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Locomotor 2 > Review of Connective Tissue Conditions > Flashcards

Review of Connective Tissue Conditions Flashcards

1
Q

what is tendinitis

A

Small tears causing localised inflammation in a tendon

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2
Q

what is a tendon made out of

A
  • dense fibrocallagenous tissue made out of fibroblasts which make collagen type I
  • Collagen type I is laid down in regular long fibres
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3
Q

what is the cause of tendinitis

A
  • Overuse
  • Collagen disorders- such as marfans
  • Renal dialysis - effects clearance and new production of collagen so can cause the tendons to become more brittle
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4
Q

What are the common sites of tendinitis

A

Lateral epicondylitis - tennis elbow

Achilles tendonitis

Supraspinatus tendinitis

Anywhere there is a tendon

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5
Q

What is the treatment of tendinitis

A

RICE

Analgesia and NSAIDs

Stretching

Surgery

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6
Q

What is long term complication of tendinitis

A

tendinosis

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7
Q

What is tendinosis

A

Chronic injury and failed healing

Can lead to full thickness tears

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8
Q

what can heal an achilles tendon

A

Partial tears in Achilles tendon may heal by forming herterotopic calcified regions due to the prostaglandins

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9
Q

30% of tendon injuries can cause

A

heterotrophic ossification

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10
Q

what are achilles tendon rupture

A

Achilles tendon rupture in athletes usually occurs at 2–6 cm above the insertion point.

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11
Q

What do prostaglandins induce

A
  • they also induce hypertrophic ossification

- cause the conversion of fibroblasts to a chondrocytes or an osteoblast

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12
Q

what do NSAIDS help prevent

A

help prevents the hypertrophic ossification

- is both supporting in that it treats symptoms but it also prevents complications

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13
Q

What is a hypertrophic ossification

A

Previously damaged tendon that calcifies becomes more brittle and may rupture

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14
Q

How does the tendon repair itself

A

Extrinsic

  • peripheral fibroblasts
  • for tendons such as achilles, rotator cuff tendons that are open and not enclosed

intrinsic

  • fibroblasts from tendons itself
  • such as the hand flexors
  • any tendon covered by a tendon sheath
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15
Q

How long does a tendon take to heal

A
  • can take up to a whole year to heal itself
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16
Q

Why does tendon take a while to heal

A
  • avascular

- rely on peripheral and intrinsic fibroblasts

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17
Q

What are the phases of healing for a tendon

A
  • Inflammation = pain, swelling and redness, decreased collagen synthesis and increased inflammatory cells
  • Repair = collagen fibre production, decreased collagen fibre organisation, decreased inflammatory cells
  • Remodelling - proper collagen fibre alignment and increased tissue strength
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18
Q

What are the two types of enthesis

A

Fibrous

Fibrocartilaginous

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19
Q

describe he two types of enthesis

A

Fibrous - collagen type I fibres get integrated into the bone

Fibrocartilaginous

  • small section of fibrocartilage at attachment site
  • go from tendon collagen type 1 to fibrocartilage which is also collagen type 1 which is unmineralised and then it becomes mineralised the collagen type I will then integrate into the bone matrix
  • this transitions the tendon and it goes stiffer in each of these tendons therefore there is a gradual change in mechanical properties
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20
Q

anything that is inserting into the bone is an

A

Enthesis

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21
Q

describe the histology of fibrous enthesis

A
  • sharply fibres - can see the collagen from the tendon inserting through the periosteum and into the bone
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22
Q

name some examples of fibrous enthesis

A

Peridontal ligament

deltoid

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23
Q

where is the insertion point for the fibrous enthesis

A

insertion point is a long distance away from the joint

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24
Q

describe the histology of fibrouscartialge enthesis

A
  • hybrid of fibrocollagenous tissue with some chondrocytes in there that can calcify
  • tendon, dense regular connective tissue and then going into the hybrid tissue
  • stacks of chondrocytes getting produced - Get a transitional tissue between cartilage and bone, able to withstand bending
25
Q

where is the insertion point for the fibrocartilage enthesis

A

close to the joint

26
Q

what is ethesitis

A

Inflammation of the enthesis

- any point of attachment point for tendon/ligament inserting into the bone

27
Q

What are the agues of enthesitis

A

Recurring stress

Autoimmune disease

  • Key pathological lesion in spondyloarthritides
  • Associated with HLA B27 arthropathies
28
Q

describe the pathogenesis of enthesitis

A
  • Vasodilation
  • inflammatory response
  • the inflammatory response with lots of proinflammaotry cytokines causes it to become more inflamed
  • causes the release of COX2 and COX2 to release chondrocytes so we get ossification at the enthesis
29
Q

what does normal enthesis have at its insertion point

A

lots of small transcortical vessels

30
Q

What are comorbid conditions for enthesitis

A

Inflammatory bowel disease

Psoriatic arthritis

Ankylosing spondylitis

31
Q

where is the tendinitis

A
  • in the belly of the tendon
32
Q

where is the inflammation with enthesitis

A

insertion point

33
Q

What is an ethesophyte

A

bony protrusion at a tendon insertion point

34
Q

Where does the enthesophyte originate from

A

Enthesophytes originate from the insertion of joint capsule, ligament or tendons.
- The articular border is not involved

