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Musculoskeletal and Rheumatology > Lecture 4: Intro to Rheumatology > Flashcards

Lecture 4: Intro to Rheumatology Flashcards

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1
Q

What is connective tissue?

A
  • binds together, supports and strengthens other body tissues
  • protects and insulates internal organs
  • compartmentalises structures such as skeletal muscle
  • major transport system within the body
  • site of stored energy reserves
  • main site of immune responses
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2
Q

What are the 3 classes of components in connective tissue?

A
  • cells
  • fibres
  • ground substance
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3
Q

3 key features of connective tissue?

A
  • doesn’t occur on free surfaces
  • has a nerve supply (except cartilage)
  • highly vascular (except cartilage and tendons)
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4
Q

What is ground substance?

A

macromolecules and multi-adhesive glycoproteins that are between cells and fibres

  • supports cells
  • binds them together
  • provides medium through which substances are exchanged e.g. hyaluronic acid
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5
Q

What are the 3 types of fibres found in connective tissue?

A
  • collagen fibres
  • elastic fibres
  • reticular fibres
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6
Q

Key features of collagen fibres?

A
  • strong, resist forces, flexible
  • made of collagen (most abundant protein in the body)
  • toughest type of fibre
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7
Q

Key features of elastic fibres?

A
  • smaller in diameter than collagen fibres
  • branch to form network
  • made of protein elastin
  • found in blood vessels , skin etc.
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8
Q

Key features of reticular fibres?

A
  • provide support for walls of blood vessels
  • net/mesh-like structure
  • made of collagen w/glycoprotein covering
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9
Q

What cell types are found in connective tissue?

A
  • fibroblasts
  • macrophages
  • mast cells
  • adipocytes
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10
Q

What are fibroblasts?

A
  • large flat cells w/branching processes

- migrate throughout connective tissue secreting fibres and ground substance

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11
Q

What are macrophages?

A
  • develop from white blood cells

- surround and engulf material by phagocytosis

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12
Q

What are mast cells?

A
  • alongside blood vessels that supply connective tissue

- produce histamine: chemical that dilates blood vessels

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13
Q

What are adipocytes?

A
  • fat cells

- store triglycerides

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14
Q

What are the 4 main types of connective tissue?

A
  • connective tissue proper
  • cartilage
  • bone tissue
  • blood
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15
Q

What is the function of connective tissue proper?

A
  • binding tissue

- resists mechanical stress especially tension

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16
Q

What cells make up connective tissue proper?

A
  • fibroblasts
  • fibrocytes
  • defense cells
  • fat cells
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17
Q

What is the matrix of connective tissue proper?

A
  • gel like ground substance

- collagen, reticular and elastic collagen

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18
Q

What is connective tissue proper split into?

A
  • loose connective tissue

- dense connective tissue

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19
Q

What is loose connective tissue split into?

A
  • areolar (structural support, lots of ground substance, most common form of loose connective tissue)
  • adipose (fat tissue, energy reserve)
  • reticular (mesh network, supports spleen etc.)
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20
Q

What is dense connective tissue split into?

A
  • regular (tight collagen fibres e.g. tendon, ligaments etc)
  • irregular (skin dermis, irregular formation of collagen)
  • elastic (vertebrae)
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21
Q

What are 2 key features of cartilage?

A
  • avascular

- no nerve supply (except perichondrium)

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22
Q

What is the function of cartilage?

A
  • strengthen + support connective tissue
  • resists compression
  • cushions and support body structures
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23
Q

What cells are found in cartilage?

A
  • chondroblasts (in growing cartilage)

- chondrocytes

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24
Q

What matrix is found in cartilage?

