Rheum E1 -Intro

Bones regulate and store _______ & _______

Calcium & Phosphate

What composes the inorganic portion of bone matrix?

Hydroxyapatite

What acts as the "cement" in the organic component of bone matrix?

Hyaluronic acid (proteoglycans)

What bone cell:

AKA stem cells, precursors for future osteoblasts found in lining of bone

Osteoprogenitor cells

What bone cell:

Responsible for ossification, made up of type 1 collagen & hyaluronic acid

Osteoblasts

What bone cell:

Derived from mesenchymal osteoprogenitor cells forming an osseous matrix, in which it becomes enclosed as an osteocyte

Osteoblasts

What bone cell:

Found in lacunae, have cytoplasmic processes that extend into the canaliculi and make contact with each other via gap junctions

Osteocytes

What bone cell:

Bone absorption

Osteoclasts

What bone cell:

Large multi-nucleated cells with acidophilic cytoplasm that remove old bone from large "resorption pits"

Osteoclasts

What is collagen?

extracellular matrices that provide scaffolding of tissues and serve as a plethora of receptors and cell-matrix signal interactions

Two major types of extracellular matrices in connective tissue:

Interstitium, Basement membrane

Interstitium or Basement membrane:

Made of mesenchymal cells and forms stroma of organs

Interstitium

Interstitium or Basement membrane:

Thin and sheet-like, comprised of endothelial and epithelial cells, surround nerve and muscle cells

Basement membrane

Which collagen type is found in basement membranes?

IV

Which collagen type is found in skin, tendon, and bone?

I

Which collagen type is found in hyaline cartilage?

II

Which collagen type is found in blood vessels and parenchymal cells?

III

Which collagen type is found in smooth muscle?

V

What is another name for stroma?

Collagens

What is another name for scaffold?

Elastin

What is Elastin?

insoluble protein polymer comprised of tropoelastin, microfibrils, and fibrilin

What work as adhesion molecules?

Glycoproteins

What is the major structural glycoprotein?

Fibronectin

What functions as "multi-purpose glue" binding extracellular matrix components together?

Proteoglycans

What are the 4 classes of interstitium/extracellular macromolecules?

Collagens, Elastin, Glycoproteins, Proteoglycans

What is cartilage?

Non-vascular, rigid connective tissue matrix

What cell types make up cartilage?

Chondroblasts, Chondrocytes

What is perichondrium?

Outer layer surrounding cartilage

What are the 3 types of cartilage?

Hyaline, Elastin, Fibrin

What type of cartilage:

Articular cartilage that lines joints

Hyaline

What type of cartilage:

Mixture of cartilage and fibrous tissue that forms syndesmoses (ie pubic symphysis

Fibrin

What type of cartilage:

Has the ability to repair itself in response to injury

Fibrin

What type of cartilage:

Only found in ligamentum nuchae of the human C-spine & rib cage; common in other mammals

Elastin

What joints have no movement?

Fibrous (Synarthrodial)

What joints have minimal movement?

Cartilaginous (Amphiarthrodial)

What are freely moveable joints?

Synovial (Diarthrodial)

What type of joints have no cartilage lining, such as the cranium & distal tib-fib?

Fibrous (Synarthrodial)

What type of joints are ostochondral joints, pubic symphysis, and spine?

Cartilaginous (Amphiarthrodial)

What is the purposed of the synovial capsule?

surround and nourish joints

What is the purpose of bursa?

shock absorption; prevent sheering

What is Synovial fluid?

Lubricant/nutritional fluid in joint capsule

What is the primary purpose of synovial fluid?

Promote ROM, Reduce friction

What are the two types of synoviocytes?

Type A, Type B

Type A or Type B synoviocytes:

Phagocytose actively cell debris & waste in joint cavity; can be considered resident macrophages

Type A

Type A or Type B synoviocytes:

Involved in nutritional production of specialized matrix constituents including hyaluronan, collagens, and fibronectin

Type B

Which synovial fluid classification:

transparent, clear, high viscosity, <200 WBC, - cultures, <3.5 mL, <25% PMN

normal

Which synovial fluid classification:

transparent, yellow, high viscosity, 0-2,000 WBC, - cultures, <25% PMN, >3.5 mL

noninflammatory

Which synovial fluid classification:

translucent/opaque, yellow-clear, low viscosity, 2-100 k WBC, >50% PMN, - cultures, >3.5 mL

Inflammatory

Which synovial fluid classification:

opaque, yellow/green, variable viscosity, 15-100 k WBC, >75% PMN, + cultures, >3.5mL

Septic

Which synovial fluid classification:

bloody, red, variable viscosity, 200-2000 WBC, 50-75% PMN, - cultures, >3.5 mL

Hemorrhagic

What type of crystal is fine, needle-like, and negatively (yellow) birefringent?

