LECTURE 1 - finished Flashcards
Sources of pain within the joint include? (5)
- joint capsule
- periosteum
- ligaments
- subchondral bone
- synovium
What are the basic pathophysiologic types of joint disease? (5)
- Infection
- Crystal deposition
- Enthesopathy
- Synovitis
- Structural/mechanical derangements
What is synovitis most commonly characterised pathologically by? (4)
• neovascularization • infiltration of the synovium with – lymphocytes – plasma cells – macrophages • synovial cell hyperplasia • Pannus formation results
What is a Pannus?
The mass of proliferating synoviocytes & invading inflammatory cells within the synovium which may infiltrate intra-articular bone and cartilage.
The pannus may also release inflammatory substances that erode the nearby cartilage and bone tissue
What are some examples of entheseal sites? (4)
- tendons and bone
- ligaments and bone
- cortical bone and the periosteum
- vertebral bodies and the annulus fibrosus
Where is the principle site of pathology in seronegative spondyloarthropathies?
The entheses
What does inflammation of entheseal sites result in? (3)
Metaplasia of the radially oriented collagen fibres, giving rise to:
- fibrous bone formation
- gradual ossification of syndesmoses (e.g., SIJ’s) and
- syndesmophyte formation along the outer fibres of the vertebral discs
What are synovial infections characterised by? (3)
- intense neutrophilic infiltration
- synovial necrosis
- subsequent formation of granulation & scar tissue
What is a sclerotome
A SCLEROTOME is the area of a bone innervated from a single spinal segment
What is inflammatory arthritis?
Inflammatory arthritis is characterized by inflammation affecting joint structures, such as the:
• synovium
• synovial cavity
• entheses
What is Non-inflammatory arthritis?
Joint disease resulting from alterations in the structure or mechanics of the joint
- cartilage or meniscal damage with/without alterations in subchondral bone structure
- alterations in joint anatomy as a result of congenital, developmental, metabolic, or past inflammatory diseases
What are the key symptoms encountered in joint disease?
- Pain
- Stiffness
- Swelling
- Loss of ROM
- Weakness
- Fatigue
What is the pain pattern during movement in inflammatory joint disease?
- Pain is present both at rest and with motion
* It is worse at the beginning than at the end of usage
What is the pain pattern during movement in non-inflammatory joint disease?
- pain occurs mainly or only during motion
- pain improves quickly with rest
- patients with advanced degenerative disease of the hips, spine, or knees may also have pain at rest and at night
Define stiffness
Definition: a perceived sensation of tightness when attempting to move joints after a period of inactivity
• It typically subsides over time
• Its duration may serve to distinguish inflammatory & non-inflammatory joint disease
What is the pattern of stiffness in inflammatory joint disease?
Stiffness is present upon waking and typically lasts 30-60 minutes or longer
What is the pattern of stiffness in non-inflammatory joint disease?
Stiffness is experienced briefly (eg, 15 min) upon waking in the morning or following periods of inactivity
3 Reasons for joint swelling in inflammatory arthritis
- synovial hypertrophy
- synovial effusion
- inflammation of periarticular structures
Reasons for joint swelling in non-inflammatory arthritis
• the formation of osteophytes causing bony swelling
• mild soft tissue swelling due to synovial:
o Cysts
o Thickening
o Effusions
What are the main crystals deposited in joints?
- monosodium urate
- calcium pyrophosphate dihydrate
- calcium phosphate (e.g. Hydroxyapatite)
- calcium oxalate
Define infectious arthritis
The synovium, and other joint structures, may become the seat of acute or chronic infections caused by bacteria, fungi, or viruses.
These infections usually arise from septicaemia and may often be seen in systemic infections.
In synovial infections, we see:
• intense neutrophilic infiltration
• synovial necrosis
• subsequent formation of granulation & scar tissue
A dense mass of fibrin, infiltrated by neutrophils, forms over the synovial surface.
Bacterial products released within the joint are capable of producing rapid cartilage and bone destruction.
