revision lecture

Question 1

What are the key features of rheumatoid arthritis?

Answer 1

Morning stiffness in and around joints Symmetrical polyarthritis typically involving the small joints of the hand and/or wrists Subcutaneous nodules Rheumatoid factor Joint erosions on radiographs

Question 2

What is rheumatoid factor

Answer 2

Antibodies that recognize the Fc portion of IgG as their target antigen typically IgM antibodies i.e. IgM anti-IgG antibody !

Question 3

What are the components of synovium?

Answer 3

Type A synoviocytes: macrophage-like phagocytic Type B synoviocytes: fibroblast-like produce hyaluronate Collagen is type I

Question 4

What substance makes synovial fluid viscous?

Answer 4

Hyaluronic acid - a non-sulphated glycosaminoglycan

Question 5

Define Reactive Arthritis

Answer 5

Sterile inflammatory synovitis following an infection whose extra-articular manifestations may include: Enthesopathy Skin inflammation (circinate balanitis, keratoderma blennorrhagicum) Eye inflammation (conjunctivitis)

Question 6

List two infections associated with Reactive Arthritis

Answer 6

Urogenital infections E.g. Chlamydia trachomatis Enterogenic infections E.g. Salmonella, Shigella, Campylobacter infections Reactive arthritis may be first manifestation of HIV or hepatitis C infection

Question 7

Define and give four examples of an enthesopathy

Answer 7

Inflammation where a ligament, tendon, fascia or capsule insert into bone. Examples include: Achilles tendonitis (painful heel) inflammation at insertion of Achilles tendon into calcaneum Plantar fasciitis (painful feet) inflammation at insertion of plantar fascia Dactylitis (swollen digits) inflammation at insertion of capsule and ligaments in digits Spondylitis (spinal inflammation) in Ankylosing Spondylitis inflammation where the outer part (annulus

Question 8

Complete this table

Answer 8

Question 9

What is the key feature of osteoarthritis?

Answer 9

Irreversible loss of articular cartilage

Question 10

What are the main pathological features of osteoarthritis?

Answer 10

focal areas of damage to articular cartilage

new bone formation at the joint margins (osteophytosis)

sclerosis of the subchondral bone

Question 11

Define and give an example of a proteoglycan

Answer 11

glycoproteins containing sulphated glycosaminoglycan chains e.g. Aggrecan

Question 12

Define and give an example of a glycosaminoglycan

Answer 12

repeating polymers of disaccharides e.g.

•Hyaluronic acid (= hyaluronate). Disaccharides are: glucuronic acid and N-acetyl glucosamine

Question 13

What is the major (i) collagen and (ii) proteoglycan found in articular cartilage?

Answer 13

(i)Type II collagen

(aide memoire – two T’s in articular cartilage = type two collagen, Bone has one in it so = type one collagen)

(ii)Aggrecan

Question 14

What is the major HLA association of:

1) Ankylosing Spondylitis
2) Reactive Arthritis
3) SLE
4) Rheumatoid arthritis

Answer 14

Ankylosing Spondylitis & Reactive Arthritis = HLA-B27

SLE = HLA-DR3

Rheumatoid arthritis = HLA-DR4

Question 15

Summarise the composition of bone

Answer 15

Bone is comprised of protein matrix (osteoid) mainly made of type 1 collagen

and mineral (hydroxyapatite) made of calcium and phosphate

Question 16

Define Osteoporosis

Answer 16

Predisposition to skeletal fractures resulting from reduction in regional or total bone mass

Question 17

Define Osteomalacia

Answer 17

Osteomalacia literally means ‘soft bones’ and is defined as impaired mineralisation of osteoid in mature bones. Rickets is impaired mineralisation in immature bones

Question 18

What causes osteomalacia?

Answer 18

Most frequently due to inadequate extracellular fluid concentration of phosphate and/or calcium

Causes include:

• Vitamin D deficiency (can measure vitamin D level so easy to determine)
• Abnormal vitamin D metabolism e.g. liver or kidney disease
• Hypophosphataemia (may be due to renal phosphate loss which can be determined by measuring urinary phosphate levels)

Question 19

Define Paget’s disease

Answer 19

Disorder of bone remodelling of unknown cause where there is increased bone resorption followed by increased bone formation. This results in disorganised mosaic pattern of woven and lamellar bone

Question 20

What does bone chemistry show in Paget’s disease?

Answer 20

high alkaline phosphatase

Question 21

What are brown tumours?

Answer 21

discrete lytic lesions

aggregates of osteoclasts and fibrous tissue

Question 22

What is chondrocalcinosis?

Answer 22

Calcification of articular cartilage

Question 23

What is renal osteodystrophy?

Answer 23

Collective Musculoskeletal disorders in chronic renal failure

Includes:

• Secondary and tertiary hyperparathyroidism
• Osteomalacia
• Soft tissue and vascular calcification