Intro to Rheum

osteoprogenitor cells

Stem cells that lie within the lining of bone

Precursors to osteoblasts

Build bone

Osteoblasts

Osteocytes lie in a ______ and extends into _______

lacunae, canaliculi

Bone absorption

Osteoclasts

Connective tissue think

Cartilage/collagen

Connective tissue is comprised of

Extracellular matrices

2 types of matrices

Interstitium and basement membrane

Function of basement membrane

Mechanical support, filtration barrier

4 classes of interstitium

Collagen

Elastin

Glycoproteins

Proteoglycans

5 types of collagen

1 skin, tendon, bone

2 hyaline cartilage

3 blood vessels, parenchymal

4 basement membrane

5 smooth muscle

Insoluble protein comprised of micro fibrils and fibrillin

Elastin

Function of proteoglycans

Multi-purpose glue

What cells make up cartilage

Chondroblasts and chondrocytes

Cartilage is surrounded by an outer layer called:

Perichondrium

3 types of cartilage

Hyaline

Fibrocartilage

Elastin

Articular cartilage that lines the joints

Hyaline

Mixture of cartilage and fibrous tissue that forms pubic symphisis

Fibrin

Elastin is only found in

Ligamentum nuchae of c spine and ribs

Name the cartilage found in each joint: fibrous, cartilaginous, and synovial

Fibrous: none (connective tissue)

Cartilaginous: hyaline cartilage & ligaments

Synovial: hyaline and synovial fluid

Enthesis

Direct insertion of ligament or tendon into bone

Synovial fluid is secreted by _____ in the _____

Synoviocytes, synovium

Type A vs B synoviocytes function

A: phagocytosose activity

B: nutrition production of hyaluronan, collagen, and fibronectin

Fine needle line, yellow crystal

Monosodium urate (gout)

Short, rhomboid blue crystals

Calcium pyphosphate

Translucent crystal that appears as stacked panes of glass

Cholesterol

Bipyramidal crystals

Calcium oxalate

What type of crystals cannot be seen without EM or alizarin stain

Hydroxapatite

Inflammatory vs non-inflammatory pain

Inflammatory: AM, swelling, warmth

Non inflammatory: PM, cold

Articular vs Periarticular Joint Pain

Articular: joint/synovial region, deep pain

Periarticular: enthesis (tendon/ligamnet/muscle) point tenderness

Rhematic S/S

-eye problems

-skin/nail changes

-fever/weight loss

-myalgias

Muscle Strength Grading

0= no movement

1= flicker movement

2= able to move with gravity

3= able to move against gravity but not resistance

4= able to oppose gravity and resistance

5= normal strength

3 C’s of arthrocentesis

Cell count

Crystal analysis

Culture & sensitivities

When is arthrocentesis indicated?

-joint swelling

-infection

-crystalline arthritis

-therapeutic injections

What do you need to do before a therapeutic injection

Drain joint fluid !!

When is arthrocentesis contraindicated?

-no steroids with infection

-cellulitis

-coagulation disorders

-DM

-prosthetics

-inaccessible joints

Rule of 3

3 injections in a joint per year

Where will fluid migrate in the knee

Superior and laterally