Intro to rheumatology Flashcards

1
Q

What are the functions of connective tissue?

A
  • binds together, supports and strengthens other body tissues
  • protects and insulates internal organs
  • compartmentalises structures such as skeletal muscle
  • the 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 three classes of components for connective tissue?

A
  1. Cells:
    - fibroblast
    - macrophage
    - mast cell
    - plasma cell
    - lymphocytes
    - leukocytes
    - adipose cells
  2. Fibres
    - reticular
    - elastic
    - collagen
  3. Ground substance
    - macromolecules
    - multi-adhesive glycoproteins
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3
Q

What are fibroblasts and what is their function?

A
  • large flat cells with branching processes

- migrate throughout connective tissue secreting the fibres and ground substance

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4
Q

What are mast cells and what is their function?

A
  • alongside blood vessels that supply connective tissue

- produce histamine

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5
Q

What is the function of reticular fibres?

A
  • provide support for the walls of blood vessels

- made of collagen with a glycoprotein covering

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6
Q

What is the ground substance of connective tissues?

A
  • between cells and fibres
  • support cells and bind them together
  • provide a medium through which substances are exchanged e.g hyaluronic acid
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7
Q

What is the most abundant protein in the body?

A

-collagen

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8
Q

What is the main function of connective tissue matrix fibres (collagen, elastin, reticular) ?

A

-provide strength and support to connective tissue

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9
Q

What are the six types of connective tissues ?

A

(-vary by the fibres, ground substance and cells contained in it)

  • loose connective tissue
  • adipose tissue
  • blood
  • fibrous connective tissue
  • cartilage
  • bone
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10
Q

What is connective tissue proper and what is its function?

A
  1. Loose connective tissue:
    - areolar
    - adipose
    - reticular
  2. Dense connective tissue
    - regular
    - irregular
    - elastic

Function:

  • binding tissue
  • resists mechanical stress especially tension
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11
Q

What cells are present in connective tissue proper and in its matrix?

A

Cells:

  • fibroblasts
  • fibrocytes
  • defense cells
  • fat cells

Matrix:

  • gel like ground substance
  • collagen, reticular and elastic collagen
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12
Q

What is the function of cartilage, the cells involved and the matrix composition?

A

-cartilage is avascular and no nerve supply (but perichondrium does)

Function:

  • strengthen and support connective tissue
  • resists compression
  • cushions and support body structures

Cells:

  • chondroblasts- in growing cartilage
  • chondrocytes

Matrix:

  • Gel-like ground substance
  • Fibres: collagen, elastic fibres in some
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13
Q

What is perichondrium?

A

the connective tissue that envelops cartilage where it is not at a joint

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14
Q

What are the three types of cartilage?

A
  1. Hyaline cartilage
  2. Elastic cartilage
  3. Fibrocartilage
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15
Q

What is hyaline cartilage?

A
  • gel like ground substance
  • end of long bones to cushion joints and at epiphyseal plates
  • most abundant cartilage in the body
  • weakest of the 3 types of cartilage
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16
Q

What is fibrocartilage?

A
  • chondrocytes scattered among visible bundles of collagen fibres
  • no perichondrium
  • strongest of the 3 types of cartilage
  • found in the intervertebral discs
  • found in the intervertebral discs
  • collagen fibre in matrix
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17
Q

What is elastic cartilage?

A
  • chondrocytes located in a threadlike network of elastic fibres
  • provides strength, elasticity and maintains the shape of certain structures (like the external ear)
  • elastic fibres in matrix
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18
Q

What is the function of bone tissue, the cells involved and what is the matrix made of?

A

Function:

  • resists compression and tension
  • protect and support

Cells:

  • osteoblasts
  • osteocytes

Matrix:

  • gel-like ground substance
  • calcified with inorganic salts
  • fibres: collagen
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19
Q

What is osseous tissue?

A

-bone tissue

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20
Q

What are the types of bone tissue?

A
  1. Compact:
    - osteon- basic unit of compact bone
    - lamellae- concentric circles of matrix
    - lacunae- spaces in the matrix that house cells
    - osteocytes- mature bone cells
  2. Spongy:
    - trabeculae- columns of bone with spaces filled with red bone marrow
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21
Q

What is in the lacuna of elastic cartilage?

A

-chondrocytes

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22
Q

What is in the lacuna of fibrocartilage?

A

-chondrocytes

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23
Q

What is an osteon?

A

-basic unit of compact bone

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24
Q

What is lamellae?

A

-concentric circles of matrix

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25
Q

What is the function of blood, the cells involved and the components of the matrix?