35
Q

where do osteophytes originate from

A

Osteophytes originate from the border of the articular cartilage

36
Q

what is the difference between enthesophyte and osteophytes

A
  • Osteophytes originate from the border of the articular cartilage
  • enthesophyte- originate from the insertion of joint capsule, ligament or tendons
37
Q

What is the treatment for enthesitis

A

RICE

Non-steroidal anti-inflammatories

Usually part of treatment of an associated polyarthritis

  • Sulfasalazine
  • methotrexate

Anti-TNF therapy
- restricted for use for severe autoimmune enthesrtiis

local radiotherapy

corticosteroid injection

injection of hyperosmolar dextrose

38
Q

what does RICE stand for

A

Rest
Ice
compression
elevation

39
Q

Anti-TNF treatment can ..

A

Resolve enthesitis

40
Q

What does the tendon sheath do

A

Protects and nourishes tendons

  • Cushions tendons
  • Guides tendons

Tendon nutrition

  • Synovial fluid from tendosynovial sheath
  • Vincula blood supply (via mesotendon)
41
Q

describe the structure fo the tendon sheath

A
  • same structure as the synovial membrane in the joint
  • has type A and Type B synoviocytes that line the inner cavity
  • has loose areolar connective tissue
42
Q

How does rheumatoid arthritis affect the tendon sheath

A

it can affect any synovial membrane therefore causes inflammation

43
Q

what is tenosynovitis

A
  • Isolated inflammation
44
Q

Describe De Quervain’s tenosynovitis

A

De Quervain’s tenosynovitis

  • fibrosis and narrowing of tendon sheath
  • caused by tendons and sheath rubbing over radial styloid process
  • caused by overuse
45
Q

What is trigger finger

A

Enlargement of tendon within the sheath therefore the tendon is outside of the tendon sheath that has been damaged and the tendon gets stuck in the tendon sheath

46
Q

What is the management of tenosynovitis

A

Treatment

  • RICE
  • Splintting
  • Anti-inflammatories
  • Corticosteroid injections

Surgery

  • Trigger finger - cut the annular ligament - giving more space for the tendons to move
  • De Quervains shave down radial styloid process
47
Q

describe the epidemiology of lupus

A
  • 10-50:100,000 in Britain = over 30,000
  • 90% female
  • More common in blacks than whites
48
Q

What is the whole name of lupus

A

Systemic lupus erythematosus

49
Q

describe the pathophysiology of lupus

A
  • antibodies against a wide range of self antigens

- ANA antibodies against intranucelar proteins such as DNA and RNA

50
Q

what are the symptoms of lupus

A

Non specific fatigue, fever, arthralgia weight changes, and dermatological

  • Small joints of hands, wrist and knees - causing them to become stretched and loose
  • Migratory asymmetrical pain not related to swelling
  • Malar facial rash in butterfly pattern
  • Photosensitivity
  • Discoid lesions
  • Alopecia

Renal nephritic disease

Neuropsychiatric

Pulmonary

Gastrointestinal - e.g. spelnomeagly

Cardiac

Hematologic

51
Q

where does the lupus malar rash extend

A

Malar facial rash extends over cheeks and bridge of nose

- gets worse when exposed to UV light

52
Q

describe why a malar facial rash occurs

A

Immune complexes cause damage to blood vessels and connective tissue
- So any tissue with a rich capillary network at risk

53
Q

what is lupus arthritis

A 
Jaccoud arthropathy (nonerosive) hand deformities
- Due to tendinitis / tenosynovitis.
54
Q

How many patients develop lupus arthritis

A
  • 90% of SLE patients develop arthralgia/arthritis
55
Q

what staining do you use for lupus patients

A

More than 95% of patients with SLE are positive for ANA

  • Titre extent of dilution that still gives a dectable pattern (but does not correlate with disease activity)
56
Q

what are the patterns of ANA staining

A

Homogeneous
- Antigen double stranded DNA (ds-DNA), histones

Speckled
- SS-A /Ro, SS-B/La (Sjögren syndrome), Sm (Smith antigen), RNP

57
Q

How do you treat lupus

A

Depends on severity of disease process
Simple prevention of exposure to triggers

NSAIDs
- Mild to moderate

DMARDs – moderate - severe and flares

  • Cyclophosphamide very effective
  • Mycophenolate mofetil
  • Methotrexate
  • Tacrolimus

Corticosteriods - flares

IV immunoglobins

58
Q

What biological treatment can you use for lupus

A

Belimumab

  • Inhibits BAFF (BLyS)
  • BAFF causes activation of B cells so this inhibits the activation of the B cell

Rituximab
- CD20 blocker

Locomotor 2 (30 decks)

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