Review of Connective Tissue Disorders Flashcards
Where does skeletal muscle act upon the tendon
Myotendinous junction
What is tendinitis
Small tears within a tendon cause localised inflammation
What causes tendinitis
Overuse
Collagen disorders
Name 3 common sites of tendonitis
- Lateral epicondyle
- Achilles tendinits
- Supraspinatus tendinitis
How can tendinitis be treated
RICE
Analgesics/ NSAID
Stretching
Surgery if very serious
How may partial achilles tendon tears heal
By forming heterotopic calcified regions– heterotopic ossification
What signals are involved in conversion from mesenchyma stem cells to hypertophic chondrocytes
COX-2 independent andCOX-2 dependent
What signals work on the hypertrophic chondrocytes to form bone cells
VEGF
Cyr61
RANKL
What happens when VEGF, Cyr61 and RANKL are activated
Angiogenesis
Osteoclast recruitment
Osteogenesis
Fracture bridging
What drugs can inhibit formation of heterotopic calcified regions
NSAIDs
What is the consequence of large calcification points forming in the tendon
Becomes more brittle
May rupture/ fracture
Why do tendons take a long time to heal
They are avascular
How does injury healing occur in extrinsic tendons
By peripheral fibroblasts
What is an intrinsic tendon
Any tendon covered by a tendon sheath
How are instrinsic tendons healed
Fibroblasts from the tendon shealth themself
What are the 2 types of enthesis
Fibrous and fibrocartilaginous
What is a fibrous enthesis
Fibrous tissue extending all the way up to the point of bone insertion
Collagen fibres insert into bone
What is a fibrocartilaginous
Small section of fibrocartilage at the attachment site
Helps to stiffen to tendon/ ligament and creates a gradual change in mechanical properties
If theres little movement of tendon/ ligament, what kind of enthesis will there be
Fibrous
Define enthesis
Any point of attachment for tendon/ ligament inserting into bone
What is enthesitis
Inflammation of the enthesis
What can cause enthesitis
Recurring stress
Autoimmune disease
What arthropathies is enthesitis associated with
HLA B27
Where do enthesis normally insert into
Porous bone where there are lots of small transcortical vessels
What happens when there is a mechanical traume to enthesis
Inflammatory process causes production of osteoblasts causing heterotropic calcification at the insertion point
Osteoblasts move into enthesis
Name 3 comorbid conditions associated with enthesitis
Inflammatory bowel disease
Psoriatic arthritis
Ankylosing spondylitis
How would enthesitis appear on an x-ray
There is an identifiable bone spur/ nodule at the insertion site
How do enthesophytes differ from osteophytes
Originate from joint capsule, tendon or ligament
The articular border is not involved and osteophytes originate from here
How should enthesitis be treated from a mechanical perspective
RICE
NSAIDs
How should enthesitis be treated from an inflammatory perspective
Sulfasalzine/ methotrexate Anti-TNF Radiotherapy Corticosteroid injection Hyperosmolar dextrose injection
When is anti-TNF used to treat enthesitis
In isolated incidents
What is the relation between ankylosing spondylitis and enthesitis
Ankylosing spondylitis is enthesitis of IV disc and anterior longitudinal ligament
How can you tell apart achilles tenditiis and achilles enthesitis
Enthesitis is lower down
What is the role of the tendon sheath
Cushions tendon
Guides tendon
Tendon nutrition
How are tendons given nutrition by tendon sheath
Synovial fluid from tendosynovial shealth
Vincula blood supply
What is De Quervians tenosynovitis
Fibrosis and narrowing of the tendon sheath
Caused by tendons and sheath rubbing over radial styloid process
What is trigger finger
Enlargement of tendon within the sheath
How is trigger finger treated surgically
Cut theannular ligament
How is De Quervians tenosynovitis treated surgically
Shave the radial styloid process
What are the signs/ symptoms of systemic lupus
Fatigue Fever Weght chances Small joints swell Asymmetrical pain Photosensitivity Neuropsychiatric probs Pulmonary fibrosis GI problem
What hypersensitivity reaction is responsible for lupus
Mainly 3, a bit of 2
Briefly describe the pathophysiology of lupus
- Immune complexes cause damage to blood vessels and connective tissue
What % of SLE patients develop arthralgia
90%
What is Jaccoud arthropathy
Hand deformities due to tendinitis/ tenosynovitis
Looks like RA but can be moved back into normal position- non erosive and no joint involement
What staining is used for lupus diagnosis
anti nuclear antibody staining
How can lupus be treated
Biological DMARDS
Belumumab
Rituximab
Mechanism of action of ritiximab
C20 blocker
