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B4 > Joints & Joint Disease > Flashcards

Joints & Joint Disease Flashcards

1
Q

What are the 2 fibres of connective tissue?

A

Collagen - resists tensile forces

Elastin - enables stretch and recoil

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2
Q

What are 3 types of connective tissue?

A

Loose irregular connective tissue
Dense irregular connective tissue
Specialised connective tissue (dense regular connective tissue, cartilage, adipose tissue, blood)

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3
Q

What are characteristics of cartilage?

A

Strong, flexible, semi rigid
Withstand compression forces
Shock absorber
Smooth surface for friction-free movement

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4
Q

What are 3 functions of cartilage?

A

Articulating surfaces of bones
Growth and development of bone (endochondral ossification)
Supporting framework

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5
Q

What are features of cartilage ECM that determine its properties?

A 
Contains aggrecan (proteoglycan) which has high water content/osmotic effect and can resist compressive forces
Fibres: collagen and elastin
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6
Q

Outline cartilage cell development

A

Mesenchymal stem cells -> Chondroblast -> Chrondrocyte

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7
Q

Outline appositional and interstitial growth of cartilage

A

Appositional: surface layers of matrix added by chrondroblasts in perichondrium (fibrous layers)

Interstitial: chondrocytes grow and divide to lay down new matrix, articular cartilage and endochondral ossification

Cartilage is avascular so relies on diffusion

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8
Q

What are 3 common types of cartilage?

A

Hyaline
Fibrocartilage
Elastic

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9
Q

What’re the difference between hyaline, fibrocartilage and elastic cartilage?

A

Hyaline is most common but weakest, contains type II collagen and proteoglycans

Fibrocartilage is strongest but has no perichondrium (contains type I collagen)

Elastic cartilage composed of elastic fibres and type II collagen and present in structures that require some degree of deformation

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10
Q

Where are hyaline, fibrocartilage and elastic cartilage found?

A

Hyaline: articular surfaces of joints, costal cartilages and epiphyseal growth plates
Fibrocartilage: insertion points of ligaments and tendons, IV discs, joint capsules, knee menisci, TMJ, pubic symphysis
Elastic cartilage: external ear, larynx, epiglottis

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11
Q

What are the 3 main groups of joints?

A

Fibrous, Cartilaginous, Synovial

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12
Q

In fibrous joints how are the bones connected? What are types of fibrous joint?

A

Bones connected by dense connective tissue containing mainly collagen - no cartilage

Sutures (between flat bones ie skull)
Syndesmoses (interosseous membrane connecting long bones)

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13
Q

How are cartilaginous joints connected? What types are there?

A

Bones connected by cartilage (either fibrocartilage +/- hyaline)

Primary joints (only hyaline cartilage) eg synchondroses like epiphyseal growth plates
Secondary joints (fibro + hyaline) eg IV disc, manubriosternal joint
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14
Q

Outline characteristics of synovial joints

A

Joint cavity between the bones containing synovial fluid (hyaline cartilage)
Joint enclosed by a joint capsule: outer fibrous membrane and inner synovial membrane
Bursa surround the joint to further reduce friction
Fibroelastic ligaments cross the joint to reinforce

Menisci in the knee are made of fibrocartilage

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15
Q

What are types of synovial joint?

A 
Hinge (elbow)
Ball & socket (glenohumeral - shoulder)
Plane (AC)
Saddle (MTP)
Pivot (radioulnar)
Codylar (MCP)
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16
Q

Briefly what is osteoarthritis?

A

Joint disease - loss of articular cartilage +/- bone leading to synovitis; inflammation affects parts of the joint and leads to reduced shock absorbing abilities of cartilage

17
Q

What are risk factors for osteoarthritis?

A

Genetic, increasing age, female, trauma, obesity, mechanical stress

18
Q

What’s the difference between primary and secondary osteoarthritis?

A

Primary - occurs due to genetic factors in the absence of precipitating insult

Secondary - occurs as sequelae of joint pathology (trauma, infection, inflammatory conditions)

19
Q

What are radiographic changes seen in osteoarthritis?

A

Joint space narrowing
Osteophytes
Subchondral cysts and sclerosis
Malalignment

20
Q

What are the signs and symptoms of osteoarthritis?

A

Joint stiffness (short lived in the morning)
Joint pain (worse on movement)
Functional limitation
Pain on rest/night

Signs:
Restricted movement
Crepitus
Bony swelling
Joint effusion
Herbenden's nodes
21
Q

How is osteoarthritis managed?

A

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

22
Q

What’s the pathophysiology of osteoarthritis?

A

Chondrocytes trigger release of cytokines, which produce and release protease enzymes to degrade cartilage/joint structures

Fibrilation of cartilage: as smooth surface lost and cracks develop

Chronic synovitis: triggered by cartilage fragments/osteophyte formation

23
Q

What are 3 types of inflammatory arthritis?

A

Rheumatoid
Spondyloarthritis
Crystal (gout)

24
Q

What’s Rheumatoid arthritis?

A

Autoimmune multi-system inflammatory disease
Inflammation of synovial membrane and articular surfaces = joint destruction
Also associated with extra-articular features affecting eyes, skin, respiratory system, cardiovascular system

25
Q

What are articular characteristics of Rheumatoid arthritis?

A

Warm, tender and swollen joints
Morning stiffness lasts >1 hours (longer than osteoarthritis)
Joint deformities

26
Q

What are some key differences between osteoarthritis and rheumatoid?

A 
RA onset between 25-50 years
OA 40yrs +
OA biomechanical; RA autoimmune inflammatory
RA affects symmetrical smaller joints
OA affects weight bearing joints
Osteophytes present in OA only
RF present in RA only
RA: morning stiffness >1hr ; OA morning stiffness <20mins
27
Q

Primary vs Secondary gout?

A

Primary (95% cases): inherited disorder overproducing, or under excreting, uric acid

Secondary: high dietary purine, drugs/conditions causing high nucleic acid turnover, lymphoma, psoriasis

28
Q

Why is gout associated sometimes with renal failure?

A

Crystals can be deposited in renal parenchyma = urate calculi (stones) formed in urine

29
Q

What are signs and symptoms of acute gout?

A 
Sudden onset, my be precipitated by alcohol, excess food, dehydration
Joint inflammation (typically in the periphery and big toe)
Tender swollen hot red joint (metatarsophalangeal joint)
30
Q

What are signs and symptoms of chronic gout?

A 
Often associated with renal impairment and long term diuretic use
Tophi formation (deposits of monosodium urate crystals in bursa, tendons, cartilage)
Chronic joint pain
31
Q

What are radiographic changes seen with gout?

A

Joint effusion
Tophi in soft tissue/soft tissue swelling
Punched out bony erosions
Joint space narrowing

32
Q

How is gout managed?

A

Reduce alcohol intake, reduce purine-rich foods, lose weight, review diuretic medication
NSAIDs in acute attack
Allopurinol in chronic gout

B4 (13 decks)

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