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11. CP - Diseases of the musculoskeletal system > (57a) Diseases of the musculoskeletal system 1 part A > Flashcards

(57a) Diseases of the musculoskeletal system 1 part A Flashcards

1
Q

What is arthritides?

A
  • pain and stiffness of a joint
  • inflammation of the joint
  • not a single disease
  • hundreds of diseases causing pain and stiffness of musculoskeletal system
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2
Q

What kind of symptoms does acute arthritis cause?

A
  • pain
  • heat
  • redness
  • swelling
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3
Q

What are the 2 commonest types of chronic arthritis?

A
  • osteoarthritis

- rheumatoid arthritis

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4
Q

What is the commonest type of joint disease?

A

Osteoarthritis

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5
Q

Osteoarthritis is also known as what?

A

Degenerative joint disease

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6
Q

What happens in osteoarthritis?

A
  • progressive erosion of articular cartilage

- results in formation of bony spurs and cysts at margins of joints

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7
Q

What causes osteoarthritis?

A
  • ageing
  • abnormal stresses in weight bearing joints
  • no apparent initiating cause
  • secondary OA eg. knee in basket ball players, elbow in baseball players
  • underlying systemic diseases such as diabetes and marked obesity
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8
Q

Where does osteoarthritis commonly affect in men and women?

A
  • men - hip

- women - knees and hands

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9
Q

Describe the pathogenesis of osteoarthritis

A
  • deterioration or loss of cartilage that acts as protective cushion between bones
  • bone forms spurs as cartilage is worn away
  • fluid-filled cysts in the marrow = subchondral cysts
  • results in pain and limitation of movements
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10
Q

What is a chondrocyte?

A

A cell which has secreted the matrix of cartilage and becomes embedded in it

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11
Q

Describe the role that chondrocytes play in osteoarthritis

A
  • chondrocytes produce interleukin-1 which initiates matrix breakdown
  • prostaglandin derivates induces the release of lytic enzymes - prevents matrix synthesis
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12
Q

Where does primary osteoarthritis affect?

A
  • fingers
  • knees
  • cervical and lumbar vertebral bodies
    etc.
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13
Q

What are Herberden’s nodes?

A

Hard or bony swellings that can develop in the DISTAL interphalangeal joints. They are a sign of osteoarthritis and are caused by formation of osteophytes (calcific spurs) of the articular cartilage in response to repeated trauma

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14
Q

What are Bouchard’s nodes?

A

Hard, bony outgrowths or gelatinous cysts on the PROXIMAL interphalangeal joints. They are seen in osteoarthritis, where they are caused by formation of calcific spurs of the articular cartilage

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15
Q

What is rheumatoid arthritis?

A

Chronic systemic disorder, principally affecting the joints

  • produces a non-suppurative proliferative synovitis
  • destruction of articular cartilage and ankylosis of joints
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16
Q

What is a synovial membrane?

A

Specialised connective tissue that lines the inner surface of capsules of synovial joints - makes direct contact with the synovial fluid lubricant

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17
Q

What is synovitis?

A

Inflammation of synovial membrane

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18
Q

What is ankylosis?

A

Abnormal stiffening and immobility of a joint due to fusion of the bones

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19
Q

What other organs does rheumatoid arthritis affect?

A
  • skin (rheumatoid nodules = commonest cutaneous manifestation, in areas of pressure)
  • muscles
  • heart
  • lungs
  • spleen
  • blood vessels
    etc.
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20
Q

Which gender is more likely to get rheumatoid arthritis?

A

Women 3-5x more likely than men

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21
Q

Describe the structure of a normal joint

A

Bone covered by articular cartilage, with a joint space in-between and a thin synovium at joint margin

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22
Q

What is a pannus?

A

Abnormal layer of fibrovascular tissue or granulation tissue - occurs over a joint surface in rheumatoid arthritis

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23
Q

How is a pannus produced in a joint?

