MSK 4: Rheumatology Flashcards by Olivia Smith

What are the functions of connective tissue?

Binds together and supports other body tissues.
Protect and insulates internal organs.
Compartmentalises structures
Transport system
Reserve energy stores
Site of immune response

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What are the three classes of components in connective tissue?

Cells
Fibres
Ground substance

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What types of cells are present in connective tissue?

Fibroblasts
Macrophages
Mast cells
Plasma cells
Lymphocytes
Leukocytes
Adipose cells

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What are the three types of fibres in connective tissue?

Reticular
Elastic
Collagen

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What two substances make up ground substance?

Macromolecules

Multiadhesive glycoproteins

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Does connective tissue have nerve or blood supply?

Yes except cartilage, and tendons aren’t vascularised.

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What is the purpose of collagen fibres in matrix?

Strong and flexible to resist forces

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What is the purpose of elastic fibres in matrix?

Branch to form network

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What is the purpose of reticular fibres in matrix?

Provide support for the walls of blood vessels

collagen covered in glycoprotein

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What is an adipocyte?

Cells that store triglycerides

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What is a fibroblast?

Large flat cell with branching processes that migrate throughout connective tissue secreting the fibres and ground substance.

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What is a macrophage?

WBC that surround and engulf material by phagocytosis

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What is a mast cell?

A white blood cell that secretes histamine.

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What are the six types of connective tissue?

Loose connective tissue
Adipose tissue
Blood
Fibrous connective tissue
Cartilage
Bone

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How do connective tissues vary?

Very by fibres, ground substance and cells contained in it. Each has a specific structure and function.

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What are the two types of connective tissue proper and examples of each?

Loose: Areolar, adipose, reticular
Dense: Regular, irregular, elastic

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What is the function of connective tissue proper?

Binding tissue

Resists mechanical stress

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What is the function and characteristics of hyaline cartilage?

Cushion joints

Weakest but most abundant

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What is the function and characteristics of fibrocartilage?

Found in intervertebral discs.

Strongest with no perichondrium.

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What is the function of elastic cartilage?

Provides strength, elasticity and maintains the shape of certain structures.

What is housed in trabeculae in spongey bone?

Red bone marrow

What is rheumatoid arthritis?

Autoimmune disorder primarily affecting joints resulting in warm swollen painful joints.

When are symptoms of arthritis worst?

Following rest

What is systemic lupus erythematosus?

Autoimmune disorder of connective tissues. Affects multiple organ systems and joints.

What is vasculitis?

A group of disorders that destroy blood vessels by inflammation.

What are the general macroscopic changes in rheumatoid arthritis?

Synovitis, bone, cartilage, erosion and angiogenesis.

What are the general microscopic changes in rheumatoid arthritis?

Cells, interleukins, ANF, synoviocytes, osteoclasts, proteases, CD4 cells, plasma cells, neutrophils.

What four things happens to a joint in rheumatoid arthritis?

Bone erosion Swollen inflamed synovial membrane Cartilage wears away Reduced joint space

Which cell produces IL-17?

Th17 (Thelper 17)

What cells does IL-17 act on to cause inflammation in rheumatoid arthritis? What factors do they produce?

Synovial lining cell (IL-6 IL-8 MCP-1 GRO-α GM-CSF) and macrophages (IL-1β TNF-α IL-6)

What cells does IL-17 act on to cause cartilage destruction in rheumatoid arthritis? What factors do they produce?

Macrophages (MMPs) and chondrocytes (NO)

What cells does IL-17 act on to cause bone destruction in rheumatoid arthritis? What factors do they produce?

Osteoclasts (RANKL)

How long does rheumatoid arthritis usually last?

The rest of the patients life.

What joints does rheumatoid arthritis typically spare?

Thoracolumbar spine | DIPs of fingers and IP of the toes

What is the difference between rheumatoid and osteoarthritis?

Rheumatoid is inflammatory not degenerative, involves antibodies and mainly affects small joints.

What feature of RA may appear at pressure points?

Subcutaneous or periosteal nodules

What clinical sign suggests RA?

Swelling around joints and synovial thickening that feels like a firm sponge.

What are the four stages of treatment?

Diagnosis Severity Treatment Moniter

What is considered when assessing the disease?

- Current activity: Morning stiffness, synovitis, fatigue, ESR. - Degree of damage: ROM and deformities, joint space narrowing and erosions on Xray, functional status. - Extra-articular manifestations: Nodules, pulmonary fibrosis, vasculitis. - Prior Rx and responses.

What are the three key parts of treatment of RA?

Education Exercise Medications

What is the effect of NSAIDs on RA?

Symptomatic relief and improved function but no change is disease progression.

What should be considered if low dose prednisone is taken long term?

Prophylactic treatment for osteoporosis

When are intra-articular steroids useful?

During flare ups of RA

What are some examples of DMARDs?

Minocycline, sulfasalazine, hydroxychloroquine, intramuscular gold.

What immunosuppressive drugs can be used as treatment for RA?

Methotrexate, azathioprine, cyclophosphamide, cyclosporine

What is the function of etanercept?

New DMARD that is a soluble TNF recpetor so blocks TNF.

What is the function of leflunomide?

Pyrimidine receptor

Why do DMARDs need to be frequently monitored?

Adverse effects commonly occur in the blood, liver, lung and kidney.