Monosodium urate (gout)

What type of crystal is short, rhomboid, and positively (blue) birefringent?

Calcium pyrophosphate (pseudogout/CPPD)

What type of crystal is translucent and appears as stacked panes of glass?

Cholesterol (HLD)

What type of crystal is bipyrimidal (irregular) and positively birefringent?

Calcium oxalate (HPTH, myositis ossificans)

What type of crystal cannot be seen without EM or Alizarin red stain?

Hydroxyapatite (Milwakee shoulder)

What is classified as acute joint pain?

< 1 month

What is classified as chronic joint pain?

> 1 month

Monoarticular

1

Oligoarticular

4

Polyarticular

5+

Inflammatory or Noninflammatory:

Pain worse in AM

Inflammatory

Inflammatory or Noninflammatory:

Cold joints

Noninflammatory

Inflammatory or Noninflammatory:

Morning stiffness >1 hour

Inflammatory

Inflammatory or Noninflammatory:

No systemic signs

Noninflammatory

Articular or Periarticular:

Mostly joint or synovial region

Articular

Articular or Periarticular:

Mostly enthesis- tendon, ligament, muscle, nerve

Periarticular

Articular or Periarticular:

Diffuse, deep pain

Articular

Articular or Periarticular:

Point tenderness

Periarticular

Articular or Periarticular:

Pain on active & passive ROM

Articular

Articular or Periarticular:

Pain on active ROM

Periarticular

Muscle strength: trace (flicker) movement

1/5

Muscle strength: able to move with gravity

2/5

Muscle strength: able to move against gravity but not resistance

3/5

Muscle strength: able to oppose gravity and resistance

4/5

What are the 3 C's of joint fluid aspiration?

Cell count (w/ diff), Crystal analysis, Culture & sensitivities

What is the first step when evaluating pts?

*done prior to xray or labs

arthrocentesis

What should you always make sure to do prior to administering a therapeutic joint injection?

Drain joint fluid completely

When should you not do an arthrocentesis?

overlying cellulitis, wound, bacteremia

When should you not inject steroids into a joint?

suspected infxn or hemarthrosis

What are serologies?

blood tests

What are Immunoassays used for?

detect the interaction between an antibody and antigen in a controlled lab setting (in vitro)

What type of immunoassay is used for RF?

Hemagglutination

What type of immunoassay involves staining patterns of ANA antibodies?

Immunofluoresence

What type of immunoassay involves DNA testing?

Immunoblotting

What type of immunoassay observes for precipitins among antibody-antibody diffusion in agar wells (ie Ouchterlong analysis)?

Immunodiffusion

What type of immunoassay separates particles according to their electrical charge (IPEP, EPEP)?

Counter electrophoresis

What type of immunoassay is used for Lyme and HIV?

Enzyme Linked Immunoabsorbant (ELISA)

What are the 5 immunoglobulins?

MADGE: IgM, IgA, IgD, IgG, IgE

When determining levels of acute phase reactants (ESR, CRP), how do you account for gender and age?

Divide age by 2, and for women add 10 to final result

What diseases can cause elevated ACE levels?

Sarcoidosis, ILD, Leprosy

What disease can cause low ACE levels?

Scleroderma (endothelial injury)

What antibody is most specific for RA and should be drawn first?

Anti-CCP

Anti-CCP antibodies may develop ______ before joint symptoms appear

Years

What are Anti-neutrophilic cytoplasmic antibodes (ANCA)?

Group of antibodies that bind to enzymes present in the cytoplasm of neutrophils

P-ANCA is what antibody?

Anti-MPO antibody

C-ANCA is what antibody?

Anti-PR3 antibody

How are results of ANA reported?

Doubling titers & Patterns of immunofluoresence

ANA titers ≥_______ are positive in most labs

1:80

ANA titers ≥_______ correlate strongly with autoimmune disease

1:320

T/F: ANA does NOT correlate with disease activity

True