A

Thickening of the synovium with synoviocyte hyperplasia, producing a pannus that is eroding into the articular cartilage

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24
Q

How does a pannus progress? (in rheumatoid arthritis)

A

Continued growth of the pannus and erosion of the cartilage with penetration into the subchondral bone, and cyst formation

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25
Q

Describe the final stage of rheumatoid arthritis

A

Filling of joint space with pannus, producing ankylosis of joint space - pannus is eroding into bone itself

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26
Q

What are the clinical creatures of rheumatoid arthritis?

A
  • malaise, fatigue and generalised musculoskeletal pain

- joints are swollen, warm, painful and stiff in the morning or after activity

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27
Q

Which joints are frequently affected by rheumatoid arthritis?

A

Small joints of the hands and feet - ending in a deformed joint

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28
Q

What are the possible pathogeneses benign rheumatoid arthritis?

A
  • genetic - HLA-DR4 and DR1
  • primary exogenous arthritogen (EBV, Borrelia etc)
  • autoimmune reaction within synovial membranes (CD4 positive T cells)
  • mediators of joint damage (cytokines)
  • IL-1-6 and TNF alpha and beta
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29
Q

4 or which criteria confirm a diagnosis of rheumatoid arthritis?

A
  1. morning stiffness
  2. arthritis in 3 or more joint areas
  3. arthritis of hand joints
  4. symmetric arthritis
  5. rheumatoid nodules
  6. serum rheumatoid factor

Typical radiographic changes (narrowing of joint space, loss of articular cartilage)

30
Q

What is serum rheumatoid factor?

A

The autoantibody that was first found in rheumatoid arthritis. It is defined as an antibody against the Fc portion of IgG. RF and IgG join to form immune complexes that contribute to the disease process

31
Q

What are rheumatoid nodules?

A

Firm subcutaneous lumps - they form close to joints affected by rheumatoid arthritis

32
Q

How is rheumatoid arthritis diagnosed?

A
  • rheumatoid factor (present in most but not all, less specific)
  • analysis of synovial fluid (confirms presence of neutrophils = inflammation)
33
Q

Rheumatoid nodules are a type of what?

A

Palisaded granuloma - type of necrotising granuloma in which the mononuclear phagocytes have elongated or spindle-shaped nuclei

34
Q

What is seen on histology in rheumatoid arthritis?

A
  • rheumatoid nodules (palisaded granulomata - pink fibrin)

- inflammatory cells (blue dots)

35
Q

What does sero-negative arthritis mean?

A

Lacks rheumatoid arthritis

36
Q

What are the zero-negative arthritides?

A
  • ankylosing spondylitis
  • Reiter’s syndrome
  • psoriatic arthritis
  • enteropathic arthritis
37
Q

What is ankylosing spondylitis?

A

A form of vertebral arthritis, chiefly affecting young males, that eventually causes ankylosis of vertebral and sacroiliac joints

38
Q

What is Reiter’s syndrome?

A

A medical condition typically affecting young men, characterised by arthritis, conjunctivitis, and urethritis, and caused by an unknown pathogen, possibly a chlamydia

39
Q

What is psoriatic arthritis?

A

Type of inflammatory arthritis that will develop in up to 30 percent of people who have the chronic skin condition psoriasis

40
Q

What is enteropathic arthritis?

A

A form of chronic, inflammatory arthritis associated with the occurrence of an inflammatory bowel disease (IBD), and is classified as a form of seronegative spondyloarthropathy

41
Q

What is gout?

A

End point of a group of disorders producing hyperuricaemia - uric acid crystals form inside the joints

42
Q

How is uric acid formed?

A

It is the end point of purine metabolism, humans do not have enzyme uricase to convert into more soluble compound

43
Q

In which ways may gout present?

A
  • acute arthritis
  • chronic arthritis
  • tophi in various sites
  • gouty nephropathy
44
Q

What are tophi?

A

Masses of uric acid clusters at different sites in the body

A deposit of crystalline uric acid and other substances at the surface of joints or in skin or cartilage, typically as a feature of gout

45
Q

What 3 forms of kidney disease can be attributed to excess uric acid? (gouty nephropathy)

A
  • acute uric acid nephropathy
  • chronic urate nephropathy
  • uric acid nephrolithiasis
46
Q

What are the clinical features of gout?

