Week 12 - Arthritis Flashcards
What are a group of long-term conditions marked by widespread inflammation in blood vessels and damage to connective tissue?
Systemic Autoimmune Rheumatic
What (3) things have a shared immune-mediated pathogenesis?
- Rheumatoid arthritis
- systemic lupus erythematosus
- systemic sclerosis
Is rheumatoid arthritis (RA) acute or chronic autoimmune disease?
Chronic autoimmune disease
Does RA affect women or men more?
women by 2.5x higher
What is the Peak incidence age of RA?
40-50 years
What is the etiology of RA?
Genetic predisposition initiated by an immunologic trigger
In RA, the immune response in leads to what (2) things?
- Synovial inflammation
- Destruction of the joint architecture
RA is initiated by what type of cells?
Helper T-cells
- local release of inflammatory mediators and cytokines that destroy the joint.
What (3) things are attracted to the area to initiate damage to joint cartilage in RA?
- Neutrophils
- Macrophages
- Lymphocytes
What are the (3) stages of pathogenesis for RA?
1) Initiated by helper T cells, local
release of inflammatory mediators
and cytokines that destroy the joint
2) Formation of antibodies
3) Anticyclic citrullinated peptide
(anti-CCP) antibodies
70-80% of people with RA have?
rheumatoid factor (RF)
Why do synovial cells & sub synovial tissues in RA undergo reactive hyperplasia? (Enlargement)
Occurs due to increased blood flow and
capillary permeability caused by inflammation
What occurs in the synovial membrane after reactive hyperplasia happens?
Angiogenesis
Angiogenesis in the synovial membrane leads to?
Formation of pannus, a type of tissue that forms in the joint and can damage the bone
The pannus spreads from?
The joint lining to the exposed bone area
Pannus contains what kind of cells
that destroy adjacent cartilage and
bone?
Inflammatory cells
Eventually, the Pannus develops
where and leads to decreased joint motion and possible ankylosis?
between the joint margins
As RA progresses, structural
changes lead to what (4) changes?
- joint instability
- muscle atrophy from disuse
- stretching of the ligaments
- involvement of tendons &
muscle
Articular (Joint) Manifestations of RA include? (3)
- Affects joints symmetrically
- Joint pain and stiffness
- Limited joint movement
Extra-articular (Systemic) manifestations of RA include?
- Rheumatic nodules
- Vasculitis – uncommon
- Dryness of eyes, mouth, mucous membranes (advanced)
- Eye changes due to scleral nodes
What are Early symptoms of extra-articular (systemic) RA? (3)
fatigue, weakness, anorexia and
weight loss due to systemic
inflammation
What is elevated and correlate with amount of RA disease activity?
ESR (Erythrocyte Sedimentation Rate) and CRP (C-reactive protein)
both tests used to measure inflammation in the body.
Rheumatic nodules form over where?
Pressure points
In physical exam for RA, what are (4) signs of RA?
- Joint- swelling tenderness
- Warmth
- Reduced motion
- Soft spongy feel
What would you see on the lab tests for RA?
- Positive RF & anti-CCP antibodies in lab tests
- ESR, CRP elevated
What are (4) Treatment plans for RA?
- Education about the disease and treatment
- Physical rest
- Therapeutic exercises , splints
- Medications
What is AKA degenerative joint disease?
Osteoarthritis
What is the most prevalent type of joint disease?
Osteoarthritis
(2) types of osteoarthritis?
- Primary (idiopathic) disorder - Unknown cause
- Secondary OA due to known underlying cause
Is osteoarthritis a single factored or multifactorial disease?
Multifactorial disease
(5) risk factors for OA?
- Family history
- Age
- Ethnicity
- Gender- female > male
- Obesity
What is the role of cartilage in joints?
Cartilage acts as a smooth weight-bearing surface, helping the joint move easily
How does cartilage, combined with synovial fluid, affect joint movement?
When combined with synovial fluid, cartilage provides very low friction, allowing smooth movement of the joint.
How does cartilage help in distributing mechanical stress in joints?
Cartilage transmits mechanical load down to the bone, helping to disperse the mechanical stress
What is a joint change related to articular cartilage in OA?
There is a gradual loss of articular cartilage.
What happens to the subchondral bone in joints in OA?
The subchondral bone becomes thicker.
What are bony outgrowths that form at the joint margins?
Osteophytes
What type of inflammation occurs in the synovial membrane from OA?
Mild synovial inflammation occurs
OA results in (4)?
- Joint pain
- Stiffness
- Limitation of motion
- Possible joint instability & deformity
What is the main cause of osteoarthritis (OA)?
“wear and tear” on the joints.
What changes occur in the cartilage during OA?
There are significant changes in both the composition and mechanical properties of cartilage.
What happens to chondrocytes in OA?
Chondrocyte injury occurs, leading to the release of cytokines.
How does chondrocyte injury affect cartilage?
It predisposes chondrocytes to additional injury and impairs their ability to maintain cartilage production and repair damage.
What early structural change occurs in chondrocytes in OA?
Chondrocytes enlarge and reorganize.
What happens to the cartilage surface in OA?
The cartilage loses its smooth surface, and cracks or micro-fractures occur.
What happens to the articular cartilage in OA?
Portions of the articular cartilage become eroded, and the exposed subchondral bone becomes thickened and polished (eburnation).
What are “joint mice” in OA?
Fragments of cartilage and bone become dislodged, creating free-floating osseocartilaginous bodies that enter the joint cavity.
What can happen to synovial fluid in OA?
Synovial fluid may leak through defects in cartilage, forming cysts.
What happens to the subchondral bone in OA?
The subchondral bone becomes sclerotic due to increased pressure on the joint surface.
What are osteophytes in OA?
Osteophytes, also known as spurs, are abnormal bony outgrowths that occur at the joint margins.
What effect does trauma to the synovial membrane have in OA?
Trauma to the synovial membrane results in nonspecific inflammation.
What are the most frequently affected joints? (2)
Hands- proximal (Bouchard’s node) and distal joints (Heberden’s node)
Heberden’s and Bouchard’s nodes are often described as? (3)
red, swollen, and tender
Does cause Heberden’s and Bouchard’s nodes cause significant loss of function?
No, but distress because of the visible disfigurement
What deformity is commonly seen in knee OA?
Joint malalignment, causing a bow-legged appearance and gait due to cartilage loss in the medial compartment.
How is OA diagnosed? (3)
history and physical exams, x-ray studies, and lab findings that exclude other diseases.
Is there a cure for OA?
No
What is the treatment for OA based on?
Symptoms presenting
Is physical rehab is part of the treatment plan for OA?
Yes
What surgical treatments might be considered for OA?
may include arthroscopy, joint replacement, osteotomies, and spinal decompression.
