Path. of Arthritis and Autoimmune Disease

Question 1

_____ is the most common disease causing morbidity in the elderly.

Answer 1

Arthritis

Question 2

What is joint pain without evidence of inflammation called?

Answer 2

arthralgia

Question 3

What is periarticular pain?

Answer 3

pain arising from structures around the joint, like tendons or bursae

Question 4

How are periarticular pain and true arthritis distinguished?

Answer 4

periarticular pain does not have effusion or point tenderness and is not worse with active motion compared to passive

Question 5

What is soft tissue pain?

Answer 5

pain from muscle, nerves, or referred from a distant site that may be interpreted as joint pain

Question 6

What are the findings in true arthritis?

Answer 6

joint effusion, active and passive joint pain

Question 7

What is arthralgia?

Answer 7

joint pain w/o evidence of inflammation

Question 8

Pain arising from structures around the joint, like tendons or bursae, is called?

Answer 8

periarticular pain

Question 9

What is monoarticular arthritis? When does it arise?

Answer 9

arthritis of one joint; most often due to infections, crystal-induced arthritis, or trauma

Question 10

What is oligoarticular arthritis? What diseases are assoc. with it?

Answer 10

arthritis seen in 2-4 joints, usually asymmetrical and involving the large joints; assoc. with ankylosing spondylitis, psoriatic arthritis, or reactive arthritis

Question 11

What is polyarticular arthritis? What diseases are assoc. with it?

Answer 11

multiple joints, symmetric, both small and large. RA, SLE, and viral syndromes

Question 12

What is a synarthrosis? Example?

Answer 12

joint where bones come together and interlock; skull

Question 13

What is an amphiarthrosis? Example?

Answer 13

bones are joined by a segment of flexible fibrocartilage;; ribs to sternum

Question 14

What is a diarthrosis?

Answer 14

most common joint- articulation cushioned with hyaline cartilage, stabilized by ligaments, actively moved by muscles, and nourished/lubricated by synovial tissues

Question 15

What is an uniaxial or hinge joint? Example?

Answer 15

moves along one plane; knee or elbow

Question 16

This arthritis is seen in 2-4 joints, usually asymmetrical and involving the large joints; assoc. with ankylosing spondylitis, psoriatic arthritis, or reactive arthritis.

Answer 16

oligoarticular arthritis

Question 17

What is a polyaxial joint? Example?

Answer 17

movement along multiple axes, such as the ball and socket joint of the shoulder

Question 18

This arthritis involves multiple joints, is symmetric, inn both small joints and large, and is found in RA, SLE, and viral syndromes.

Answer 18

Polyarticular arthritis

Question 19

What are ligaments composed of?

Answer 19

bundles of parallel type 1 collagen

Question 20

What is the most common joint- an articulation cushioned with hyaline cartilage, stabilized by ligaments, actively moved by muscles, and nourished/lubricated by synovial tissues?

Answer 20

a diarthrosis

Question 21

____ are active drivers of joint motion whereas ____ are passive restraints.

Answer 21

Tendons; ligaments

Question 22

What is an enthesis?

Answer 22

where tendons and ligaments insert into the bone

Question 23

Why are entheses important in the spondylo-arthropathies?

Answer 23

they can become inflamed, cause erosions, and calcify in these diseases

Question 24

What are bursae?

Answer 24

synovial-lined sacs supported by dense regular CT designed to slide and cushion tissues

Question 25

Where do bursae occur? Example?

Answer 25

between tendon and bone, tendons and ligaments, or between tendons; subacromial bursa over the shoulder

Question 26

What is Axial Arthropathy?

Answer 26

arthritis involving the spine

Question 27

What is Ankylosis?

Answer 27

Fixation of a joint as the result of a disease process, with fibrous or bony union across the joint

Question 28

What is Sacroiliitis?

Answer 28

Inflammation of the sacroiliac joint

Question 29

What is Spondylitis?

Answer 29

Inflammation of one or more vertebrae of the spine

Question 30

What is an Osteophyte?

Answer 30

A bony outgrowth of bone

Question 31

What is a Syndesmophyte?

Answer 31

Calcification of a ligament or tendon at site of bony insertion

Question 32

What is a Synchondrosis?

Answer 32

A union between two bones formed by cartilage

Question 33

Give an example of a synchondrosis.

Answer 33

pubic symphysis, manubrosternal joints, costosternal joints

Question 34

What is inflammation of the sacroiliac joint called?

Answer 34

sacroiliitis

Question 35

What is inflammation of one or more vertebrae of the spine called?

Answer 35

spondylitis

Question 36

What is a bony outgrowth of bone?

