Introduction to Rheumatology Flashcards
Cartilage collagen fibers are anchored in…
Subchondral bone
Purpose of the cartilage collagen fibers?
They form a meshwork that entraps the larger proteoglycan aggregates
What are cartilage proteoglycan aggregates?
Very large, hydrophilic molecules. They are made of glycosaminoglycans. The pressure of the bound water gives cartilage its elasticity.
Vascularity of Cartilage?
Its avascular.
All components of articular cartilage are produced by…
chondrocytes
Nutrition for chondrocytes come from…
Synovial fluid
Where is synovial fluid generated
Synovial membrane
How big is a normal synovial membrane?
1-3 cells thick with an underlying delicate connective tissue network (adipose, capillaries, fibrous parenchyma)
Name the rheumatic disease associated with the joint site.
Joint Space
Joint Infection Microcrystaline arthritis (Gout)
Name the rheumatic disease associated with the joint site.
Muscle
Myositis
Name the rheumatic disease associated with the joint site
Synovial Membrane
RA/Synovitis
Name the rheumatic disease associated with the joint site.
Enthesis
Enthesopathy
Ankylosing spondylitis
Name the rheumatic disease associated with the joint site.
Cartilage
Cartilage Degeneraion
Osteoarthritis
Name the rheumatic disease associated with the joint site.
Bony End-Plate
Avascular Necrosis
Five details important to gather in a rheumatology patient history
- Time, Rapidity of Onset
- Determine # of joints
- Constitutional Symptoms
- Response to Therapy
- Functional Status
Typically few joints are involved in…(3)
Gout
Seronegative spondyloarthropathies
OA
Typically many joints are involved in…(4)
RA
SLE
Seronegative spondyloarthropathies
Fibromyalgia
Gout responds remarkably well to…
NSAIDs
Fibromyalgia responds very well to…
Exercise
What three things did he recommend to score in the physical exam?
Swelling 0-3
Tenderness 0-4
Limitation 0-4
Four Types of Labs one might ask for as a rheumatologist
Routiene CBC/Chemistries
ESR/CRP/Hemoglobin/Albumin (Acute Phase Reactants)
Rheumatoid Factor + Antinuclear Antibodies
Joint Aspiration
Why look at ESR, CRP, Hemoglobin, etc.?
To assess systemic inflammation
When should you do a Joint Aspiration
Monoarthritis
Undiagnosed Polyarthritis
One joint swelling out of proportion with the others
What are you looking for on an X ray
Ankylosing spondylitis, Calcium pyrophosphate deposition disease, OA
What does he mean when he says rheumatism?
Pain around the joint but not in the joint
Common Rheumatology treatments
- Exercise
- Physical Therapy, Occupational Therapy
- NSAIDS
- Corticosteroids
- DMARDS
Risks of chronic NSAID use?
GI bleeds, Renal Insufficiency, High BP, Stroke
How are corticosteroids delivered?
Intraarticular injections in arthritis
Can be used systemically in inflamm. arthritis and autoimmune conditions
What are DMARDS?
Disease Modifying Anti-Rheumatic Drugs
These drugs try to treat underlying immune defect in many of the autoimunes.
Examples of DMARDS
Hydrocychloroquin
Gold
Methotrexate
Musculoskeletal complaints that are nonarticular include…
Trauma
Rheumatism – Bursitis, Tendonitis, Fibromyalgia
Musculoskeletal complaints in a joint less than 6 weeks old
Crystal induced arthritis
Septic arthritis
Viral arthritis
Early chronic arthritis presentation
Musculoskeletal complaints in a joint over 6 weeks old with NO INFLAMMATION
Osteoarthritis
Internal Derangement
Musculoskeletal complaints in a joint over 6 weeks old with Inflammation of many joints
RA
SLE
PA
Musculoskeletal complaints in a joint over 6 weeks old with Inflammation of few joints
Seronegative spondyloathropathy (AS, Reiter's, Psor.) Juvenile Rheumatoid Crystal Induced Septic Early Polyarthritis