A
  • transient attacks of acute arthritis
  • crystallisation of urates within and about joints
  • leading to chronic gouty arthritis and disposition of masses of urates in joints and other sites (tophi)
47
Q

On histology in gout, what surrounds the tophi?

A

Histiocytes (scavenger cells)

48
Q

What are the symptoms of pyogenic osteomyelitis?

A
  • systemic illness: fever, malaise, chills

- marked pain over the affected area

49
Q

What do you see on X-ray in pyogenic osteomyelitis?

A

Lytic focus of bone destruction surrounded by zone of sclerosis

50
Q

How is pyogenic bacteria caused?

A
  • caused by bacteria
  • haematogenous spread
  • extension from contiguous site
  • direct implantation
51
Q

What are the features of infective arthritis?

A
  • acutely painful and swollen joints with restricted movements
  • fever, leucocytosis, elevated ESR
52
Q

What are the bacterial causes of infective arthritis?

A
  • staphylococcus
  • streptococcus
  • gonococcus
  • mycobacteria
53
Q

What are the conditions that predispose to infective arthritis?

A
  • trauma
  • IV drug abuse
  • debilitating illness
54
Q

What are the features of osteoporosis?

A
  • increased porosity of the skeleton
  • reduction in bone mass
  • localised or entire skeleton
  • primary or secondary
  • primary-age and postmenopausal
55
Q

Osteoporosis is associated with…

A
  • physical activity
  • muscle strength
  • diet
  • hormonal status
56
Q

What are the clinical features of osteoporosis?

A
  • vertebral fractures
  • frequent falls
  • kyphosis
  • scoliosis
57
Q

What are the secondary causes of osteoporosis?

A
  • endocrine disorders (hyperparathyroidism, type 1 diabets)
  • neoplasia (multiple myeloma)
  • malnutrition
58
Q

Osteoclast dysfunction leads to which bone disease?

A

Paget’s disease

59
Q

What is the histological hallmark of Paget’s disease?

A

Mosaic pattern “collage of matrix madness”

Mish mash of new bone formation - ineffective born that fractures easily

60
Q

Which infection causes Paget’s disease?

A

Paramyxovirus

61
Q

How does osteoclast dysfunction lead to Paget’s disease?

A
  • initial osteolytic stage
  • predominant osteoblastic activity
  • burnt out osteosclerotic stage
  • net effect = gain in bone mass
  • but newly formed bone is disordered and architecturally unsound
62
Q

What type of fractures are common in Paget’s disease?

A

Chalk stick type fractures (bone breaks like chalk) - since the new bone is not architecturally stable

63
Q

What is the most common symptom of Paget’s disease?

A

Pain

64
Q

Who is affected by Paget’s disease?

A
  • males more than females

- begins in 50s

65
Q

Paget’s disease can give rise to tumours. Give an example of a benign tumour it can cause

A

Giant cell tumour

66
Q

Paget’s disease can give rise to tumours. Give examples of malignant tumours it can cause

A
  • osteosarcoma
  • chondrosarcoma
  • malignant fibrous histiocytoma
67
Q

What is osteomalacia?

A

Defects in matrix mineralisation related to lack of vitamin D, leads to decreased bone density/too little bone = osteopenia

  • skeletal deformities are not seen but bone breaks very easily
68
Q

What is hyperparathyroidism?

A

Excessive secretion of parathyroid hormone (PTH) - increased bone resorption and calcium mobilisation from the skeleton

69
Q

What is the overall effect of hyperparathyroidism?

A

Hypercalcaemia

due to increased bone resorption, increased renal tubular reabsorption and retention of calcium

70
Q

What is the condition of increased bone resorption due to hyperparathyroidism called?

A

Osteitis fibrosa cystica

71
Q

What is renal osteodystrophy?

A

Skeletal changes of chronic renal disease

  • increased osteoclastic bone resorption
  • delayed matrix mineralisation
  • osteosclerosis
  • growth retardation
  • osteoporosis

11. CP - Diseases of the musculoskeletal system (4 decks)

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