LECTURE 1 - finished

Question 1

Sources of pain within the joint include? (5)

Answer 1

• joint capsule
• periosteum
• ligaments
• subchondral bone
• synovium

Question 2

What are the basic pathophysiologic types of joint disease? (5)

Answer 2

• Infection
• Crystal deposition
• Enthesopathy
• Synovitis
• Structural/mechanical derangements

Question 3

What is synovitis most commonly characterised pathologically by? (4)

Answer 3

• neovascularization
• infiltration of the synovium with
 – lymphocytes
 – plasma cells
 – macrophages
• synovial cell hyperplasia
• Pannus formation results

Question 4

What is a Pannus?

Answer 4

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

Question 5

What are some examples of entheseal sites? (4)

Answer 5

• tendons and bone
• ligaments and bone
• cortical bone and the periosteum
• vertebral bodies and the annulus fibrosus

Question 6

Where is the principle site of pathology in seronegative spondyloarthropathies?

Answer 6

The entheses

Question 7

What does inflammation of entheseal sites result in? (3)

Answer 7

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

Question 8

What are synovial infections characterised by? (3)

Answer 8

• intense neutrophilic infiltration
• synovial necrosis
• subsequent formation of granulation & scar tissue

Question 9

What is a sclerotome

Answer 9

A SCLEROTOME is the area of a bone innervated from a single spinal segment

Question 10

What is inflammatory arthritis?

Answer 10

Inflammatory arthritis is characterized by inflammation affecting joint structures, such as the:
• synovium
• synovial cavity
• entheses

Question 11

What is Non-inflammatory arthritis?

Answer 11

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

Question 12

What are the key symptoms encountered in joint disease?

Answer 12

• Pain
• Stiffness
• Swelling
• Loss of ROM
• Weakness
• Fatigue

Question 13

What is the pain pattern during movement in inflammatory joint disease?

Answer 13

• Pain is present both at rest and with motion

* It is worse at the beginning than at the end of usage

Question 14

What is the pain pattern during movement in non-inflammatory joint disease?

Answer 14

• 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

Question 15

Define stiffness

Answer 15

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

Question 16

What is the pattern of stiffness in inflammatory joint disease?

Answer 16

Stiffness is present upon waking and typically lasts 30-60 minutes or longer

Question 17

What is the pattern of stiffness in non-inflammatory joint disease?

Answer 17

Stiffness is experienced briefly (eg, 15 min) upon waking in the morning or following periods of inactivity

Question 18

3 Reasons for joint swelling in inflammatory arthritis

Answer 18

• synovial hypertrophy
• synovial effusion
• inflammation of periarticular structures

Question 19

Reasons for joint swelling in non-inflammatory arthritis

Answer 19

• the formation of osteophytes causing bony swelling
• mild soft tissue swelling due to synovial:
o Cysts
o Thickening
o Effusions

Question 20

What are the main crystals deposited in joints?

Answer 20

• monosodium urate
• calcium pyrophosphate dihydrate
• calcium phosphate (e.g. Hydroxyapatite)
• calcium oxalate

Question 21

Define infectious arthritis

Answer 21

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.