MS1: Introduction to Rheumatology Flashcards
most common type of joint
synovial joint
what is a synovial joint
fluid filled joint cavity covered by a fibrous capsule
3 main features of a synovial joint
articular capsule
articular cartilage
synovial fluid
what is the articular capsule
surrounds the joint and is continous w periosterum of the bones
layers of the articular capsule
fibrous layer and synovial layer
what is the capsular ligament
holds together articulating bones and supports synovium
what is the fibrous layer
consists of white fibrous tissue - capsular ligament
what is the synovial layer
highly vascularized serous connective tissue - absorbs and secretes synovial fluid
function of synovium
mediates nutrient exchange betw blood and joint fluid
what are the cell types of synovium
type A
type B
type C
what are type A cells
from macrophage - antigen ability = phagocytosis
what are type B cells
fibroblast like - rich in rough ER and dendritic processes
produces synovial fluid, hyaluronic acid, fibronectin and collagen
what are type C cells
intermediate cell type - precursor to either type A or B
cells found on superficial layer of the synovium
type A
cells found on deep layer of the synovium
type B
function of synovial fluid
lubricates articular cartilage and nourishment through diffusion
origin of of synovial fluid
from unltrafiltrate of blood plasma and regulated by synovium
how much synovial fluid in a healthy knee
2 mL
what is synovial fluid consist of
hyaluronin
lubricin
proteinase
collageneses
prostaglandins
function of hyaluronin
increases viscosity and elasticity of articular cartilage
lubricates surface betw synovuim and cartilage
function of lubricin
key lubricating glycoprotein - boundary layer lubrication
reduces friction betw opposing surfaces of cartilage
2 main roles of articular cartialge
minimize friction and absorbs shock
functions of synovial fluid
lubrication
nutrient distrbution
shock absroption
how does articular cartilage get nutrients
avascular and relies from passive diffusion of synovial fluid
what are accessory ligaments
separate ligaments or parts of joint capsule
what are bursae
small sac lined by synovial membrane and filled with synovial fluid - become inflamed following infection or irritation by over-use of the joint (bursitis)
location of bursae
key points of friction in a joint
desrcibe the nerve supply of synovial joints
rich supply from articular nerves - proprioceptive and nociceptive
what is hilton’s law
nerves supplying a joint also supply the muscles moving the joint and the skin covering
what is arthritis
joint disorder w inflammation and joint pain
what is arthralgia
joint pain
areas affected in articular arthritis
synovium
synovial fluid
articular cartilage
intraarticular ligaments
joint capsule
artciular bone
characteristics of articular arthritis
deep diffuse pain - crepitation
pain and LOM on active and passive movement
swelling
instability, locking and deformity
areas affected in non-articular arthritis
ligaments, tendons, bursae
muscle, fascia, bone
nerve and skin
characterisitcs of non-articular arthritis
painful on active only not passive motion
focal tenderness in adjacent regions
finding remote from capsule
findings of inflammatory arthritis
four cardinal signs
systemic symptoms
laboratory evidence
morning stiffness - severe and lasts for hours may improve w activity and AIF
four cardinal signs of inflammation
erythema - rubor
warmth - calor
pain - dolor
swelling - tumor
causes of inflammatory arthritis
infectious
crystal induced
immune related
reactive
idiopathic
example of infectious inflammatory arthritis
Neisseria gonorrhoea or Mycobacterium tuberculosis
example of crystal-induced inflammatory arthritis
gout
example of immune related inflammatory arthritis
RA and SLE
example of reactive inflammatory arthritis
rheumatic fever and Reiter’s syndrome
causes of non-inflammatory disorders
degeneration
pain amplification
trauma related to rotator cuff tear
repetitive use
neoplasm
symptoms of non-inflammatory arthritis
intermittent stiffness - daytime gel and only <60 min
pain w/o swelling or warmth
absence of inflammatory or systemic features
day time gel
arthritis common in male
gout and spondyloarthropathies
arthritis common in female
RA, SLE, fibromyalgia
arthritis common in young
16 below
SLE and reactive arthritis
arthritis common in middle age
fibromyalgia and RA
arthritis common in elderly
OA and polymyalgia rheumatica
what to ask for in patient’s profile
sex
age
familial predilection
race
arthritis common in abrupt onset
septic and gout
arthritis common in insidous onset
OA, RA, fibromyalgia
arthritis common in chronic evolution
OA
arthritis common in chronic intermittent
crystal induced, lyme
arthritis common in migratory evolution
rheumatic fever, gonococcal or viral arthritis
arthritis common in additive evolution
RA. psoriatic
arthritis common in acute
infectious, crystal induced, reactive
arthritis common in chronic
OA, RA, fibromyalgia
what to ask for progression of disease
onset - abrupt/insidious
evolution - chronic/intermittent/migratory/additive
duration - acute/chronic
monoarticular
1
oligoarticular or pauciarticular
2-3 joints - crystal and infectious
polyarticular
more than 3 joints - OA and RA
classification of articular
mono. oligo, poly
classification of non-articular
focal - CTS and tendinitis
diffuse - polymyosistis and fibromyalgia
common arthritis for symmetric joint involvememt
RA
common arthritis for asymmetric joint involvememt
gout, spondyloarthropathy
common arthritis for UE joint involvememt
RA and OA
common arthritis for LE joint involvememt
reactive arthritis and hout
common arthritis for axial skeleton involvement
OA and ankylosing spondylitis
not so much RA excdpt s cervical common dun
what are precipitating events
trauma
intake of drugs
comorbidities
conditions associated w eyes
Behcet’s, sarcoidis, spondyloarthritis
conditions associated w GI tract
scleroderma, inflammatory bowel disease
conditions associated w genitourinary tract
reactive arthritis, gonococcemia
conditions associated w nervous system
lyme disease, vasculitis
when is xray useful
trauma
chronic infection
progressive disability
monoarticular involvement
common xray findings for chronic
calcification
joint space narrowing, erosion, ankylosis
new bone forms
subchondral cysts
what is ultrasound for
for soft tissue abnormalities - bakers cyst
macroscopic laboratory findings
volume
color
clarity
viscosity
mucin clot
normal volume of synovial fluid analysis
normal is 3.5 mL ; inflamed up to 25 mL
color of normal synovial fluid
pale yellow and clear
color of hemmorhage synovial fluid
red, brown or xanthochromic
color of non-inflammatory synovial fluid
yellow clear
color of inflammatory synovial fluid
yellow cloudy
color of crystal synovial fluid
white, cloudy and milky
color of non-inflammatory and inflammatory effusions synovial fluid
deep yellow
normal mucin clot
4-6 c,
clarity, color and viscosity of normal synovial fluid
transparent, clear, high
clarity, color and viscosity of non-inflamatorry synovial fluid
transparent. yellow, high
clarity, color and viscosity of inflammatory synovial fluid
translucent, yellow, low
clarity, color and viscosity of septic synovial fluid
opaque, dirty yellow, variable
clarity, color and viscosity of hemmorhagic synovial fluid
bloody, red, variable
WBC/mm3 of normal
<200
WBC/mm3 of non-inflammatory
200-2,000
WBC/mm3 of inflammatory
2000-10000-100000
WBC/mm3 of septic
> 80000
WBC/mm3 of hemorrhagic
200-2000
group 1 non-inflammatory
Osteoarthritis, degenerative diseases
group 2 inflammatory
Gout, pseudogout, spondyloarthropathies, rheumatoid arthritis, Lyme’s disease, systemic lupus erythematosus
group 3 septic
Non-gonococcal or gonoccal septic arthritis
group 4 hemorrhagic
Hemophilia. Trauma tumors
