Term
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Definition
| Study of arthritis and allied conditions including connective tissue disease and other inflammatory, degenerative and metabolic disorders of musculoskeletal system |
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Term
| What are the incidences of arthritis |
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Definition
43 Million Americans
1 million cases Annually
3rd leading cause of work limitations in the US
Rates is greater for women |
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Term
| Which state has the highest incidence? The lowest? |
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Definition
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Term
| What are two risk factors for arthritis? |
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Definition
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Term
| What are the three types of joints? |
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Definition
| Synarthrodial/fibrous, cartilaginous/amphiarthorsis, and synovial/diarthrodial |
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Term
| Characteristics of Synarthodial/fibrous joints |
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Definition
little or no movement, ie skull bones
-lack a joint cavity |
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Term
| Cartilaginous/amphiarthrosis joints |
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Definition
| Bones joined by cartilage i.e. intervertebral disk |
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Term
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Definition
| most affected by rheumatoid diseases. These are freely moveable joints |
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Term
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Definition
| most affected by rheumatoid diseases. These are freely moveable joints |
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Term
| Blood and nerve supply of synovium |
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Definition
-does not cover articulating cartilage
-good blood supply to the synovial membrane
-innervated only by autonomic fibers to vessels |
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Term
| What are the two layers of the synovium and their functions |
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Definition
subintimal- vascular, has mast cells, macrophages
intimal (A cells - remove bacteria;
B cells - secrete hyaluronic acid) |
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Term
| What produces the synovial fluid (superfiltrated plasma) |
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Definition
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Term
| Characteristics of synovial fluid |
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Definition
clear, straw colored
thick- viscosity 50-200x water
Function of hyaluronic acid
Consistency of egg white
lubricates joint - reduces friction
source of nutrients for articulating artilage |
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Term
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Definition
Acetic Acid added to synovial fluid
a. Forms a ppt with hyaluronic acid
b. poorer clot formed with more inflammation since hyaluronic acid reduced by lysosomal action
c. color of fluid becomes cloudier with increased inflammation |
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Term
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Definition
layer of hyaline cartilage that covers and protects the ends of each bone
Properties: not static, undergoes turnover maintained by chondrocytes
-reduces friction in joint and distributes forces
-cartilage composed of chondrocytes, collagen, proteoglycans, protein and water
-property of resiliency |
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Term
| Cartilage may wear down when... |
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Definition
-it has no blood supply in adults
-body changes occur with aging as in osteoarthritis |
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Term
| joint inflammation can result in... |
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Definition
-increased synovial fluid (overproduction)
-vascular phase of inflammation takes place in synovium --Rheumatoid arthritis |
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Term
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Definition
| Precipitation of urate crystals |
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Term
| Systemic Lupus Erythematosus (SLE) |
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Definition
| damage of connective tissues of lungs, kidneys, blood vessels |
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Term
| Pathogenesis of Joint inflammation |
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Definition
1. Involves immune system components, plasma factors and other small molecular mediators
2. Exduate inflammation predominates followed by degeneration
-can get extensive formation of fibrous tissue that limits movement |
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Term
| Characteristics of a non-inflammatory joint disease vs inflammatory |
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Definition
1. Reduced or absent synovial membrane inflammation
2. lack of systemic signs and symptoms
3. Near normal synovial fluid |
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Term
| Most prevalent non-inflammatory disease (#1 form of arthritis in the U.S. over 27 million) |
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Definition
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Term
| Pathological features of osteoarthritis |
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Definition
1. degeneration and loss of articulating cartilage in synovial joints
Two categories:
Primary (idiopathic) - no known factors, most common, aging most important factor
b. Secondary - risk factors (joint, stress, trauma) |
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Term
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Definition
Primary loss of articulating cartilage (becomes yellowish grey), more water and less proteoglycans.
Cartilage loses glistening appearance, increase breakdown of collagen (bone left unprotected). Bone becomes sclerotic (dense and hard).
Cysts may develop in bone (synovial fluid leaks into bone), osteophytes (bone spurs) can grow out of the joint.
