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Medicine 2 Week 6 - 11 > Introduction to Joints of the Lower Limbs and Clinical Relevence > Flashcards

Introduction to Joints of the Lower Limbs and Clinical Relevence Flashcards

1
Q

What is the most common joint type

A

Synovial Joints

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2
Q

Describe the articular surfaces of synovial joints

A

Free

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3
Q

Describe a synovial joint

A

Bones/Cartilage are joined in a fibrous joint capsule that is continuous with the periosteum of the joined bones

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4
Q

Name the epithelial cells which surround the joint cavity

A

Synovium

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5
Q

Describe the nature and role of synovium cells

A

Simple squamous epithelial cells that produce joint fluid

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6
Q

Fibrous Capsule

A

Layer which surrounds the articular capsule of a synovial joint

**Lined with synovium

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7
Q

Additional supporting structures that keep synovial joints together

A

Ligaments, Tendons, Muscles

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8
Q

Main types of Synovial Joint Disease

A

Bursitis
Osteoarthritis
Rheumatoid Arthritis
Gout

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9
Q

Bursa and their lining/role

A

Fluid filled sac which provides free movement between bones and tendons or muscles around a joint

Lined by synovial cells, secreting synovial fluid

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10
Q

Bursitis - Causes, Symptoms & Common areas

A

Inflammation of the Bursae

From repetitive use, trauma or arthritis

Pain when inflamed as they become swollen, causing pressure & reducing friction free properties

Shoulder, Olecranon, Knee

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11
Q

Why is the name Osteoarthritis misleading

A

Because it is a disease of cartilage (chondro-) not a disease of bone (osteo-) like the name might suggest

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12
Q

Osteoarthritis

A

Loss of articular cartilage and synovitis due to inflammation

Degenerative wear and tear condition

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13
Q

Causes of osteoarthritis

A

Primary: Idiopathic

Secondary: Trauma, Inflammatory Disease, Joint Defects - that change distribution of stress at joints

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14
Q

Risk factors of osteoarthritis

A

Age, Sex, Race, Bone Mass, Obesity

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15
Q

Pathogenesis of Osteoarthritis

A

Amount of proteoglycans and collagen in cartilage reduce during age, while water increases causing ‘swelling’ and less shock absorbing

This causes surface cracks and the bone is exposed and they rub on each other, becoming burnished from wear

Fragments come away as it cracks, causing synovium to inflame
This leads to pain during movement of join

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16
Q

Eburnation

A

the appearance of bone following a degenerative process in which subchondral or otherwise exposed bone acquires a “polished” articular surface

**YOU CAN IDENTIFY OSTEOARTHRITIS SKELETONS SINCE MANY OF THEIR BONES HAVE POLISHED SURFACES

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17
Q

Osteophytes

A

Abnormal Bony Outgrowths that form during osteoarthritis

They limit the movement of the joint and can be quite painful

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18
Q

Crepitation

A

Palpable or audible grating/crunching sensation produced by motion

Seen in osteoarthritis patients

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19
Q

Discuss the changes that occur in early vs late osteoarthritis

A

In early stage, joint spaces narrow and start to crack as fragments are found in the joint capsule

In late phase, osteophytes also form and bony cysts start to form. Swelling is seen due to cartilage fragments as well as synovial inflammation
Bone/cartilage are eroded

20
Q

What is the key actor in causing osteoarthritis

A

A change in composition of the cartilage matrix to increase water and disrupt its ability to absorb shock

21
Q

Two diagnostic tests for Osteoarthritis

A

Crepitations
Narrowing of joint spaces seen on x-ray

**ALSO HISTORY

22
Q

Clinical Manifestations of Osteoarthritis

A

Pain
Limited Range of Movement
Swelling
Crepitation

Painful other joints as a result of compensation

23
Q

Where osteoarthritis is commonly seen

A

Lumnar and Cervical Spine

Proximal/Distal Hand Joints

1st Metatarsophalangeal Joint

Knee

Hip

24
Q

Treatment of Osteoarthritis

A

Rehabilitation
Drugs
Surgery

25
Q

How would osteoarthritis of the hand look

26
Q

Rheumatoiod Arthritis

A

Chronic systemic inflammation involving synovial joints with autoimmune causes due to a circulating antibody complex

Complex forms with IgG to form immune complexes found in joint synovium, fluid & elsewhere

Inflammation as result of macrophages and neutrophil reaction

27
Q

What type of joints are more targeted by Rheumatoid Arthritis

A

Peripheral Synovial Joints

28
Q

Sex Risk Factors of Rheumatoid Arthritis

A

2-3x women than men

29
Q

Symptoms of Rheumatoid Arthritis

A 
Fatigue
Anorexia
Weight Loss
Joint Aching/Stiffness
Low Grade Fever
Anaemia
30
Q

Why is the repair process damaging in rheumatoid arthritis

A

This process involves laying down collagen which ends up restricting movement

31
Q

Pannus

A

Hyperplasia of synovium and angiogenesis creating vascular granulation tissue (pannus)

32
Q

Ankylosis

A

Stiffening & Fusion of a joint

33
Q

Pathogenesis of Rheumatoid Arthritis

A

Unknown immune response causes synovial inflammation

Neutrophils, Macrophages & Lymphocytes get recruited causing phagocytosis of immune complexes, releasing lysosomal enzymes

Joint cartilage is destroyed and further inflammatory cells get recruited leading to vasodilation and thus redness & swelling

Inflammtory cells in pannus destroy cartilage and bone cause ankylosis

34
Q

Ankylosis

A

Stiffening & Fusion of a joint

35
Q

Development of Rheumatoid Arthritis

A

Synovium is inflamed as result of antigen antibody complexes, they then destroy the cartilage and create pannus

It is repaired leading to pannus being laid down while bone is erroded

Since the bone is eroded, the body tries to then convert all the panus into bone, leading to ankylosis and bone fusion

36
Q

Clinical Manifestations of Rheumatoid Arthritis

A

***DONT MEMORISE

37
Q

What changes might be seen in the X-ray of a Rheumatoid Arthritis patient

A

Narrowing of the space is not likely to be seen, but if there is an ossification of the pannus then there may be evidence of this on the x-ray

38
Q

Discuss blood tests for Rheumatoid Arthritis Diagnosis

A

Serum Rheumatoid Factor

It is positive in 80% of RA patients but positive in <5% of normal patients

39
Q

Differences between RA and OA

A

RA has more inflammation than OA and this is likely to be seen visibly and in blood

RA patient may have positive serum rheumatoid factor

Bony alkylosis may be seen in RA

40
Q

Gout

A

Crystal Arthropathy - Crystals of Uric Acid in Joint Space

Uric acid arises from excess purine intake and lack of ability to break it down

41
Q

Primary Gout

A

Hyperuricaemia as result of underexcretion of uric acid from kidney

42
Q

Secondary Gout

A

Excess intake of foods with high purines like red meat

43
Q

Where do gout crytsals commonly form

A

MP Joint of big toe and in soft tissues

44
Q

Incidence of gout in male vs female patients

A

Higher in men

45
Q

Pseudogout

A

Aging cartilage degeneration - age related Osteoarthritis - calcium pyrophosphate crystals stack in joint cavity

Common in elderly

**DONT STRESS ON THIS

46
Q

***FOCUS MORE ON OSTEOARTHRITIS AND RA AS OPPOSED TO GOUT AND BURSITIS

Medicine 2 Week 6 - 11 (54 decks)

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