Rheumatology

Question 1

Compare and contrast the composition of cartilage and bone

Answer 1

Cartilage is thin, avascular, flexible and resistant to compressive forces.
Bone is highly vascularised, and its calcified matrix makes it very strong.

Question 2

What are the 3 main types of cartilage? How do they differ in structure? Give
examples of the location of each.

Answer 2

Hyaline - most common, found in the ribs, nose, larynx, trachea. Is a precursor of bone.

Fibro- is found in invertebral discs, joint capsules, ligaments.

Elastic - is found in the external ear, epiglottis and larynx.

Question 3

What are the two ways in which bone grows?

Answer 3

intramembranous ossification and endochondral ossification. The term ‘ossification’ refers to the process of forming bone

Question 4

Cartilage growth is from what process?

Answer 4

Chondrification (also known as chondrogenesis) is the process by which cartilage is formed from condensed mesenchyme tissue, which differentiates into chondroblasts and begins secreting the molecules (aggrecan and collagen type II) that form the extracellular matrix.

Question 5

Describe the process of endochondral ossification.

Answer 5

Unlike intramembranous ossification, which is the other process by which bone tissue is created, cartilage is present during endochondral ossification.

Question 6

What is an osteoclast? How does it differ form an osteoblast/osteocyte?

Answer 6

Osteoblasts are the kind of bone cells responsible for the bone formation. It is also responsible for the mineralization of the bone structure. Osteoclasts are type of bone cells that removes bone tissue by removing the mineral matrix of the bone and dissolving the collagen part of the bone

Question 7

What is meant by the ‘Crystal Arthropathies’?

Answer 7

Crystal arthropathy is a class of joint disorder (called arthropathy) that is characterized by accumulation of tiny crystals in one or more joints.

Question 8

What are ‘loose bodies’ and ‘Heberden’s nodes’ and when would you find them?

Answer 8

Loose bodies are small loose fragments of cartilage or a bone that float around

These bony growths are generally found on the finger joints nearest the fingertip, also called the distal interphalangeal or DIP joints. Similar joint swellings located on the lower joint, the proximal interphalangeal or PIP, are called Bouchard’s nodes.

Question 9

What features do the seronegative arthopathies have in common

Answer 9

the presence in the blood of an antibody called rheumatoid factor.

Question 10

What is Reiter’s syndrome?

Answer 10

haracterized by arthritis, conjunctivitis, and urethritis, and caused by an unknown pathogen, possibly a chlamydia.

Question 11

What is infective Arthritis?

Answer 11

It may also be referred to as septic arthritis. It occurs when an infection caused by a bacteria or virus spreads to a joint or the fluid surrounding the joint. This fluid is called the synovial fluid. … Infectious arthritis usually only occurs in one joint.

Question 12

Describe Rheumatoid Arthritis in detail:

Answer 12

In rheumatoid arthritis, the body’s immune system attacks the joint lining (synovium), leading to cartilage and bone damage. If untreated, chronic joint inflammation can lead to permanent joint damage and deformity.
When someone has rheumatoid arthritis, the membranes around his or her joints become inflamed and release enzymes that cause the surrounding cartilage and bone to wear away.

Question 13

What is SLE?

Answer 13

Systemic lupus erythematosus (SLE) is an autoimmune disease. In this disease, the body’s immune system mistakenly attacks healthy tissue. It can affect the skin, joints, kidneys, brain, and other organs.

Question 14

What is psoriatic arthropathy?

Answer 14

Psoriatic arthritis (also arthritis psoriatica, arthropathic psoriasis or psoriatic arthropathy) is a type of inflammatory arthritis that will develop in between 6 and 42% of people who have the chronic skin condition psoriasis.

Psoriatic arthritis usually affects the distal joints (those closest to the nail) in fingers or toes. The lower back, wrists, knees or ankles also may be affected

Question 15

What is Ankylosing spondlyitis?

Answer 15

a form of spinal arthritis, chiefly affecting young males, that eventually causes ankylosis of vertebral and sacroiliac joints.

Ankylosis is an abnormal stiffening and immobility of a joint due to fusion of the bones.