Study These Flashcards
A
  • gel-like ground substance

- fibres: collagen, elastic fibres in some

25
What are the 3 types of cartilage?
- elastic cartilage - fibrocartilage - hyaline cartilage
26
Key facts about hyaline cartilage?
- gel-like ground substance - end of long bones to cushion joints + at epiphyseal plates - found in many articular surfaces - most abundant cartilage in the body - weakest of 3 types of cartilage - chondrocytes have gloss like appearance
27
Key facts about fibrocartilage?
- chondrocytes scattered among visible bundles of collagen fibres - strongest of 3 collagen types - no perichondrium - found in intervertebral discs - shock absorbing - lots of thick collagen fibres
28
Key facts about elastic cartilage?
- chondrocytes located in threadlike network of elastic fibres - provides strength, elasticity and maintains shape of certain structures e.g. external ear - similar to hyaline but w/increased elastin
29
What is the function of bone tissue?
- resists compression + tension | - protect + support
30
What cells are in bone tissue?
- osteoblasts | - osteocytes
31
What is the matrix of bone tissue?
- gel-like ground substance - calcified with inorganic salts - fibres: collagen
32
What are the 2 types of bone tissue (osseous tissue)?
- compact | - spongy
33
What is compact bone tissue made of?
- OSTEON: basic unit of compact bone - LAMELLAE: concentric circles of matrix - LACUNAE: spaces in matrix that house cells - OSTEOCYTES: mature bone cells
34
What is spongy bone tissue made of?
TRABECULAE: columns of bone w/spaces filled with red bone marrow
35
What is the function of blood?
- transport oxygen, CO2, nutrients, waste and other substances
36
What cells are in blood?
- RBCs (erythrocytes) - WBCs (leukocytes) - platelets
37
What is the matrix of blood?
- liquid - plasma - no fibres
38
Name 2 rheumatological disorders?
- rheumatoid arthritis (RA) | - system lupus erythematosus (SLE)
39
What is rheumatoid arthritis?
- autoimmune disorder primarily affecting joints resulting in warm, swollen, painful joints - symptoms typically worse following rest
40
What is SLE?
- autoimmune disorder of connective tissues, affects multiple organ systems and joints
41
What are the general macroscopic changes in RA?
- synovitis - bone - cartilage - erosion - angiogenesis diagram
42
What are the general microscopic changes in RA?
- cells - IL - ANF - synoviocytes - osteoclasts - proteases - CD4 cells - plasma cells - neutrophils
43
What are the joint changes in RA?
- swollen inflamed synovial membrane - hyaline cartilage wears away - reduced joint space - bone erosion
44
What immune system factors are involved in RA?
- IL-6: role in inflammation - TNF-alpha: role in inflammation - IL-17: role in starting inflammation, cartilage destruction and bone destruction by making cells produce other ILs
45
Possible causes of RA?
- environmental factors - epigenetic modifications - susceptibility genes likely a combination of factors
46
Key features of RA?
- symptoms last >6 weeks + often last remainder of life - inflammatory synovitis = palpable synovial swelling, morning stiffness >1 hr and fatigue - symmetrical + polyarticular (more than 3/4 joints affected)
47
Which joints are typically involved in RA?
- typically involves wrists, MCP and PIP joints (metacarpophalangeal and proximal interphalangeal)
48
What joints are usually spared in RA?
- thoracolumbar spine | - DIPs of fingers and IPs of toes (distal interphalangeal and interphalangeal)
49
What are the 3 COMMON SYMTOMS of RA?
- JOINT PAIN - STIFFNESS - SWELLING
50
Key differences between RA and osteoarthritis?
- RA = inflammatory, Osteo = degenerative - RA = autoantibodies, Osteo = no antibodies - RA = small joints, Osteo = large weight bearing joints (hips, knees, shoulders)
51
What are some signs of RA?
- may have nodules: subcutaneous or periosteal at pressure points - rheumatoid factor in blood (not specific for RA but high titre early is bad sign) - marginal erosions and joint space narrowing on x-ray
52
What x-ray changes are there in RA?
- soft tissue swelling - joint space loss - erosions (juxta-articular) - subluxation
53
What are the treatment principles of RA?
- confirm diagnosis - determine severity - treatment: start aggressive treatment early, use safest plan that matches aggressiveness of disease - monitor: treatment for adverse effects, disease activity, revise prescription (Rx) as needed
54
What are the critical elements of assessment in a treatment plan?
- assess current activity - document degree of damage - document extra-articular manifestations - assess prior Rx responses + side effects
55
What are the critical elements of therapy in a treatment plan?
- education - exercise (ROM, conditioning and strengthening exercises) - medications (analgesic and/or anti-inflammatory, immunosuppressive, cytotoxic + biologic)
56
What are the drug treatment options for RA?
- NSAIDs - symptomatic relief, improved function, no change in progression - Low-dose prednisone - may substitute NSAID, bridge therapy - Intra-articular steroids - useful for flares - DMARDs- minocycline, sulfasalazine, hydroxychloroquine, intramuscular hold - immunosuppressive drugs - methotrexate, azathioprine, cyclophosphamide, cyclosporine
57
What new drugs/DMARDs are being used for RA?
- leflunomide | - etanercept
58
What extraarticular manifestations of RA are there?
- liver - cardiovascular - neurological - musculoskeletal - bone marrow - spleen
59
What are the common symptoms of SLE?
- alopecia - malar rash (butterfly skin rash) - arthralgia - oral ulcers - photosensitivity

Musculoskeletal and Rheumatology (5 decks)

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