasonography

Question 32

T/F: RA usually affects the small joints of the feet and hands asymmetrically

Answer 32

false; SYMMETRICALLY

Question 33

Which gender does OA impact more commonly before age 45?

Answer 33

men

Question 34

T/F: OA usually presents symmetrically in the joints on both sides

Answer 34

false; usually begins in joints on one side of the body

Question 35

Do patients with OA or RA commonly experience longer lasting morning stiffness?

Answer 35

RA