A

-complex cell formation and differentiation

Function:
-transport oxygen, carbon dioxide, nutrients, wastes and other substances

Cells:

  • erythrocytes (RBC)- transport oxygen
  • leukocytes (WBC)- function in immunity
  • platelets- blood clotting

Matrix:

  • liquid
  • plasma
  • no fibres
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26
Q

What are the two main types of connective tissue proper?

A

-loose and dense

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27
Q

Which type of cartilage are you most likely to find at the epiphyseal (growth) plate?

A

-hyaline cartilage

28
Q

Which of the three types of cartilage is the strongest?

A

-fibrocartilage

29
Q

Which substance is house in the trabecular of spongy bone?

A

-red bone marrow

30
Q

What are the three rheumatological disorders?

A
  • rheumatoid arthritis RA
  • systemic lupus erythematosus SLE
  • vasculitis
31
Q

What is rheumatoid arthritis?

A
  • autoimmune disorder primarily affecting joints resulting in warm swollen painful joints
  • symptoms are worse following rest
32
Q

What is systemic lupus erythematous?

A
  • autoimmune disorder of connective tissue

- affects multiple organ systems and joints

33
Q

Which is vasculitis?

A

-a group of disorders that destroy blood vessels by inflammation

34
Q

What are the general macroscopic and microscopic changes in rheumatoid?

A

Macroscopic:

  • synovitis
  • bone
  • cartilage
  • erosion
  • angiogenesis diagram

Microscopic:

  • cells
  • IL
  • ANF
  • synoviocytes
  • osteoclasts
  • proteases
  • CD4 cells
  • plasma cells
  • neutrophils
35
Q

What are the joint changes in rheumatoid?

A
  • bone erosion
  • swollen inflamed synovial membrane
  • cartilage wears away
  • reduced joint space
36
Q

What causes inflammation in RA?

A
  • Th17 cells produce IL-17
  • IL-17 acts on synovial lining cells, these release IL-6, IL-8, MCP-1, GRO-alpha, GM-CSF =inflammation

-IL-17 acts on macrophages, these release IL-1, TNF-alpha, IL-6 =inflammation

37
Q

What causes cartilage destruction in RA?

A
  • Th17 cells produce IL-17
  • IL-17 acts on chondrocytes, these release NO = cartilage destruction
  • IL-17 action macrophages, these release MMPs = cartilage destruction
38
Q

What causes bone destruction in RA?

A
  • Th17 cells produce IL-17

- IL-17 acts on osteoblasts, these release RANKL = bone destruction

39
Q

( What are the three key symptoms of RA? )

A
  • joint pain
  • stiffness
  • swelling
40
Q

What are the key features of RA?

A
  1. symptoms last > 6 weeks
    - often lasts the remainder of patients’ life
  2. inflammatory synovitis:
    - palpable synovial swelling
    - morning stiffness > 1hr, fatigue
  3. symmetrical and polyarticular (>3 joints):
    - typically involves wrists, MCP, PIP joints
    - typically spares certain joints; thoracolumbar spine, DIPs of the fingers and IPs of the toes
  4. may have nodules: subcutaneous or periosteal at pressure points
  5. marginal erosions and joint space narrowing on x-ray
    - ulnar deviation
41
Q

Compare and contrast rheumatoid versus osteoarthritis?

A

Rheumatoid:

  • inflammatory
  • autoantibodies
  • small joints affected
  • rapid onset
  • bilateral, symmetrical pattern
  • morning stiffness
  • ESR

Osteoarthritis:

  • degenerative
  • no antibodes
  • large weight bearing joints affected
  • slow onset
  • asymmetric
  • uncommon stiffness in morning
42
Q

What is ESR?

A

-erythrocyte sedimentation rate

43
Q

What is CRP?

A

-C-reactive protein

44
Q

What is PIP?

A

-proximal interphalangeal joint

45
Q

What is MCP?

A

-metacarpophalangeal joint

46
Q

What is DIP?

A

-distal interphalangeal joint

47
Q

What is CMC?

A

-carpometacarpal joint

48
Q

What is RF?

A

-rheumatoid factor

49
Q

What happened to ESR and CRP levels in RA?

A

-elevated

50
Q

What happened to ESR and CRP levels in OA?

A

-normal

51
Q

Tell me about finger PIP swelling in RA?

A
  • swelling is confined to the area of the joint capsule

- synovial thickening feels like a firm sponge

52
Q

What are you looking for in x-rays of RA?

A

-soft tissue swelling
-erosions
-joint space loss
-subluxation-partial dislocation
-

53
Q

What is the typical course of RA?

