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Block 4: Anatomy + Physiology > Joints and joint disease > Flashcards

Joints and joint disease Flashcards

1
Q

What types of fibre are found in connective tissue?

A

Collagen (types 1,2 and 3)

Elastin

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2
Q

Where are type 1 collagen fibres found?

A 
Bones
Tendons
Ligaments
Dermis
Organ capsules
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3
Q

What are the characteristics of cartilage?

A 
Strong 
Flexible 
Rigid 
Smooth surface for free movement 
Shock absorber
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4
Q

What are the functions of cartilage?

A

Articulating surfaces of bones
Growth and development of bones (through endochondral ossification)
Support (e.g. trachea)

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5
Q

What are the features of the cartilage extracellular matrix?

A 
Contains aggrecan (a proteoglycan) - acts to resist compressive forces
Contains fibres (collagen and elastin)
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6
Q

Where are cartilage cells derived from?

A

Mesenchymal stem cells –> Chondroblasts (cartilage building cells)–> Chondrocyte (mature cell)

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7
Q

How can cartilage grow?

A
  1. Appositional growth

2. Interstitial growth

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8
Q

How does appositional growth occur?

A

Surface layer of matrix is added by chondroblasts in the perichondrium

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9
Q

How does interstitial growth occur?

A

Chondrocytes grow and divide and lay down new matrix
Articular cartilage and endochondral ossification
[Occurs in childhood and adolescence]

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10
Q

How does cartilage growth and repair differ with age?

A

Regeneration is poor after childhood

Large defects involve replacement with dense connective tissue

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11
Q

Where is elastic cartilage found?

A

External ear
Larynx
Epiglottis

[structures that require degree of deformation with ability to regain original shape]

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12
Q

What fibres are found in elastic cartilage and what properties do these give?

A

Elastic fibres
Type II collagen fibres

[Properties of elastic cartilage: strong, flexible and resilient]

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13
Q

What is a joint?

A

Point at which 2 + bones articulate

[no movement required to be classified as a joint]

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14
Q

What are the common diseases affecting joints?

A

Osteoarthritis
Rheumatoid arthritis
Gout

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15
Q

How is osteoarthritis characterised?

A

Loss of articular cartilage with or without loss of bone leading to synovitis (inflammation of the synovium)
Reduces shock absorbing abilities of cartilage

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16
Q

Where are type 2 collagen fibres found?

A

Hyaline cartilage

Elastic cartilage

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17
Q

Where are type 3 collagen fibres found?

A

Structural framework of spleen, liver, lymph nodes, smooth muscle and adipose tissue

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18
Q

What are the functions of elastin?

A

Enable stretch and recoil of tissues

Often mixed with collagen to prevent overstretch

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19
Q

Where is elastin found?

A

[Wide variety of structures]
Walls of large arteries
Lungs
Skin

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20
Q

What are the various types of connective tissue?

A

Loose irregular connective tissue (e.g. glands, part of serrous membrane etc.)
Dense irregular connective tissue (e.g. dermis of skin, sheaths of nerves, capsules of organs)
Specialised connective tissue (e.g. tendons, ligaments, cartilage, adipose tissue, blood etc.)

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21
Q

What is the structure of cartilage?

A

Lined with a perichondrium (that has an outer fibrous layer and an inner cellular layer)
Cartilage is avascular so is supplied by diffusion from perichondrium

22
Q

What is hyaline cartilage and where is it found?

A

Most common but the weakest form of cartilage

Found in articular surface of joints, costal cartilages and epiphyseal growth plates

23
Q

What are the properties of hyaline cartilage?

A 
Type II collagen fibres (short and dispersed) 
Proteoglycans (lots!) 
Perichondrium layer (except on articular surfaces)
24
Q

What is fibrocartilage and where is it found?

A

Strongest form of cartilage
Found in insertion points of ligaments/ tendons to bone; intervertebral disks; joint capsules; knee menisci; pubic symphysis; temporomandibular joint

25
Q

What are the properties of fibrocartilage?

A 
Type I collagen (thick parallel bundles alternating with hyaline matrix) 
No perichondrium (however often found next to hyaline cartilage)
26
Q

How can joints be classified?

A

Synarthrodial (fixed, no movement)
Amphiarthrodial (slight movement)
Diarthrodial (free movement)

27
Q

What are fibrous joints?

A

Bones connected by dense connective tissue

No cartilage present

28
Q

Where are fibrous joints found?

A

Sutures of skull (synarthrodial)

Syndesmoses - interosseous membrane connecting long bones (amphiarthrodial)

29
Q

What are cartilaginous joints?

A

Bones connected entirely by cartilage (hyaline, fibrocartilage or both)
Allow for more movement than fibrous joint but less than others e.g. synovial
Primary and Secondary

30
Q

What are primary cartilaginous joints?

A

Only hyaline cartilage present

[e.g. epiphyseal growth plate, costal cartilages)

31
Q

What are secondary cartilaginous joints?

A

Hyaline cartilage lines bone with pad of fibrocartilage in between the hyaline
[e.g. intervertebral discs, pubic symphysis, manubriosternal joint]

32
Q

What are the features of synovial joints?

