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MSK > Introduction to Rheumatology > Flashcards

Introduction 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 main types connective tissue?

A

Cells
Fibres
Ground substance

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3
Q

What are the different types of cells?

A 
1- Fibroblast
2 - Macrophage
3 - Mast Cell
4 - Plasma Cell
5 - Lymphocytes
6 - Leukocytes
7 - Adipose Cell
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4
Q

What comprises the extra-cellular matrix?

A

Fibres

Ground substance

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5
Q

What are the different types of fibres?

A

Reticular
Elastic
Collagen

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6
Q

What are the different types of ground substance?

A

Macromolecules

Mulitadhesive glycoproteins

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7
Q

Where will you not find connective tissue?

A

Does not occur on free surfaces

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8
Q

What supplies connective tissue?

A 
Has a nerve supply (except cartilage)
Highly vascular (except cartilage and tendons)
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9
Q

What is the function of the ground substance?

A

Between the cells and fibers

Supports cells

Binds them together

Provides a medium through which substances are exchanged.
Ex. Hyaluronic Acid

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10
Q

What is the function of collagen fibres?

A

Strong, resist forces, flexible

Made of collagen (most abundant protein in the body)

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11
Q

What is the function of elastic fibres?

A

Smaller in diameter than collagen fibres
Branch to form network
Made of protein elastin

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12
Q

What is the function of reticular fibre?

A

Provide support for the walls of blood vessels

Made of collagen with a glycoprotein covering

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13
Q

What are the two types of proper connective tissue?

A

Loose connective tissues

Dense connective tissues (more collagen)

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14
Q

What are the three types of cartilage?

A

Hyaline
Elastic
Fibro

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15
Q

What are the three types of loose connective tissue?

A

Areolar
Adipose
Reticular- forms mesh network for support of organs e.g. the spleen

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16
Q

What are the three types of dense connective tissues?

A

Regular- tight collagen fibres
Irregular- e.g. skin dermis
Elastic- e.g. vertebrae

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17
Q

What are the main functions of proper connective tissue?

A

Function
Binding tissue
Resists mechanical stress esp. tension

Cells
Fibroblasts
Fibrocytes
Defense cells
Fat cells

Matrix
Gel like ground substance
Collagen, reticular and elastic collagen

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18
Q

What is the function of cartilage?

A

Strengthen and supports connective tissue
Resists compression
Cushions and support body structures

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19
Q

What cells are present in cartilage?

A

Chondroblasts – in growing cartilage

Chondrocytes

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20
Q

What are the main features of hyaline cartilage?

A

Gel like ground substance

Most abundant cartilage in the body

End of long bones to cushion joints and at epiphyseal plates

Weakest of the 3 types of cartilage

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21
Q

What are the main features of fibrocartilage?

A

Chondrocytes scattered among visible bundles of collagen fibers

No perichondrium

Strongest of the 3 types of cartilage

Found in the intervertebral discs

22
Q

What are the main features of elastic cartilage?

A

Chondrocytes located in a threadlike network of elastic fibers
Provides strength, elasticity and maintains the shape of certain structures (like the external ear)

23
Q

What are the two types of bone?

A

Spongy

Compact

24
Q

What is the function of bones?

A

Resists compression and tension

Protect and support

25
Q

What matrix is present in bones?

A

Gel-like ground substance
Calcified with inorganic salts
Fibers: Collagen

26
Q

What is the structure of compact bones?

A

Osteon – basic unit of compact bone

Lamellae – concentric circles of matrix

Lacunae – spaces in the matrix that house cells

Osteoytes – mature bone cells

27
Q

What is the structure of spongy bones?

A

Trabeculae – columns of bone with spaces filled with red bone marrow

28
Q

What is rheumatoid arthritis?

A

autoimmune disorder primarily affecting joints resulting in warm swollen painful joints. Symptoms are typically worse following rest.

29
Q

What is SLE?

A

Systemic lupus eryrhematosus

30
Q

What is Systemic lupus eryrhematosus?

A

autoimmune disorder of connective tissues. Affects multiple organ systems and joints

31
Q

What is vasculitis?

A

is a group of disorders that destroy blood vessels by inflammation

32
Q

What are the general changes in rheumatoid? Macroscropic

A

synovitis, bone, cartilage, erosion and angiogenesis diagram

33
Q

What are the general changes in rheumatoid? Microscropic

A

cells, IL, ANF, synoviocytes, osteoclasts, proteases, CD4 cells, plasma cells, neutrophils

34
Q

Does rheumatoid arthritis have a genetic component?

A

Yes

Mainly in young females

35
Q

What are the symptoms of rheumatoid arthritis?

A 
Joint main occurring in various joints
Palpable synovial swelling
Morning stiffness 
Joint deformity 
May have nodules: subcutaneous or periosteal at pressure points
Often last a lifetime
36
Q

Where do symptoms arise?

A

Symmetrical and polyarticular (> 3 joints)
Typically involves wrists, MCP, and PIP joints
Typically spares certain joints
Thoracolumbar spine
DIPs of the fingers and IPs of the toes

37
Q

What differentiates rheumatoid arthritis from osteo?

A

Inflammatory vs. degenerative
Autoantibodies vs. no antibodies
Small joints vs. large weight baring joints

38
Q

How can RA be diagnosed?

A

45% positive in first 6 months
85% positive with established disease
Not specific for RA, high titer early is a bad sign
Marginal erosions and joint
space narrowing on x-ray
Blood tests
Ultrasounds used to detect inflammation in soft tissue

39
Q

What are signs of finger PIP swelling?

A

Swelling is confined to the area of the joint capsule

Synovial thickening feels like a firm sponge

40
Q

What inflammatory factors are involved in RA?

A

IL-6
IL-17
IL-1beta
TNF-alpha

41
Q

What are PIPs?

A

Proximal interphalangeal joints

42
Q

Give an example of joint deformities that can develop

A

Ulnar deviation

43
Q

What is the typical course of RA?

A

Damage occurs early in most patients
50% show joint space narrowing or erosions in the first 2 years
By 10 years, 50% of young working patients are disabled

44
Q

How is life expectancy affected by RA?

A

Women 10 years less, men 4 years less

45
Q

What are the treatment principles?

A

Diagnosis
Severity
Treatment (aggressive/conservative)
Monitor

46
Q

Who is involved in the care of those with RA?

A 
Physios
Doctors
Nurses
Occupational therapists 
etc
47
Q

What is first line treatment for RA?

A

Analgesia
Physio
Steroids (short term)

48
Q

What are the drugs used in the long term treatment of RA?

A

Disease modifying anti-rheumatic drugs
e.g.
hydroxychloroquin, sulfasalazine

Immunosuppressive drugs
e.g. methotrexate (also DMARD)

49
Q

What are the extraarticular manifestations?

A 
Liver
Cardiovascular
Neurological 
Musculoskeletal
Bone Marrow
Spleen
50
Q

What are the symptoms of lupus?

A 
Alopecia
Malar rash
Arthralgia
Oral ulcers
Photosensitivity
51
Q

What type of disorder is lupus?

A

Connective tissue disorder

52
Q

What are the symptoms of scleroderma?

A

Reflux
Raynaud’s
Digital ulcerations

MSK (6 decks)

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