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Musculoskeletal and Rheumatology > Lecture 4: Intro to Rheumatology > Flashcards

Lecture 4: Intro to Rheumatology Flashcards

1
Q

What is connective tissue?

A
  • binds together, supports and strengthens other body tissues
  • protects and insulates internal organs
  • compartmentalises structures such as skeletal muscle
  • major transport system within the body
  • site of stored energy reserves
  • main site of immune responses
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2
Q

What are the 3 classes of components in connective tissue?

A
  • cells
  • fibres
  • ground substance
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3
Q

3 key features of connective tissue?

A
  • doesn’t occur on free surfaces
  • has a nerve supply (except cartilage)
  • highly vascular (except cartilage and tendons)
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4
Q

What is ground substance?

A

macromolecules and multi-adhesive glycoproteins that are between cells and fibres

  • supports cells
  • binds them together
  • provides medium through which substances are exchanged e.g. hyaluronic acid
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5
Q

What are the 3 types of fibres found in connective tissue?

A
  • collagen fibres
  • elastic fibres
  • reticular fibres
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6
Q

Key features of collagen fibres?

A
  • strong, resist forces, flexible
  • made of collagen (most abundant protein in the body)
  • toughest type of fibre
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7
Q

Key features of elastic fibres?

A
  • smaller in diameter than collagen fibres
  • branch to form network
  • made of protein elastin
  • found in blood vessels , skin etc.
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8
Q

Key features of reticular fibres?

A
  • provide support for walls of blood vessels
  • net/mesh-like structure
  • made of collagen w/glycoprotein covering
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9
Q

What cell types are found in connective tissue?

A
  • fibroblasts
  • macrophages
  • mast cells
  • adipocytes
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10
Q

What are fibroblasts?

A
  • large flat cells w/branching processes

- migrate throughout connective tissue secreting fibres and ground substance

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11
Q

What are macrophages?

A
  • develop from white blood cells

- surround and engulf material by phagocytosis

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12
Q

What are mast cells?

A
  • alongside blood vessels that supply connective tissue

- produce histamine: chemical that dilates blood vessels

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13
Q

What are adipocytes?

A
  • fat cells

- store triglycerides

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14
Q

What are the 4 main types of connective tissue?

A
  • connective tissue proper
  • cartilage
  • bone tissue
  • blood
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15
Q

What is the function of connective tissue proper?

A
  • binding tissue

- resists mechanical stress especially tension

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16
Q

What cells make up connective tissue proper?

A
  • fibroblasts
  • fibrocytes
  • defense cells
  • fat cells
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17
Q

What is the matrix of connective tissue proper?

A
  • gel like ground substance

- collagen, reticular and elastic collagen

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18
Q

What is connective tissue proper split into?

A
  • loose connective tissue

- dense connective tissue

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19
Q

What is loose connective tissue split into?

A
  • areolar (structural support, lots of ground substance, most common form of loose connective tissue)
  • adipose (fat tissue, energy reserve)
  • reticular (mesh network, supports spleen etc.)
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20
Q

What is dense connective tissue split into?

A
  • regular (tight collagen fibres e.g. tendon, ligaments etc)
  • irregular (skin dermis, irregular formation of collagen)
  • elastic (vertebrae)
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21
Q

What are 2 key features of cartilage?

A
  • avascular

- no nerve supply (except perichondrium)

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22
Q

What is the function of cartilage?

A
  • strengthen + support connective tissue
  • resists compression
  • cushions and support body structures
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23
Q

What cells are found in cartilage?

A
  • chondroblasts (in growing cartilage)

- chondrocytes

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24
Q

What matrix is found in cartilage?

A
  • gel-like ground substance

- fibres: collagen, elastic fibres in some

25
Q

What are the 3 types of cartilage?

A
  • elastic cartilage
  • fibrocartilage
  • hyaline cartilage
26
Q

Key facts about hyaline cartilage?

A
  • gel-like ground substance
  • end of long bones to cushion joints + at epiphyseal plates
  • found in many articular surfaces
  • most abundant cartilage in the body
  • weakest of 3 types of cartilage
  • chondrocytes have gloss like appearance
27
Q

Key facts about fibrocartilage?

A
  • chondrocytes scattered among visible bundles of collagen fibres
  • strongest of 3 collagen types
  • no perichondrium
  • found in intervertebral discs
  • shock absorbing
  • lots of thick collagen fibres
28
Q

Key facts about elastic cartilage?

A
  • chondrocytes located in threadlike network of elastic fibres
  • provides strength, elasticity and maintains shape of certain structures e.g. external ear
  • similar to hyaline but w/increased elastin
29
Q

What is the function of bone tissue?

A
  • resists compression + tension

- protect + support

30
Q

What cells are in bone tissue?

A
  • osteoblasts

- osteocytes

31
Q

What is the matrix of bone tissue?

A
  • gel-like ground substance
  • calcified with inorganic salts
  • fibres: collagen
32
Q

What are the 2 types of bone tissue (osseous tissue)?

