Joint Pathology

Question 1

what is the function of collagen in cartilage?

Answer 1

Holds GAGs together

Question 2

because cartilage is avascular where does it receives its nutrients from?

Answer 2

NON-articular: Perichondrium

Articular: Synovial fluid

Question 3

what is synovial fluid?

Answer 3

ultra filtrate of blood with added substances such as hyaluronic acid

Question 4

What are the main types of cells that make up the synovium?

Answer 4

Type A synoviocytes (macrophage like)

Type B synoviocyte (fibroblast like)

Question 5

Arthritis is an umbrella term relating to?

Answer 5

damage to joints

Question 6

osteoarthritis is an example of

Answer 6

Degenerative Disease

Question 7

Rheumatoid Arthritis is an example of

Answer 7

Autoimmune Arthritis

Question 8

Gout (crystal induced) is an example of

Answer 8

Acute inflammation arthritis

Question 9

Osteoarthritis is more common in

Answer 9

hard working joints (knee and hands)

Question 10

first symptoms to be noticed in Rheumatoid Arthritis is

Answer 10

oligoarthritis (1-4) or polyarthritis (>5)

Question 11

one diagnostic characteristics of Rheumatoid Arthritis is

Answer 11

Morning Stiffness

Question 12

Gout is described as

Answer 12

incredibly painful inflammation in a single joint due to the accumulation of crystals of uric acid

Question 13

what is podagra?

Answer 13

inflammation of the articulation of the hallux of the foot in the context of gout

Question 14

in Osteoarthritis what parts of the joint are affecteD?

Answer 14

the caspsule, synovium, cartilage and bone

Question 15

in Osteoarthritis, explain why there is hypertrophy and hyperplasia of the cartilage

Answer 15

because as part of the pathological disease there is a reduction in the amount of matrix present in the cartilage decreasing its shock absorbent properties. proliferation is a deficient savaging mechanism

Question 16

what is fibrillation of the cartilage?

Answer 16

destruction of the cartilage with the formation of gaps or clefts

Question 17

what is eburnation?

Answer 17

It is an ivory-like reaction of bone occurring at the site of cartilage erosion. The bone tissue now becomes the outer most layer and there is the formation of subchondral cysts

Question 18

in the context of Osteoarthritis what is the changes observed in Bone and Cartilage

Answer 18

B –> Eburnation and osteophytes

C –> Erosion and Fibrillation

Question 19

What are osteophytes?

Answer 19

out pouches of bone caused by the proliferation of bone tissue

Question 20

what are some of the signs observed in Osteoarthritis?

Answer 20

Crepitus, osteophytes, painful [slow onset] worst after activity [end of day]
NO FEVER

Question 21

how is diagnosis of Osteoarthritis performed?

Answer 21

mostly clinical [diagnosis of exclusion]

X rays do not correlate with the symptoms of the patient

Question 22

if an X-ray is performed on a patient with Osteoarthritis what will be seen?

Answer 22

loss of joint space
subchondral cysts
subchondral sclerosis –> thickening of the bone
osteophytes

Question 23

in Osteoarthritis how doe subchondral cysts form?

Answer 23

the lack of articular cartilage and the destruction of the bone allows for synovial fluid to enter the the bone

Question 24

What are the risk factors for the development of Osteoarthritis?

Answer 24

Ageing 
Obesity
Previous Injury
Repeated heavy use
[all that relate to damage to cartilage]

Question 25

Rheumatoid Arthritis needs to be treated with medication because

Answer 25

Rapidly progressive, patient disabled in 10 years

Question 26

in Rheumatoid Arthritis there is the formation of granulation tissue in the synovium, which is known as

Answer 26

Pannus

Question 27

what cells and cytokines are central to Rheumatoid Arthritis

Answer 27

Th17 Th1 TNF-alpha

Question 28

what are some of the histological features of Rheumatoid Arthritis

Answer 28

Villus Formation form the synovium Synovial Hperplasia Mononuclear Infiltration Development of germinal centres deposition of fibrin and neutrophils into the joint space erosion of the cartilage and bone due to the pannus destruction of bone, cartilage and ligaments scarring and LORM [if untreated]

Question 29

what are some of the signs of Rheumatoid Arthritis?

Answer 29

Warm, swollen joints (rubbery) Systemic Symptoms present (LOW, fever) Morning Stiffness

Question 30

if the joint gets better with use it is more likely to be ---1---- if not ---2---

Answer 30

1 Rheumatoid Arthritis | 2 Osteoarthritis

Question 31

What is a rheumatoid nodule?

Answer 31

Granulomatous Inflammation with central necrosis

Question 32

Diagnosis for Rheumatoid Arthritis

Answer 32

``` Inflammatory Tests (ESR, CRP, FBE) more specific Tests (rheumatoid factor--> autoantibody) ```

Question 33

Xray indicators of Rheumatoid Arthritis

Answer 33

Osteopenia Uniform loss of joint space* Erosion of bone surrounding the synovium

Question 34

Risk factors for the development of Rheumatoid Arthritis

Answer 34

Genetic (some HLA haplotypes, ~50%) Female Increasing age (up to 55) Smoking

Question 35

what is the main cause of Gout

Answer 35

too much uric acid in the body

Question 36

Hyperuricaemia is a strong indicator of Gout

Answer 36

Necessary for the development of the condition but not determinant Create levels change and not accordingly with the condition

Question 37

what is the cause of pain in gout?

Answer 37

the immune reaction and activation of the inflammasome due to the uric acid crystals

Question 38

Why is there lysis of neutrophils in the gouty joint?

Answer 38

because the crystals are filamentous and penetrate the cell membrane causing leaking and death

Question 39

what are tophi and where do they form?

Answer 39

accumulation of uric acid in soft tissue

Question 40

some of the events that can trigger gout are?

Answer 40

alcohol, dehydration, trauma and dietary indiscretion

Question 41

what type of inflammation occur in the tophi?

Answer 41

Granulomatous Inflammation

Question 42

what are some of the signs in gout?

Answer 42

acutely inflamed joint rarely systematic signs tophi if chronic and uncontrolled Pain, redness, swelling, heat in joint

Question 43

what is the gold standard for the diagnosis of gout?

Answer 43

Joint or tophi Aspiration (negatively birefringent crystals with neutrophils)

Question 44

in x rays what is the main finding?

Answer 44

Tophi | No loss of joint space

Question 45

what are the risk factor for gout?

Answer 45

``` Male Obese Age Defects in uric acid metabolism Genetic ```