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Clinical Studies > Joint Disease > Flashcards

Joint Disease Flashcards

1
Q

What are the two layers of a joint?

A

Fibrous joint capsule

Inner synovial fluid layer

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2
Q

What is subchondral bone?

A

Cortical bone beneath the cartilage of a joint

  • provides support for articular cartilage
  • Has Haversian system running parallel to the joint surface
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3
Q

Describe the synovial membrane…

A

Vascular connective tissue

  • No basement membrane
  • Functional continuation of vascular space
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4
Q

What are the different types of cells that can be found in a synovial membrane?

A
  • Type A: macrophagic
  • Type B: secretory and fibroblastic, possible functional adaptation
  • Type C?: Transitional between A and Bs
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5
Q

What is synovial fluid composed of?

A
  • Hyaluronic acid
  • Collagen
  • Lubricin
  • pro- MMP
  • Interleukins
  • Eicosanoids (PGE2)
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6
Q

What are periarticular ligaments and joint capsules composed of?

A

Type I collagen

Elastin fibres

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7
Q

Describe the insertion points of periarticular ligaments…

A

Parallel bundles of collagen course through the fibrocartilage and calcified cartilage before inserting on bone

  • reduces that chance of avulsion
  • responds to physical stimuli by hyper/ atrophy
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8
Q

What are the three words that describe articular cartilage best?

A
  • Aneural
  • Avascular
  • Alymphatic
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9
Q

Describe Articular Cartilage…

A
  • Aneural
  • Avascular
  • Alymphatic
    • nutrition and metabolic waste removal through diffusion

1-12% chondrocytes
70-80% ECM

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10
Q

What is important about synovial joint pressure?

A

They have a sub-atmospheric pressure when they are in neutral position
- This contributes to the stability of the joint

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11
Q

What are the layers of cartilage histologically?

A
  • Superficial
  • Intermediate
  • Deep
  • Tide mark
  • Calcified cartilage
  • Subchondral bone
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12
Q

What are the components of cartilage ECM?

A
  • Collagen
  • Aggrecan
  • Tissue fluid
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13
Q

What are the mechanical properties of cartilage ECM?

A
  • Tensile strength: type II collagen
  • Compressive stiffness: the negatively charged glycosaminoglycans attract several times their weight in water
    • responsible for the compressive stiffness of the cartilage
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14
Q

Describe the lubrication of joints…

A

Hydrostatic “Weeping” lubrication

    • Lubrication under load
    • Water is squeezed out of the cartilage matrix

“Boundary” lubrication

    • Low load lubrication
    • Hyaluronic acid and other molecules
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15
Q

Describe the biomechanical action of joints…

A

The correspondence of joints increases under load
- Increased stability

Stress is distributed

  • to the epiphysis which deforms
    • subsequent bone remodelling

Muscles absorb large proportion of the load

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16
Q

What does bone remodelling aim to achieve?

A

Maximum strength and shock absorption capacity

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17
Q

What does maintaining joint integrity require?

A
  • Healthy cartilage
  • Healthy subchondral bone
  • Congruent articular surface
  • Extra-articular support (ligaments and muscles etc)
  • Normal motion
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18
Q

What is DJD/ osteoarthritis?

A

A NON-INFLAMMATORY disorder of movable joints characterised by the degeneration and loss of articular cartilage and the development of new bone on joint surfaces and margins

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19
Q

What is the pathogenesis of DJD?

A
  • ABNORMAL cartilage with flawed biomechanical properties undergoing NORMAL forces

OR…

  • NORMAL healthy cartilage subjected to ABNORMAL micro/ major trauma
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20
Q

What are some examples of Normal stress on Abnormal cartilage?

A
  • Aging
  • Osteochondrosis
  • Inflammation of soft tissue
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21
Q

What are some examples of Abnormal stress on Normal cartilage?

A
  • Cyclic trauma
  • Athletic trauma
  • Loss of stability i.e. fractures
  • Joint congruence changes
  • Remodelling and necrosis in SC bone
22
Q

What does fibrillation of cartilage look like?

A

The cartilage surface looks like floating seaweed

23
Q

What are cartilage wear lines usually caused by?

A

The presence of fragment in a join

24
Q

Describe severe cartilage erosion…

A

SC bone exposed with no cartilage at all

25
Q

What are the bony changes that occur with DJD?

A
  • SC bone sclerosis
  • Periarticular osteophytosis (bony growths)
  • SC bone erosion/ lysis
  • SC cyst formation
26
Q

How can DJD be diagnosed?

A
  • Clinical signs
  • Diagnostic Imaging
  • Synovial fluid analysis
  • Surgical techniques
27
Q

What are the clinical manifestations of DJD?

A
  • Pain
  • Reduced range of motion
  • Effusion
  • Synovial fluid changes
28
Q

Describe how the pain comes about in DJD…

A
  • Synovium is stimulated (cartilage aneural)
  • Periarticular soft tissues are highly innervated
  • Effusion stimulates stretch receptors
  • Periarticular fibrosis results in reduced compliance
  • Periosteal inflammation
  • SC bone pain and increased intramedullary pressure
29
Q

Describe how DJD results in a reduced range of motion…

A
  • Synovial proliferation (Acute)
  • Articular fibrosis (chronic)
    • body trying to counteract stability
  • Effusion causes pain which negatively feedback to muscles which then change their load to the joint
30
Q

Describe DJD synovial effusion…

A

Increased permeability of the synovial membrane > protein leakage > increased COP > volume increased > pain and destabilisation

Variable depending on the cause of the process

31
Q

What do you do in a physical exam when trying to diagnose joint disease?

