Week 2 Flashcards
what is Rheumatoid Arthritis
Insidious onset.
Joint swelling.
Early morning stiffness >30mins.
Symetric.
Dramatic NSAID response.
Chronic, symmetrical, inflammatory, deforming, polyarthritis
1%.
Costly.
Pathology of Rhuematoid Arthritis
Unknown.
Genetic + environmental factors.
Primary site of inflammation = synovium.
TNFa
Secreted by macrophages.
Induces:
cyto/chemokines.
VEGF.
Metalloproteinase synthesis (enzymes that break down proteins - articular cartilage degradation)
Pannus
Inflammation and proliferation of the synovium leads to formation of PANNUS. Thus, destruction in bones/tendons/ligaments/vessels.
Hypertrophied synovium = Pannus.
Made of macrophage and mesenchymal cells.
Chronic Systemic Inflammation can lead to;
Early IHD.
Dementia.
Osteoporosis.
Pain sensitisation.
Sarcopenia (reduced muscle bulk).
Insulin resistance.
Test for Rheumatoid Arthritis
Anti-CCP Antibodies.
Rheumatoid Factor (RF).
ESR.
CRP.
CCP = Cyclic Citrullinated Peptide. nr = <15.
Citrulline is an AA created from altered Arginine.
RF proteins are produced by immune system that atk healthy tissue.
nr = <15iU/mL.
ESR range 0-22 (M) 0-29(F). Increased ESR associated w/ inflammation.
CRP icnreases IL-6 secretion from macrophages. nr = <8 mg/L.
RA Treatment
Disease-Modifying Anti-Rheumatic Drugs (DMARD’s).
- Methotrexate
- Leflunomide.
Methotrexate MOA: inhibits Nucleotide synthesis via DHF.
OsteoArthritis
Most common Joint Disorder.
Degenerative.
DIP and PIP typically in dominant hand.
Symptoms with Activity.
Risk Factors for OA
Female.
Age.
Genetic.
Obesity.
Oestrogen deficiency.
Pain in OA
Prostaglandins.
Synovitis.
Cytokines.
Muscle spasm.
Venous congestion.
Crystal Arthritis
Gout: Uric Acid Crystals.
Calcium Phosphate Disease: Calcium pyrophosphate Dihydrate (CPPD) crystals.
Chronic joint damage.
Most common in men.
Gout
Patho
Decreased Urate excretion OR
Increased Urate production. Resulting in Hyperuricaemia, crystal formation at the joint.
Alcohol increases purine catabolism in liver, producing lactate acid which can inhibit urea secretion via renal tubules.
Masses formed = Tophaceous
Decreased Urate clearance more common.
Podagra (gout affecting big toe).
Conditions that cause Hyperuricaemia
Lymphoma.
Leukaemia.
Haemolytic anaemia.
Psoriasis.
Comorbidites in Gout
Renal Impairment.
Coronary Heart Disease.
Metabolic Syndrome:
- Obesity
- Dyslipidemia
- HTX
- T2D
Contraindications in Gout
Furosemide.
Thiazide Diuretic.
Low-dose aspirin.
Cyclosporin.
Septic Arthritis
Joint pain & swelling.
Systemic symptoms.
Trauma, recent local infection, IV drug use.
Borders of Cubital Fossa
Lateral = Brachioradialis
Medial = Pronator Teres
Floor = Brachialis
Superficial Flexors of Forearm & Innervation
Pronator Teres
Flexor Carpi Ulnaris
Flexor Capri Radialis
Palmaris Longus
Medial Epicondyle.
Intermediate Flexors of Forearm
Flexor Digitorum Superficialis
Origin: Medial epicondyle & medial aspect of ulna.
Split attachment at the base of middle phalanx.
Deep Flexors of Forearm
Flexor Digitorum Profundus
Flexor Pollicis Longus
Pronator Quadratus
FDP = attaches at base of distal phalanx.
Innervation Forearm Flexors
Median nerve = All but 1/2 FDP
Ulnar Nerve = 1/2 FDP, FCU
Ulnar nerve and Artery track together and enter the wrist together.
Superficial Forearm Extensors
Ext. Carpi Radialis Longus
Ext. Carpi Radialis Brevis*
Ext. Carpi Ulnaris*
Ext. Digitorum*
Ext. Digiti Minimi*
Anconeus
Brachialis
* = CEO, Lateral epicondyle
Deep Extensors of Forearm
Supinator
Ext. Pollicis Brevis
Ext. Pollicis Longus
Abductor Pollicis Longus
Ext. Indicis
Innervation of Posterior compartment muscles
Forearm Extensors
Radial Nerve.
Lumbricals
Ulnar nerve.
Attached between Flexor Digitorum Profundus and Extensor Apparatus.
Flexion of MCP while balancing flexor and extensor function.
Muscles of Thenar Eminence & Innervation
Opponens Pollicis.
Abductor Pollicis Brevis.
Flexor Pollicis Brevis.
All innervated by Median nerve.
Deep Muscle of Thenar Eminence
Adductor Pollicis.
Ulnar nerve.
Interosseous Muscles
Palmar: Adductor of digits towards middle finger. From metacarpal, connecting to extensor apparatus.
Dorsal: Abduct, on both sides of metacarpal, attach to extensor apparatus.
Both innervated by Ulnar nerve.
PAD = Palmar ADDuct.
DAB = Dorsal ABduct.
Muscles of Hypothenar Eminence & Innervation
Opponens Digiti.
Abductor Digiti Brevis
Flexor Digiti Brevis.
Ulnar Nerve (C8-T1)
Median Nerve innervates what hand muscles
Thenar eminence except ADDUCTOR pollicis.
Radial 2 lumbricals.
Ulnar does the rest.
Blood Supply of the Hand
Arterial: Ulnar + Radial form Superficial and Deep Palmar Arches. Digital arteries bud off the arches.
Venous: Dorsal digital veins > Dorsal metacarpal veins > Dorsal Venous Arch > Cephalic and Basalic veins.