Answer 36

osteophyte

Question 37

What is a calcification of a ligament or tendon at the site of bony insertion called?

Answer 37

a syndesmophyte

Question 38

What is a union between two bones formed by cartilage called?

Answer 38

Synchondrosis

Question 39

In a diarthrodial joint, the articular surface of the bone is covered by _____.

Answer 39

hyaline cartilage

Question 40

What is hyaline cartilage made of?

Answer 40

type II collagen, proteoglycans (chondroitin and keratin sulfate), hyaluronic acid, water

Question 41

_____ is a thin layer of cells and a capsule that covers all intra-articular surfaces other than the articular areas of cartilage.

Answer 41

Synovium

Question 42

What is synovium made of?

Answer 42

a well ordered matrix of microfibrils and proteoglycan aggregates with synovial cells

Question 43

Synovial cells are divided into 2 types: Type A cells are _____ and derived from the _____; Type B cells are _____.

Answer 43

macrophage-like, bone marrow; fibroblast-like

Question 44

What is inflamed synovium called?

Answer 44

synovitis

Question 45

What is pannus? What disease is this assoc. with?

Answer 45

diffusely inflamed and thickened synovium; RA

Question 46

The area under the cartilage is called the _____.

Answer 46

subchondral bone

Question 47

This area commonly becomes dense or sclerotic in osteoarthritis.

Answer 47

the subchondral bone

Question 48

Which joints are involved in OA?

Answer 48

DIPs, PIPs, first carpometacarpal joint (CMC), cervical spine, lumbosacral spine, hips, knees, first metatarsophalangeal joint (MTP)

Question 49

Which joint pathologies have an acute onset?

Answer 49

septic joints, crystal diseases

Question 50

Which allele is assoc. with RA?

Answer 50

HLA-DR4

Question 51

Synovial cells are divided into 2 types: _____ are macrophage-like and derived from the bone marrow; _____ are fibroblast-like.

Answer 51

Type A cells; Type B cells

Question 52

Which allele is assoc. with axial arthropathies?

Answer 52

HLA-B27

Question 53

Which alleles are assoc. with SLE?

Answer 53

HLA-DR2, HLA-DR3, C4A null allele

Question 54

When inflammation occurs in the body, a large number of systemic and metabolic changes occur which are collectively referred to as the _____.

Answer 54

acute-phase response (APR)

Question 55

Cytokines stimulate the ____ to produce ____, and during this time it decreases _____ production.

Answer 55

liver; acute phase proteins; albumin

Question 56

General measurements of the acute phase inflammatory response are the ____ and the ______.

Answer 56

erythrocyte sedimentation rate (ESR); C-reactive protein (CRP)

Question 57

What does ANA stand for?

Answer 57

antinuclear antibody

Question 58

What is vasculitis?

Answer 58

inflammation of blood vessels

Question 59

How are the vasculitides categorized?

Answer 59

size of the BVs involved

Question 60

What does ANCA stand for?

Answer 60

antineutrophil cytoplasmic antibodies

Question 61

What does CRP stand for?

Answer 61

C-reactive protein

Question 62

The ESR is an indirect way of screening for elevated concentrations of acute phase proteins made by the liver that result in increased ______ (rouleaux formation), causing them to fall more rapidly.

Answer 62

aggregation of erythrocytes

Question 63

CRP is a pentameric protein that behaves as a primitive _____. It can activate the classic complement pathway and bind to the Fc gamma receptor. It rapidly rises in 2 to 3 days after an acute inflammatory stimulus.

Answer 63

immunoglobulin

Question 64

What are ANCAs?

Answer 64

antibodies to cytoplasmic antigens found in neutrophils

Question 65

The ANCAs may be directly involved in the patho-genesis of _____.

Answer 65

pauci-immune types of vasculitis

Question 66

The ____ is a set of closely-linked genes whose products regulate the recognition of foreign antigens by T cells.

Answer 66

MHC

Question 67

The ESR is an indirect way of screening for elevated concentrations of acute phase proteins made by the liver that result in increased aggregation of erythrocytes (______), causing them to fall more rapidly.

Answer 67

rouleaux formation

Question 68

____ may be directly involved in the pathogenesis of pauci-immune types of vasculitis.

Answer 68

ANCAs

Question 69

CRP is a pentameric protein that behaves as a primitive immunoglobulin. It can activate the _____ and bind to the _____ receptor. It rapidly rises in 2 to 3 days after an acute inflammatory stimulus.

Answer 69

classic complement pathway; Fc gamma

Question 70

The MHC is a set of closely-linked genes whose products regulate the recognition of foreign antigens by ___.

Answer 70

T cells