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ELM2 - pathology > tutorial 2 - bone & joint disease > Flashcards

tutorial 2 - bone & joint disease Flashcards

1
Q

What are the 3 key components of a normal joint?

A

Cartilage, synovium, supporting ligaments/joint capsule

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2
Q

What are the 4 key causes of painful joints (arthritis)?

A
  1. Gout/gouty arthritis
  2. Osteoarthritis
  3. Rheumatoid Arthritis
  4. Septic Arthrtis
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3
Q

What is the most common type of joint disease?

A

Osteoarthritis

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4
Q

What has the strongest association with OA?

A

Advancing age

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5
Q

Which joints are most affected by osteoarthritis?

A

weight bearing joints - knee, hips, lumbar spine, etc.

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6
Q

What is the pathogenesis of osteoarthritis?

A

Altered chondrocyte homeostasis with overactivity of degrading enzymes. This leads to a decrease in proteoglycans and type II collagen, resulting in degradation of cartilage

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7
Q

What are the effects of OA on the joint space, as seen on xray?

A

Narrowing of the joint space

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8
Q

What are the 5 key pathological changes seen with osteoarthritis?

A
  1. Fibrillation of cartilage
  2. eburnation (ivory bone)
  3. sclerosis
  4. subcondral cysts
  5. Osteophytes
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9
Q

What is cartilage fibrillation?

A

Process that occurs in OA where chondrocytes proliferate and then die causing fraying of the cartilage surface

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10
Q

What is eburnation?

A

In OA, a bone end that is devoid of cartilage getting polished by the grinding action of bone on bone.

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11
Q

What is bone sclerosis in OA?

A

When bone underneath areas of lost cartilage become more dense, likely to compensate for changes in weight distribution

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12
Q

What are subchondral cysts?

A

In OA, small cysts that form in the head of the bone when fluid is forces into cracks in the bony surface and become surrounded by a fibrous capsule.

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13
Q

What are osteophytes?

A

Mushroom shaped bony outgrowths that develop at the margins of articulating bones in OA

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14
Q

What is the name for osteophytes of the distal interphalangeal joints in osteoarthritis?

A

Heberden nodes

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15
Q

What is the name for osteophytes of the proximal interphalangeal joints in osteoarthritis?

A

Bouchard nodes

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16
Q

What are the treatments for OA?

A

Physiotherapy, analgesia, modified activity, joint replacement

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17
Q

Which joints tend to be involved in rheumatoid arthritis?

A

small joints of hands, feet, wrists, elbows, ankles, knees

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18
Q

What are the 2 most common antibodies present in patients with RA?

A

Rheumatic Factor (RF), Anti Cyclic Citrullinated Peptides (Anti CCPs)

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19
Q

What gene is related to susceptibility to RA?

A

HLA (human leukocyte antigen) gene

20
Q

What environmental factors can exacerbate or initiate the autoimmune response in rheumatoid arthritis?

A

Smoking, infection

21
Q

What activates the initial inflammatory synovitis in patients with RA?

A

Antigen bound to MHC is presented to T helper cells, which produced cytokines to recruit macrophages and plasma cells to the synovium

22
Q

What are the role of activated and lymphocytes and macrophages in the pathogenesis of RA?

A

They produce TNF which stimulates proliferation of fibroblasts, synovial cells and chondrocytes which proliferate and secrete proteolytic enzymes that destroy cartilage. Also, T cells activated osteoclasts leading to bone resorption

23
Q

What is the term for the chronically inflamed, thickened synvovium in RA?

A

Pannus

24
Q

What cells activated osteoclasts triggering bone resorption in RA?

A

T cells

25
Q

What is the role of citrullination of proteins in the RA pathogenesis?

A

Proteins are citrullinated, making them foreign to the immune system, meaning they are attacked by lymphocytes.

26
Q

What is the role of TNF in RA pathogenesis?

A

It is released from activated macrophages and stimulates chondrocytes and synovial cells to secrete proteases which destroy cartilage

27
Q

What are the components of the pannus?

A

thickened synovium, granulation tissue, fibrosis, inflammatory cells

28
Q

What is the term for bone end fusion, as seen in rheumatoid arthritis?

A

Ankylosis

29
Q

What are some of the systemic complications of RA?

A

anaemia of chronic inflammation, fatigue, weight loss, subcutaneous rheumatoid nodules

30
Q

What are the typical hand deformities seen in RA?

A

Radial deviation of wrist, ulnar deviation of the fingers,

31
Q

What finger joint deformities are seen in RA?

A

Boutonnière deformity, Swan neck deformity

32
Q

What are the classes of pharmacological RA treatments?

A

NSAIDs, DMARDs, glucocorticoids

33
Q

What is osteomyelitis?

A

Inflammation of the bone marrow

34
Q

What is pyogenic osteomyelitis?

A

When a pyogenic bacteria infects the bone shaft resulting in pus production and increased pressure inside the bone.

35
Q

What is the involucrum in osteomyelitis?

A

New bone laid down under the periosteum and over the dead bone underneath

36
Q

What is the sequestrum in osteomyelitis?

A

Dead bone resulting from pressure in the marrow or loss of blood supply

37
Q

What leukocyte will be prevelant in histology of osteomyelitis?

A

Neutrophils

38
Q

What is gout?

A

Arthritis initiated by deposition of urate crystals within and around joints

39
Q

What is primary gout?

A

Gout caused by excess uric acid of an unknown cause

40
Q

What is secondary gout?

A

Gout caused by conditions that lead to increased production of uric acid or decreased excretion of uric acid

41
Q

What is acute gout?

A

When urate crystals precipitate within the joint triggering an acute inflammatory reaction.

42
Q

Why does gout usually occur in peripheral joints?

A

Because the synovial fluid has a lower temperature, making it easier for the crystals to precipitate

43
Q

What joint is most commonly affected by gout?

A

First metatarsophalangeal joint (great toe)

44
Q

What is the pathogenesis of chronic gout?

A

With repeated attacks of acute gout, urate crystals eventually deposit in the synovial membrane creating tophi. This triggers a chronic inflammatory reaction causing pannus formation and bone destruction.

45
Q

What are the findings upon aspiration of synovial fluid in a patient with septic arthritis?

A

Cloudy, yellow, contains bacteria, neutrophils

ELM2 - pathology (19 decks)

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