A
  • Inspection from feet to the tops of limbs
  • Full physical exam
  • Palpation
32
Q

What should joint disease palpation consist of?

A

Depends on species

  • Passive manipulation
  • Manipulation under sedation
  • Flexion tests in the lameness exam
33
Q

What imaging can be done to help diagnose joint disease?

A
  • Radiography
  • Ultrasonography
  • Thermography
  • Nuclear scintigraphy (injected radioactive subs)
  • CT
  • MRI
  • Diagnostic Arthroscopy
34
Q

What are you looking for on a radiograph when trying to diagnose joint disease?

A
  • SC bone sclerosis
  • Periarticular osteophytosis
  • SC bone lysis
  • SC cyst formation
  • Soft tissue swelling
  • Loss of joint space
35
Q

How is DJD treated?

A

Lifestyle adjustment

  • Keep it moving
  • Control animal’s weight

Anti-inflams

  • NSAIDs
  • IA corticosteroids

Chondroprotective agents
- chondroitin etc.

Surgery

  • Debridement
  • Arthrodesis surgery
  • Joint realignment
  • Joint resurfacing
  • Joint replacement therapy
36
Q

How can an isolated insult injury create a vicious cycle of chronic joint damage?

A
  • Ongoing inflammation
  • Intra-articular irritant
  • Incongruity
  • Instability

Treatment of any joint disease is trying to break this cycle!

37
Q

What is the prognosis of DJD?

A
  • Control is better than cure
  • Combination of therapies
  • Ultimately surgery if possible
38
Q

What is traumatic arthritis?

A
  • Single/ repetitive trauma
  • With/ without fracture and/or ligamentous damage
  • If recent, haemorrhage may be present in synovial fluid
  • May lead to DJD if untreated
39
Q

Does cartilage have good healing capability?

A

No

  • defects of 3-4mm can heal by matrix flow
  • > 5mm defects heal with fibrocartilage
  • Full thickness defects heal better than partial thickness defects
  • Age of animal and amount of weight bearing at the site also determine the ability for the cartilage to heal
40
Q

What is infectious arthritis?

A
  • Inflammatory
  • Severe pain and joint effusion
  • Foals : haematogenous
  • Adults: penetrating
41
Q

How do you diagnose Infectious arthritis?

A
  • Physical exam
  • Radiographs (bony lysis)
  • Joint aspirate for fluid analysis and culture/ sensitivity
    • turbid
    • high protein
    • high cell count
    • 90% neutrophils
42
Q

How do you treat bony arthritis?

A
  • Remove any infectious organisms
    • Joint lavage
    • Debridement
    • Curettage
  • Long term AB therapy
  • Chondroprotective therapy
    • NSAIDS
    • Hyaluronic acid/ chondroitin sulfate etc.
43
Q

What is osteochondrosis?

A

A defect in endochondral ossification

  • retained necrotic cartilage core or thickening
  • +/- necrotic SC bone
  • Believed to be multifactorial
  • Strongly associated with rapid growth rate
  • Nutritional imbalance contributes to more generalised OC (Cu and Zn)
44
Q

What is endochondral ossification?

A
  • When a cartilage template precedes bone formation
  • Occurs in the epiphysis at at the metaphyseal growth plate

Chondrocytes at the articular surface of a joint are different to those involved in endochondral ossification

45
Q

What are the osteochondral lesions

A

Deranged development epiphyseal cartilage

May lead to:

  • Collapse of SC bone
  • Osteochondral fragments
  • Cyst-like lesion formation under the cartilage
46
Q

What are the predisposing factors to Osteochondrosis…

A
  • Exercise in excess of physiological levels may cause trauma to developing cartilage/ bone
  • More likely to cause damage if there is an underlying endochondral ossification defect
  • Large body size
  • Poor conformation
47
Q

What type of animals tend to have osteochondrosis?

A
  • Young and rapidly growing
  • Effusion +/- intermittent lameness history
  • May have recent exacerbation by trauma
  • Often bilateral
48
Q

Osteochondritis dissecans (OCD) vs Osteochondrosis…

A

OCD: specifically a lesion with dissecting cartilage flap

OC: generic term. Includes fragmentation and SC cystic lesions as well

49
Q

Where are horses likely to get OC?

A
  • Tibiotarsal joint
  • Femoropatellar joint
  • Femorotibial joint
  • Metacarpophalangeal joint
  • Scapulohumeral joint
50
Q

Where are dogs likely to get OC?

A
  • Scapulohumeral joint
  • Elbow joint
  • Tibiotarsal joint
  • Stifle
51
Q

How do you treat OCD?

A
  • Remove cartilaginous flaps
  • Curettage or corticosteroid injection of SC bone cysts
  • Articular support, as in DJD

Clinical Studies (19 decks)

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