A
  • damage occurs early in most patients
  • lowered life expectancy:
  • women 10 years less, men 4 years
54
Q

What is the typical pattern of pain and stiffness in RA?

A

Inflammatory pattern:

-worse when resting (therefore moving stiffness) and improves with activity

55
Q

What are the key x-ray changes found in rheumatoid arthritis?

A
  • loss of joint space
  • juxta-articular bone erosions
  • soft tissue swellings
  • osteopenia
  • subluxations
56
Q

What are the treatment principles for RA?

A
  1. Diagnosis
  2. Severity
  3. Treatment:
    - when damage begins early, start aggressive treatment
    - use the safest treatment plan that matches the aggressiveness of the disease
  4. Monitor:
    - treatment for adverse effects
    - disease activity, revise Rx (prescription) as needed
57
Q

What are the elements of the assessment for RA?

A

Assess current activity:
-morning stiffness, synovitis, fatigue, ESR

Document the degree of damage

  • ROM and deformities
  • joint space narrowing and erosions on x-ray
  • functional status

Document extra-articular manifestations
-nodules, pulmonary fibrosis, vasculitis

Asess prior Rx responses and side effects

58
Q

What are the critical elements of therapy for RA?

A
  1. Education:
    - build a cooperative long-term relationship
    - use materials from the arthritis foundation and the ACR
    - assistive devices
  2. Exercise:
    - ROM, conditions, strengthening exercises
  3. Medications:
    - analgesic and/or anti-inflammatory
    - immunosuppressive, cytotoxic, biologic
    - balance efficacy and safety with activity
59
Q

What are the drug treatment options for RA?

A
  1. NSAID:
    - symptomatic relief, improved function
    - no change in disease progression
  2. Low-dose prednisone (<10mg QD):
    - may substitute for NSAID
    - used as bridge therapy
    - if used long term, consider prophylactic treatment for osteoporosis
  3. Intra-articular steroids:
    - useful for flares
  4. DMARDs- disease modifying drugs
    - minocycline- modest effect, may work best early
    - sulfasalazine, hydroxychloroquine- moderate effect, low cost
    - intramuscular gold- slow onset, decreases progression, rare remission, requires close monitoring
  5. Immunosuppressive drugs:
    - methotrexate- most effective single DMARD, good benefit to risk ratio
    - Azathioprine- slow onset, reasonably effective
    - Cyclophosphamide- effective for vasculitis, less so for arthritis
    - Cyclosporin- superior to placebo, renal toxicity
  6. New DMARDs
    a) Leflunomide:
    - pyrimidine inhibitor
    - effect and side effects similar to those of MTX
    b) Ethanercept:
    - soluble TNF receptor, blocks TNF
    - rapid onset, quite effective in refractory patients in short-term trials and in combinations with MTX
    - injection site reactions, long-term effects unknown, expensive
60
Q

What is monitoring of treatment with DMARDs?

A
  • these drugs need frequent monitoring
  • blood, liver, lung, and kidney are frequent sites of adverse effects
  • interval of laboratory testing varies with the drug (4-8 week interval commonly needed)
  • most patients need to bee seen 3-6 times a year
61
Q

What are the extraarticular manifestations of RA?

A
  • liver
  • cardiovascular
  • neurological
  • musculoskeletal
  • bone marrow
  • spleen
62
Q

What are the manifestations of SLE?

A
  • alopecia
  • malar rash
  • arthralgia
  • oral ulcers
  • photosensitivity
63
Q

What is UCTD?

A

-undifferentiated connective tissue disease

64
Q

What is scleroderma and what are its manifestations?

A

-chronic autoimmune disease that affects the skin, connective tissue and internal organs

  • reflux
  • Raynaud’s
  • digital ulcerations
65
Q

What are sicca symptoms?

A

-dryness of exocrine glands, e.g dry eyes, skin, mouth

66
Q

lecture slides

A

https://d3c33hcgiwev3.cloudfront.net/6a4GAB1BTdGuBgAdQW3RGw_2d8c3a2535d34867862b89587fc10744_SV_Final_MSK_LE07Introduction_to_Rheumatology.pdf?Expires=1580860800&Signature=CXo0ClidAKZ9p~Hc3z39BALYKQ6FxWvAQwr1q0J1J~OMdy2S1GxR3dhnkiUNhzU5D4E1~XHakXeZ9dNHuQl3j0IC1Fmh6aCy6Vi-tjib60ZR9Fcj-LYW6KfrwYsA-pUOenWzrxmY6fb7Lmb4DOIMxoSUjhfXVA5NqHOpfxFJLRI&Key-Pair-Id=APKAJLTNE6QMUY6HBC5A