Rheumatology

Question 1

What are tendons?

Answer 1

Fibrous collagen tissue attaching muscles to bone

Question 2

What are ligaments?

Answer 2

Flexible fibrous tissue joining bone to bone

Question 3

What are the structural joint classification?

and their main points

Answer 3

Fibrous joints - No space between bones -like in skull
Cartilaginous joints - e.g.joints between spinal vertebrae
Synovial joints - Space between bones with synovial fluid

Question 4

What are the functional joint classification?

Answer 4

Synarthroses -Generally allow no movement
Amphiarthroses - Allow very limited movement
Diarthroses - Allow for free movement of the joint

Question 5

What is synovial fluid made out of?

Answer 5

Hyualuric acid

Question 6

What makes up the articular cartilage?

Answer 6

Type 2 collagen

Proteoglycan

Question 7

What is cartilage made up of?

Why does it heal poorly?

Answer 7

Chondrocytes
ECM - mainly aggrecan, proteoglycans and water
It is avascular (no blood supply)

Question 8

Two main divisions of arthritis

Answer 8

Osteo - degenerative (cartilage is worn out)

Inflammatory- main type is rheumatoid

Question 9

Quick summary of osteo arthritis

And clincial signs

Answer 9

Joint pain, creaking joints, instability, immobility

Bone spurs (osteophytes)
Lack of space between bones

Question 10

What is inflammation?

Answer 10

Rubor - redness
Dolor - pain
Calor -heat
Tumor - swelling

Caused by: increased blood flow, migration of white blood cells, cytonkine production (IL-6, IL-1, IL-17, TNF-Alpha

Question 11

What is septic arthritis?
Why?
How does it present?

Answer 11

Arthritis caused by bacterial infection
Immunosuppressed, rheumatoid arthritis, intravenous drug use
Acute painful , red, hot swelling of a join ussually a fever. Normally in a single joint

Question 12

What is crystal arthritis?

Maintypes

Answer 12

When crystals deposit in the joints

Gout and pseudogout

Question 13

What is gout?

Caused by?

Answer 13

Uric acid crystals in joint, acute mono arthritis. May have tofi (crystal depsotis under skin).

Hyperuricaemia
Increased intake of purines (beer etc.)
Kidney failure

Question 14

What causes pseudogout?

Risk factors?

Answer 14

Calcium pyrophosphate deposition

Background osteoarthritis, elderly patients, intercurrent infection

Question 15

Difference between gout and pseudogout on synovial fluid analysis

Answer 15

Gout: needle shaped - negative birefringence

Pseudogout: rhomboid shaped - POSITIVE (remember p) birefringence

Question 16

What is Rheumatoid arthritis?

How does it present?

Answer 16

Chronic auto immune inflammatory join disease presenting with polyarthritis.

Usually symmetrical and affects small joints

Primarily: swelling in synovium

Question 17

What si the most important cytokine in rheumatoid arthritis?

Answer 17

TNF-alpha

Question 18

How is rheumatoid arthritis diagnosed?

Answer 18

Rheumatoid factor - IgM antibody against the patient’s normal IgG
Antibodies to citrullinated proteins antigens

Question 19

Treatment and Managment of rheumatoid arthritis

Answer 19

Prevention of damage via early diagnosis
Using DMARD’s
1st line treatment:
Methotrexate with hydroxychloroquine or sulfasalazine
2nd line:
Biological treatments (proteins) - that target inflammatory cytokines (anti-TNF-alpha)
Prednisolone