Question 16

What are:

a) Osteogenesis imperfecta
b) Bone necrosis
c) Bone cysts

Answer 16

an inherited disorder characterized by extreme fragility of the bones.

Osteonecrosis is bone death caused by poor blood supply. It is most common in the hip and shoulder, but can affect other large joints such as the knee, elbow, wrist and ankle

A bone cyst is a fluid-filled hole that develops inside a bone. They can occur at any age, but most often affect children and young adults. Bone cysts don’t usually cause any symptoms. They are not cancerous and they do not usually pose a serious threat to health

Question 17

Explain the aetiology, signs and symptoms of:

a) Osteomyelitis
b) Paget’s disease of bone

Answer 17

Osteomyelitis is an infection in a bone. Infections can reach a bone by traveling through the bloodstream or spreading from nearby tissue. Infections can also begin in the bone itself if an injury exposes the bone to germs

Paget’s disease is a chronic disorder that can result in enlarged and misshapen bones. The excessive breakdown and formation of bone tissue causes affected bone to weaken—resulting in bone pain, misshapen bones, fractures, and arthritis in the joints near the affected bones.

Question 18

What are the causes, signs and symptoms of:

a) Hypercalcaemia
b) Hypocalcaemia?

Answer 18

Hypercalcaemia, also spelled hypercalcemia, is a high calcium (Ca2+) level in the blood serum. Hypo is low.

Caused by lack of or too much vitamin D and hypothyroidism.

Question 19

What is the difference between primary, secondary and tertiary hyperparathyroidism?

Answer 19

Primary - one parathyroid gland (or more) produces excess PTH. This may be asymptomatic.

Secondary - there is increased secretion of PTH in response to low calcium because of kidney, liver, or bowel disease.

Tertiary - there is autonomous secretion of PTH, usually because of chronic kidney disease (CKD).

Question 20

. What is an osteosarcoma?

Answer 20

a malignant tumour of bone in which there is a proliferation of osteoblasts.

Question 21

What is a chondrosarcoma?

Answer 21

Chondrosarcoma is a cancer composed of cells derived from transformed cells that produce cartilage. Chondrosarcoma is a member of a category of tumors of bone and soft tissue known as sarcomas.

Question 22

Describe:

a) Renal osteodystrophy
b) Rickets and osteomalacia
c) Osteopenia
d) Osteoporosis

Answer 22

Renal osteodystrophy is a bone disease that occurs when your kidneys fail to maintain proper levels of calcium and phosphorus in the blood. It’s common in people with kidney disease and affects most dialysis patients.

Osteomalacia (adults) and rickets (children) are caused by inadequate mineralisation of bone matrix. Vitamin D deficiency causes low calcium and phosphate, which lead to secondary hyperparathyroidism.

a medical condition in which the protein and mineral content of bone tissue is reduced, but less severely than in osteoporosis.

Osteoporosis is a disease where decreased bone strength increases the risk of a broken bone. It is the most common reason for a broken bone among the elderl

Question 23

. What is Achondroplasia?

Answer 23

a hereditary condition in which the growth of long bones by ossification of cartilage is retarded, resulting in very short limbs and sometimes a face which is small in relation to the skull.

Question 24

What is Ewing’s sarcoma?

Answer 24

Ewing’s sarcoma or Ewing sarcoma (/ˈjuːɪŋ/) is a malignant small, round, blue cell tumor. It is a rare disease in which cancer cells are found in the bone or in soft tissue. The most common areas in which it occurs are the pelvis, the femur, the humerus, the ribs and clavicle (collar bone).

Question 25

With reference to osteoporosis:

a) What are the changes in bone?
b) What are the symptoms?
c) What are the long term problems?
d) Are there any cures?

Answer 25

Osteoporosis, or porous bone, is a disease characterized by low bone mass and structural deterioration of bone tissue, leading to bone fragility

Symptoms and long term problems are Back pain, caused by a fractured or collapsed vertebra.
Loss of height over time.
A stooped posture.
A bone fracture that occurs much more easily than expected.

Calcium and Vit D important but no cures