Lecture: Introduction to Rheumatology

Question 1

What is rheumatology?

Answer 1

The diagnosis and treatment of painful conditions of locomotorius (muscle, joint, tendons) and connective tissue

Question 2

What is arthritis?

Answer 2

Inflammation of the joint SO technically it’s synovitis

Question 3

What are the clinical features of arthritis?

Answer 3

• Redness (rubor)
• Increased warmth (calor)
• Pain (dolor)
• Swelling/fluid accumulation (synovial effusion)
• Stiffness (especially AM) = fanctio laesa

Question 4

What are the clinical classifiers of arthritis?

Answer 4

• Duration (acute less than 6 weeks vs chronic)
• Number of joints involves (mono, oligo, poly= 4+)
• Distribution (symmetrical/asymmetrical)

Question 5

What is the clinical distribution of RA?

Answer 5

Chronic symmetrical polyarthritis involving small joints

Question 6

What is the clinical distribution of gout?

Answer 6

Acute mono-arthritis

Question 7

What does the synovium do?

Answer 7

• Elasticity to allow movement of adjacent, non-deformable tissues
• Control of synovial fluid volume/lubrication of cartilage
• Composition and nutrition of chondrocytes
• Performs immunological surveillance of articular microenvironment

Question 8

What is the synovium?

Answer 8

The soft tissue inner lining of diarthrodial joints, tendon sheaths and bursae

Question 9

What are the two layers of the synovium?

Answer 9

1. Continuous surface layer of cells = intima
   - MAC and fibroblasts
   - Fluid between the intimal surfaces (rich in hyaluronic acid)
2. Underlying connective tissue (sub-intima)
   - Rich in blood and lymphatic tissues
   - Resident fibroblasts and infiltrating cells
   - Extracellular collagenous matrix

Question 10

What are type A synoviocytes?

Answer 10

Macrophages

• Intima and sub-intima
• Prominent nonspecific esterase activity (NSE)
• Provide immunosurveillance for joint (FcgRIIIa)
• Normally the minority of cells in normal intima but increase in arthritis
• CD163 and CD68

Question 11

What are type B synoviocytes?

Answer 11

Fibroblasts

• CD68 positive
• CD55 positive
• Production of hyaluronan
• Regulate cellular trafficking (through expression of adhesion molecules)
• Fibroblasts activity in intima is reduced in immune mediated arthritis

Question 12

What 3 initial things are you trying to figure out when someone presents with joint pain?

Answer 12

Is it arthritis?
- Inflammation of the synovium

Is it arthralgia?
- Pains and aches from periarticular tissue (tendinitis)

Is it (osteo) arthrosis?
- Primarily non-inflammatory degradation of cartilage and subchondral bone (–> arthralgia/soft tissue pain)

Question 13

What is the framework of rheumatology?

Answer 13

1. Systemic inflammatory autoimmune disease
   - Chronic arthritis
   - Spongylarthritis
   - Connective tissue diseases
   - Vasculitides
2. Arthritis caused by
   - Metabolic condition (CPPD, gout)
   - Infectious agent (acute)
3. Degenerative joint/bone conditions
   - OA
   - OP
4. Soft tissue pain syndromes (systemic/regional)

Question 14

What happens to fibroblast activity in immune-mediated arthritis?

Answer 14

Reduced activity in the intima

Question 15

What happens to MAC in the intima in arthritis?

Answer 15

In normal intima there is a minority of MAC but in arthritis there are lots of MAC in the intima

Question 16

Which kinds of rheumatic conditions have increased mortality?

Answer 16

Metabolic +

Chronic arthritis ++