A

Joint cavity between bones containing synovial fluid
Hyaline cartilage lines bones
Joint enclosed in a joint capsule (which has an outer fibrous membrane and an inner synovial membrane which secrets synovial fluid)
Fibroelastic ligaments cross joints to prevent excessive movement and provide reinforcement

33
Q

What is a bursa?

A

Sac made of synovial membrane and containing synovial fluid

Reduces friction between structures

34
Q

What are the various types of synovial joints?

A

Classified by movement:

Hinge (flexion/ extension)
Ball and socket (movement in several axes)
Plane (gliding/ sliding)
Saddle (concave and convex surfaces)
Pivot (rotation)
Condyloid (flexion/ extension/ adduction/ abduction, circumduction)

35
Q

What are the risk factors for osteoarthritis?

A 
Genetics
Age 
Female 
Trauma 
Mechanical stress (on joints) 
Obesity
High bone density 
Low bone density (increases risk of progression to hips and knees)
36
Q

What is the difference between primary and secondary osteoarthritis?

A 
Primary = caused by genetic factors and occurs in the absence of a precipitating insult 
Secondary = caused by sequelae of joint pathology (trauma, infection, inflammation etc.)
37
Q

What is the pathophysiology of osteoarthritis?

A
  1. Changes in composition of cartilage (reducing shock absorption)
  2. Erosion of cartilage in joints causing fissures
  3. Ulceration of cartilage (exposes underlying bone causing microfractures and subchondral cysts)
  4. New bone growth (osteophytes, subchondral sclerosis)
  5. Synovitis
  6. Thickening of joint capsule (causing stiffness and reduced movement)
38
Q

What radiographic changes can be seen in osteoarthritis?

A

Joint space narrowing (loss of cartilage)
Subchondral cysts and sclerosis
Osteophytes (hard swellings around small hand joints)
Malalignment

39
Q

What are Herbeden Nodes?

A

Hard swellings around distal interphalangeal joints

40
Q

What are Bouchards Nodes?

A

Hard swellings around proximal interphalangeal joints

41
Q

What are the signs and symptoms of osteoarthritis?

A 
Joint stiffness and pain (worse on movement) 
Functional limitation (restricted movement) 
Rest/ night pain 
Crepitus 
Bony swelling 
Joint effusion 
Joint instability/ deformity 
Muscle wasting
42
Q

What is the management for osteoarthritis?

A

Education
Non-pharmacological (exercise/ physio/ aids)
Pharmacological pain management (topical/ oral)
Surgical (joint replacement, fusion or excision/ realignment surgery)

43
Q

What are the forms of inflammatory arthritis?

A

Rheumatoid arthritis
Spondyloarthritis (e.g. psioratic, ankylosing spondylitis, enteropathic e.g. IBD)
Crystal arthritis (e.g. gout)

44
Q

What is rheumatoid arthritis?

A

Multi-system autoimmune inflammatory disorder, primarily affecting the joints
Symptoms caused by inflammation of synovial membrane and articular surfaces leading to joint destruction
Characteristics include warm, tender and swollen joints; morning stiffness (lasts approx. 1 hour) and joint deformities

45
Q

What characterises investigation findings for rheumatoid arthritis?

A

positive Rheumatoid factor

Raised inflammatory markers

46
Q

What causes gout?

A

Inflammatory response to urate crystals deposited in and around the joint and synovial fluid leading to synovitis, cartilage destruction and joint degeneration
Caused by hyperuricaemia (high levels of uric acid) leading to crystal formation typically in peripheries due to lower temperatures (e.g. metatarsal-phalangeal joints)

47
Q

What is secondary gout?

A

5% of cases
Factors causing overproduction or underexcretion of uric acid e.g. alcohol, drugs, chronic renal failure, high purine diet

48
Q

What is primary gout?

A

95% of cases

Inherited disorder causing overproduction or underexcretion of uric acid

49
Q

What are the signs and symptoms of acute gout?

A

Sudden onset
Joint inflammation (tender, swollen, hot, red) - typically first metatarsophalangeal joint
Can be precipitated by excess food or alcohol, dehydration or diuretics

50
Q

What are the signs and symptoms of chronic (tophaceous gout)?

A

Tophi (deposits of monosodium urate crystals in bursae, tendons, cartilage or periarticular bones)
Chronic joint pain
Associated with renal impairment and long-term use of diuretics

51
Q

What are the radiographic changes seen in gout?

A 
Joint effusion 
Bony erosions 'punched out' 
Opacities (tophi) in soft tissue
Soft tissue swellings
Narrowing of joint spaces (in later stages)
52
Q

How can gout be managed?

A

Lifestyle changes (e.g. reduce alcohol; avoid purine-rich food such as red meat, shellfish and spinach; weight loss; medication review esp. diuretics)
NSAIDs or Colchicine for acute attacks
Allopurinol (a Xanthine Oxidase Inhibitor) to reduce uric acid synthesis in chronic gout

Block 4: Anatomy + Physiology (12 decks)

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