A
  • compact

- spongy

33
Q

What is compact bone tissue made of?

A
  • OSTEON: basic unit of compact bone
  • LAMELLAE: concentric circles of matrix
  • LACUNAE: spaces in matrix that house cells
  • OSTEOCYTES: mature bone cells
34
Q

What is spongy bone tissue made of?

A

TRABECULAE: columns of bone w/spaces filled with red bone marrow

35
Q

What is the function of blood?

A
  • transport oxygen, CO2, nutrients, waste and other substances
36
Q

What cells are in blood?

A
  • RBCs (erythrocytes)
  • WBCs (leukocytes)
  • platelets
37
Q

What is the matrix of blood?

A
  • liquid
  • plasma
  • no fibres
38
Q

Name 2 rheumatological disorders?

A
  • rheumatoid arthritis (RA)

- system lupus erythematosus (SLE)

39
Q

What is rheumatoid arthritis?

A
  • autoimmune disorder primarily affecting joints resulting in warm, swollen, painful joints
  • symptoms typically worse following rest
40
Q

What is SLE?

A
  • autoimmune disorder of connective tissues, affects multiple organ systems and joints
41
Q

What are the general macroscopic changes in RA?

A
  • synovitis
  • bone
  • cartilage
  • erosion
  • angiogenesis diagram
42
Q

What are the general microscopic changes in RA?

A
  • cells
  • IL
  • ANF
  • synoviocytes
  • osteoclasts
  • proteases
  • CD4 cells
  • plasma cells
  • neutrophils
43
Q

What are the joint changes in RA?

A
  • swollen inflamed synovial membrane
  • hyaline cartilage wears away
  • reduced joint space
  • bone erosion
44
Q

What immune system factors are involved in RA?

A
  • IL-6: role in inflammation
  • TNF-alpha: role in inflammation
  • IL-17: role in starting inflammation, cartilage destruction and bone destruction by making cells produce other ILs
45
Q

Possible causes of RA?

A
  • environmental factors
  • epigenetic modifications
  • susceptibility genes
    likely a combination of factors
46
Q

Key features of RA?

A
  • symptoms last >6 weeks + often last remainder of life
  • inflammatory synovitis = palpable synovial swelling, morning stiffness >1 hr and fatigue
  • symmetrical + polyarticular (more than 3/4 joints affected)
47
Q

Which joints are typically involved in RA?

A
  • typically involves wrists, MCP and PIP joints (metacarpophalangeal and proximal interphalangeal)
48
Q

What joints are usually spared in RA?

A
  • thoracolumbar spine

- DIPs of fingers and IPs of toes (distal interphalangeal and interphalangeal)

49
Q

What are the 3 COMMON SYMTOMS of RA?

A
  • JOINT PAIN
  • STIFFNESS
  • SWELLING
50
Q

Key differences between RA and osteoarthritis?

A
  • RA = inflammatory, Osteo = degenerative
  • RA = autoantibodies, Osteo = no antibodies
  • RA = small joints, Osteo = large weight bearing joints (hips, knees, shoulders)
51
Q

What are some signs of RA?

A
  • may have nodules: subcutaneous or periosteal at pressure points
  • rheumatoid factor in blood (not specific for RA but high titre early is bad sign)
  • marginal erosions and joint space narrowing on x-ray
52
Q

What x-ray changes are there in RA?

A
  • soft tissue swelling
  • joint space loss
  • erosions (juxta-articular)
  • subluxation
53
Q

What are the treatment principles of RA?

A
  • confirm diagnosis
  • determine severity
  • treatment: start aggressive treatment early, use safest plan that matches aggressiveness of disease
  • monitor: treatment for adverse effects, disease activity, revise prescription (Rx) as needed
54
Q

What are the critical elements of assessment in a treatment plan?

A
  • assess current activity
  • document degree of damage
  • document extra-articular manifestations
  • assess prior Rx responses + side effects
55
Q

What are the critical elements of therapy in a treatment plan?

A
  • education
  • exercise (ROM, conditioning and strengthening exercises)
  • medications (analgesic and/or anti-inflammatory, immunosuppressive, cytotoxic + biologic)
56
Q

What are the drug treatment options for RA?

A
  • NSAIDs - symptomatic relief, improved function, no change in progression
  • Low-dose prednisone - may substitute NSAID, bridge therapy
  • Intra-articular steroids - useful for flares
  • DMARDs- minocycline, sulfasalazine, hydroxychloroquine, intramuscular hold
  • immunosuppressive drugs - methotrexate, azathioprine, cyclophosphamide, cyclosporine
57
Q

What new drugs/DMARDs are being used for RA?

A
  • leflunomide

- etanercept

58
Q

What extraarticular manifestations of RA are there?

A
  • liver
  • cardiovascular
  • neurological
  • musculoskeletal
  • bone marrow
  • spleen
59
Q

What are the common symptoms of SLE?

A
  • alopecia
  • malar rash (butterfly skin rash)
  • arthralgia
  • oral ulcers
  • photosensitivity

Musculoskeletal and Rheumatology (5 decks)

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