Term
| Where is synovial tissue found? Not found? |
|
Definition
| Lining fibrous joint capsule, covers tendons & ligaments. Not on articular surfaces or menisci. |
|
|
Term
| What cell type coats the surface of synovial tissue? |
|
Definition
|
|
Term
| What are the 2 types of synoviocytes & how do they differ? |
|
Definition
Type 1 (A): Phagocytic cells, therefore ↑ lysosomes/vacuoles
Type 2 (B): Synthesizing cells (make hyaluronate), therefore ↑ RER |
|
|
Term
| Main component of synovial fluid? |
|
Definition
| Glycosaminoglycans, specifically hyaluronic acid |
|
|
Term
| Physical characteristics of normal synovial fluid? |
|
Definition
| Clear, highly viscous (like egg whites) |
|
|
Term
| Function of synovial fluid? |
|
Definition
| Lubricate articular cartilage & provide nourishment via diffusion |
|
|
Term
| 3 types of joint lubrication? + describe |
|
Definition
1)Boundary - molecular film very thin,
2)Weeping - pressure to cartilage causes fluid to weep out,
3) Boosted - fluid in peaks & valleys |
|
|
Term
| Characteristics of Inflammatory synovial fluid? |
|
Definition
| Increased vloume, low viscosity, cloudy yellow, increased WBCs/PMNs |
|
|
Term
| What type of synovial fluid would be found w crystal synovitis or RA? |
|
Definition
|
|
Term
| Characteristics of SEPTIC synovial fluid? |
|
Definition
| Increased volume, mixed viscosity, opaque, increased WBCs/PMNs, Gram + |
|
|
Term
| What type of joint is synovial? |
|
Definition
|
|
Term
| 2 layers of joint capsule in synovial joints? |
|
Definition
Outer=fibrous layer,
Inner=highly vascular synovial membrane |
|
|
Term
| Function of menisci in joints? |
|
Definition
| Fibrocartilagenous washer, aids in rotation stability. |
|
|
Term
| In which 3 joints would you find menisci? |
|
Definition
| Knee, radiocarpal joint, sternoclavicular. |
|
|
Term
| What does the Mucin Clot test test for and how? |
|
Definition
| Addition of acetic acid to normal joint fluid should cause all the hyaluronic acid (mucopolysaccharide) to clump into a mucin clot. In RA damage to the synovial cells causes decreased hyaluronate production & there is either no mucin clot or it just falls apart, making the lqd look cloudy. |
|
|
Term
| What mucopolysaccharide is found in the synovial fluid around joints & in the vitreous humor of eyes? |
|
Definition
|
|
Term
| What is hyperuricemia and why does it occur? |
|
Definition
| High concentration of uric acid in the blood due to overproduction or underexcretion. |
|
|
Term
| Which is more common, the overproduction or underexcretion of uric acid? |
|
Definition
|
|
Term
| 3 causes of uric acid overproduction? |
|
Definition
| 1)Ethanol, 2)Genetics, 3)Myeloproliferative disorders (ie psoriasis) |
|
|
Term
| How can renal insufficiency contribute to gout? |
|
Definition
| Underexcretion of uric acid. |
|
|
Term
| 4 drugs that can lead to underexcretion of uric acid? |
|
Definition
| Diuretics (CHF), low dose Aspirin, Heparin, Cyclosporine (transplant pts) |
|
|
Term
| When are women more susceptible to gout & why? |
|
Definition
| After menopause, estrogen has a uricosuric effect. |
|
|
Term
|
Definition
| 1)Asymptomatic Hyperuricemia, 2)Acute Gout, 3)Intercritical Gout, 4)Chronic Tophaceous Gout |
|
|
Term
| What causes pain in Acute Gout? |
|
Definition
| Precipitating uric acid crystals are being phagocytosed by WBCs causing an inflammatory cascade. |
|
|
Term
| During what phase is a good time to initiate uric acid lowering therapy? |