Articulating cartilage probably lost through enzymatic breakdown (cytokines IL 1 and TNF) which produce/release proteases |
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Term
| The loss of ________ from articulating cartilage is hallmark of osteoarthritic process. |
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Definition
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Term
Summary of pathologic characteristics:
-Erosion of _________________
-Sclerosis _______underneath cartilage
-formation of ________________ |
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Definition
| of articulating cartilage; of bone; bone spurs (osteophytes) |
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Term
| What is the 1st symptom of DJD (clinical manifestation) |
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Definition
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Term
| True/False: Synovial fluid usually free of inflammation in DJD |
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Definition
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Term
| Signs to look for during diagnosis based on clinical and radiological findings of DJD |
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Definition
| see cystic bone changes, ostephytes, sclerosis |
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Term
| Inflammatory joint disease is commonly termed _______ and characterized by inflammatory damage or destruction of ______, _____, and __________. |
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Definition
| arthritis; synovial membrane, articulating cartilage; systemic signs of inflammation |
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Term
| Rheumatoid arthritis - A _______ ________ autoimmune disease. |
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Definition
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Term
| Probably rheumatoid arthritis is a _______group of disorders in which _______of multiple joints is a major manifestation. |
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Definition
| heterogeneous; inflammation |
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Term
| Although many patients have systemic manifestations, the most common manifestation is ____ involvement. |
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Definition
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Term
| RA (rheumatoid arthritis) have _______ _________ of collagen. |
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Definition
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Term
| RA is characterized by ______ deformalities and _______ - accompanied by pain |
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Definition
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Term
| True/False: RA is more common in men |
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Definition
| False; more in women (2.5-3 :1 ratio during childbearing years) |
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Term
| True/false: onset of RA is exacerbated |
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Definition
| False; insidious and may be acute |
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Term
| True/false: RA occasionally goes into remission spontaneously or in response to treatment |
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Definition
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Term
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Definition
| no single agent available, combination of genetics and environment |
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Term
| Possible sources of RA (bacterial or viral agents) |
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Definition
Epstein-Barr virus (EBV)
Parvovirus infection (small dna viruses)
Bacteria and mycoplasms |
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Term
| Etiology of RA (genetics+ immunity) |
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Definition
| Some immune response that is unidentifiable in genetically susceptible individuals. Activates help T cells, release cytokines. Eventually, get antibody formed to reach with fragments of normal antibodies. |
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Term
| In etiology of RA, transformed autoantibodies IgG and igM and some igA are termed _____ - and form immune complexes |
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Definition
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Term
| RA is what type of injury? (type) |
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Definition
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Term
| RA have a ________ production of antigenic material that chronically stimulate the immune response. |
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Definition
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Term
| True/false: Anti-proteoglycan antibodies also have been demonstrated in synovial fluid of patients with RA. |
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Definition
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Term
| Which two compoents can be used to distinguish two aspects of synovial inflammation? |
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Definition
| synovial fluid and membrane |
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Term
| Synovial fluid phase comprised predominately of _______ which phagocytize immune complexes and release many _____. ___ is also in constant supply. |
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Definition
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Term
| Synovial membrane- perivascular infiltration with _____ and a striking accumulation of new blood vessels (angiogenesis) |
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Definition
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Term
| Ultimately transform to a granulation tissue (______) that covers articulatng cartilage |
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Definition
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Term
| This tissue is rich in inflammatory cells that secrete _______ and various mediators of __________ to destroy cartilage and bone. Eventually leads to joint instability and muscle atrophy |
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Definition
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Term
| In synovitis (synovial inflammation), monocytes/macrophages and fibroblasts release ______ and chemotactic factors to resorb bone |
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Definition
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Term
| In synovitis (synovial inflammation), ______ from diminished blood flow (loss of functional synovial membrane-vascularity decreased as a granulation tissue and fibrosis develops) causes _______, which stimulates hydrolytic enzymes and cause more damage. |
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Definition
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Term
| In synovitis (synovial inflammation),Immune complexes - contain RF- play a major role in _________ of the immune response. |
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Definition
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Term
| In synovitis (synovial inflammation), amplification of immune response leaks to proliferative synovitis - serves as ____ |
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Definition
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Term
| PMN amplification of inflammatory condition lead to what? |
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Definition
| aggregation, degranulation, and superoxide generation |
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Term
| Inflammatory pathways activated by synovitis (synovial inflammation |
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Definition
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Term
| Constitutional symptoms (systemic disease) of RA |
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Definition
| fatigue, anemia, fever, wt loss |
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Term
| Symmetrical polyarthritis |
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Definition
| pain at rest and with motion |
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Term
| Clinical manifestation of RA: major complaint - morning stuffness for more than _____ mins |
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Definition
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Term
| In RA, ___ can result. Joints may become ankylosed. Loss of _________ from pain and swelling (early) and from _____ (later) |
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Definition
| deformity;mobility;fibrosis/sclerosis |
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Term
| in RA clinical manifestation, ______ disease (associated systemic manifestation >20%) |
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Definition
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Term
| In RA clinical manifestation, Subcutaneous ______ ______ (granulomas) in 15-50% of patients. |
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Definition
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Term
| True/false: extra-articular disease is correlated with persistent joint inflammation and high titers of RF |
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Definition
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Term
| ____% of patients have circulating immune complexes and auto antibodies in serum. |
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Definition
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Term
| Presence of ______ factor helpful test although not positive RF, not seen in 30% of patients with RA |
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Definition
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Term
| How many diagnostic criteria is needed out of 7 to classify as RA? What are the 7 criterias? |
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Definition
| 4; examine immune complexes and autoantibodies in serum, presence of RF factor, anemia, elevated ESR, synovial fluid viscosity, radiological features (narrower joint) |
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Term
| Which one of these dieases is osteophytes found? RA or osteoarthritis? |
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Definition
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Term
| Pannus is present in which disease (RA or osteoarthritis) |
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Definition
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