Week 2 - Ageing versus pathology

Question 1

Necrosis

Answer 1

Necrosis is when the cell body dies abruptly due to uncontrolled external factors.

Question 2

Apoptosis

Answer 2

Apoptosis is when cells commits suicide due to cell turn over and to be replaced with new cells.

Question 3

Which cell destruction process requires energy Apoptosis or Necrosis?

Answer 3

Apoptosis is an active process that requires energy.

Question 4

Pathological process Osteoarthritis

Answer 4

Degenerative disease

Cartilage degradation
Bone rubbing
Osteophytes and bone spurs form around articular surface
Sub-chondral sclerosis (hardening)
Synovial membrane inflammation
Surrounding structures become thickened and contract over time - decreased mobility

Question 5

Is osteoarthritis usually bilateral or unilateral?

Answer 5

Unilateral and in bigger joints

Question 6

What type of disease is Osteoarthritis?

Answer 6

Degenerative

Question 7

Treatment for Osteoarthritis

Answer 7

Reduce external stress
Weight loss
Braces, walking sticks, shoe insoles
Exercise program

Pain management through paracetamol or NSAIDS

Joint replacement

Question 8

Symptoms of Osteoarthritis

Answer 8

• Pain or aching.
• Stiffness.
• Decreased range of motion (or flexibility)
• Swelling.

Question 9

Risk factors of Osteoarthritis

Answer 9

50 years, female, obesity, family history, physical demanding job/sport

Question 10

What type of disease is Rheumatoid arthritis?

Answer 10

Autoimmune disease

Question 11

Rheumatoid - bilateral or unilateral?

Answer 11

Bilateral effecting hands and feet, but can also occur in larger joints

Question 12

Risk factors for Rheumatoid arthritis

Answer 12

Genetic predisposition, external factors e.g. smoking

Question 13

Pathological process - Rheumatoid arthritis

Answer 13

Inflammation in synovial membrane around the joint (synovitis), hyperplasia of synovial cells forsm thickened aggressive tissue “pannus”, cells in the pannus then release TNF, interleukins and others that degrade cartilage and bone, fibrosis and ankylosis can occur over time in joint fusing joints. Chronic pain.

Question 14

Signs and symptoms - Rheumatoid Arthritis

Answer 14

• Stiffness in more than one joint.
• Pain or aching in more than one joint.
• Tenderness and swelling in more than one joint.
• The same symptoms on both sides of the body (such as in both hands or both knees).
• Weight loss.
• Fever.
• Fatigue or tiredness.
• Weakness.

Question 15

Treatments - Rheumatoid Arthritis

Answer 15

• non-steroidal anti-inflammatory drugs (NSAIDs)
• corticosteroid medicines or injections
• disease-modifying anti-rheumatic drugs (DMARDs)
• biological DMARDs.
• exercise,to keep the joints flexible and muscles strong.

Question 16

Ankylosing Spondylitis - what happens?

Answer 16

Inflammation at Enthesis attachment points - ligaments, tendons, capsule
Where tendon/ligaments attaches to bone
Mainly localised in spine and SIJ

Question 17

Difference between primary and secondary ankylosing spondylitis

Answer 17

Primary - genetic predisposition

Secondary - older age groups. Associated with psoriasis and inflammatory bowel disease

Question 18

Inflammatory process of AS

Answer 18

• HLA-B27 (protein on WBC) misfolding in endoplasmic reticulum
• Accumulation of inflammatory cells (mainly macrophages & lymphocytes) occur in joint capsule, fibrocartilage, periosteum and enthuses.
• These cells erode bone - increases & activates osteoblasts - lay down new matrix
• New matrix becomes callus and becomes osseous. This changes the Enthesis.
• New Enthesis = Syndesmophyte

Question 19

Signs and symptoms of AS

Answer 19

LBP and stiffness
Stiffness is progressive

Question 20

Diagnosis of AS

Answer 20

MRI - can see “itis” years before sclerosis / ankylosis

X-ray can see the sclerosis (too late)

Question 21

Shiny Corner Sign - AS

Answer 21

Xray’s show brightness at the corners of VB due to inflammation and subsequent healing in those areas, new bone is then created to attempt to repair the inflammation

Question 22

Romanus Lesion - AS

Answer 22

Erosion or loss of definition at the vertebral endplates

Question 23

Bamboo spine - AS

Answer 23

Late stage AS - appearance of spine looks like bamboo, square and straight

Question 24

Treatment of AS

Answer 24

Physiotherapy - maintain RoM in spine and peripheral joints

Pharmacological - NSAIDS for pain

Surgical - prevent major deformity