|
Definition
| Intercritical (eye of the storm) |
|
|
Term
|
Definition
|
|
Term
| What do gout crystals look like under the microscope? |
|
Definition
| Negatively bifringent (yellow when parallel to polarizing light), needle shaped, intracellular. |
|
|
Term
| What do pseudogout crystals look like under the microscope? |
|
Definition
| Positively bifringent (blue when parallel to polarizing light), rhomboid shaped |
|
|
Term
| What are pseudogout crystals made of? |
|
Definition
|
|
Term
| How does Chronic Tophaceous Gout present? |
|
Definition
| Polyarticular synovitis & Tophi on joints. |
|
|
Term
| What are the 4 most common sites to be affected by gout? |
|
Definition
| Big toe, heel, ankle, instep |
|
|
Term
| What attributes of septic arthritis aspirate differentiate it from that of gout? |
|
Definition
| Low glucose (vs normal), extra-cellular crystals |
|
|
Term
| What would aspirate of a tophus look like under microscope? |
|
Definition
| Gout crystals but no cells |
|
|
Term
| What is the most important disease to r/o when diagnosing gout & why? |
|
Definition
| Septic arthritis, can cause irreversible destruction of cartilage in 2 days |
|
|
Term
| What bacteria is most likely to grow in synovial fluid w extracellular crystals & WBC >80,000? |
|
Definition
|
|
Term
| What is contraindicated in acute gout? |
|
Definition
| Uric acid lowering agents |
|
|
Term
| Treatment choices for acute gout? |
|
Definition
| NSAIDs, Colchicine, Intraarticular Steroids, Systemic Steroids |
|
|
Term
| How does colchicine prophylaxis prevent gout attacks? |
|
Definition
| Keeps tubules from forming --> stops macrophages from dividing |
|
|
Term
| What are 4 situations that would indicate initiation of Uric Acid lowering therapy? |
|
Definition
| 1)Recurrent attacks (despite colchicine), 2)Uric acid stones (could be in kidney), 3)Tophi (could also be in kidney), 4)Prior to chemo (which lyses a ton o cells) |
|
|
Term
| Who would benefit from a Uricosuric agent? |
|
Definition
|
|
Term
| Which uric acid lowering therapy is indicated for an overproducer? |
|
Definition
| Xanthine Oxidase Inhibitor |
|
|
Term
| Is hypercalcemia a risk factor for pseudogout? |
|
Definition
|
|
Term
| 9 risk factors for pseudogout? |
|
Definition
| Hyperparathyroidism, hypothyroidism, diabetes, advanced age, acute illness, Wilson's disease, hemochromatosis, ochronosis, osteoarthritis |
|
|
Term
| 4 most common sites for pseudogout? |
|
Definition
| knee, ankle, wrist, shoulder |
|
|
Term
| Risk factors for Milwaukee Shoulder? |
|
Definition
| Old lady w severe chronic synovitis, Overuse & osteoarthritis in dominant arm, Rotator cuff tear |
|
|
Term
| What is Milwaulkee Shoulder (pathogenesis)? |
|
Definition
| Rapidly progressive destructive arthritis due to Calcium Hydroxy Apatite deposition, CHA crystals are phagocytosed --> inflammatory cascade |
|
|
Term
| How does the CHA that causes Milwaukee Shoulder get into the joint fluid in the first place? |
|
Definition
| Overuse & wear n tear shears it off bone |
|
|
Term
| What is the method of diagnosis for Milwaukee Shoulder? |
|
Definition
| CHA crystals on Electron Microscope |
|
|
Term
| Treatment for Milwaukee Shoulder? |
|
Definition
| NSAIDs, colchicine, aspiration, intra-articular steroids, rehab |
|
|
Term
| What is the only true "cure" for Milkwaukee Shoulder? |
|
Definition
| Rotator cuff repair &/or complete shoulder replacement |
|
|
