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  /Title (26-pathophysiology-of-the-msk-system.pdf)
  /Creator (Cheatography)
  /Author (bee.f (bee.f))
  /Subject (26 Pathophysiology of the MSK System Cheat Sheet)
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    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{26 Pathophysiology of the MSK System Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{bee.f (bee.f)} via \textcolor{DarkBackground}{\uline{cheatography.com/180201/cs/37968/}}}
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  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}bee.f (bee.f) \\
  \uline{cheatography.com/bee-f} \\
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  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Published 13th April, 2023.\\
   Updated 13th April, 2023.\\
   Page {\thepage} of \pageref{LastPage}.
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  Measure your website readability!\\
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\begin{document}
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\begin{multicols*}{2}

\begin{tabularx}{8.4cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{8.4cm}}{\bf\textcolor{white}{Introduction}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{{\bf{What is pathologic synovial disease?}}\{\{nl\}\}- Inflammatory\{\{nl\}\}- Infectious\{\{nl\}\}- Degenerative\{\{nl\}\}- Traumatic\{\{nl\}\}- Haemorrhogic\{\{nl\}\}- Neoplastic\{\{nl\}\}=\textgreater{} Leading to irreversible joint destruction} \tn 
% Row Count 5 (+ 5)
% Row 1
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\mymulticolumn{1}{x{8.4cm}}{{\bf{What are arthritides?}} Inflammation of joints due to infectious, metabolic, or constitutional causes} \tn 
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\begin{tabularx}{8.4cm}{X}
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\mymulticolumn{1}{x{8.4cm}}{\bf\textcolor{white}{Synovial joint}}  \tn
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\mymulticolumn{1}{p{8.4cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/bee-f_1681387430_Joint.svg.png}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\begin{tabularx}{8.4cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{8.4cm}}{\bf\textcolor{white}{Pathophysiology}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{⏺ {\bf{Physiology/ function}} in abnormal states → specifically the {\bf{functional changes}} that {\emph{accompany}} a particular syndrome or disease} \tn 
% Row Count 3 (+ 3)
% Row 1
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\mymulticolumn{1}{x{8.4cm}}{⏺ It's about disordered function, i.e. there's function but it's abnormal} \tn 
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% Row 2
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\mymulticolumn{1}{x{8.4cm}}{⏺ When you wish to find/define the pathophysiology of a condition it's helpful to ask: {\bf{What's not functioning well?}}} \tn 
% Row Count 8 (+ 3)
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\begin{tabularx}{8.4cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{8.4cm}}{\bf\textcolor{white}{Mechanisms}}  \tn
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\mymulticolumn{1}{x{8.4cm}}{⏺ Determined by the pathophysiology, i.e. disordered function} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{8.4cm}}{⏺ They're the {\bf{defects}} in {\bf{systems}}, {\bf{organs}}, {\bf{cellular}} \& {\bf{molecules}} that constitute the {\bf{{\emph{triggers}}}} of specific diseases} \tn 
% Row Count 5 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{⏺ They {\bf{originate}} \& {\bf{explain}} the clinical signs \& symptoms} \tn 
% Row Count 7 (+ 2)
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\mymulticolumn{1}{x{8.4cm}}{⏺ When you wish to find/define the mechanism of disease, it's helpful to ask: {\bf{How is the specific {\emph{pathophysiology}} leading to occurrence of these specific {\emph{signs \& symptoms}}?}}} \tn 
% Row Count 11 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\begin{tabularx}{8.4cm}{X}
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\mymulticolumn{1}{x{8.4cm}}{\bf\textcolor{white}{Gout}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{{\bf{Signs \& symptoms:}}\{\{nl\}\}- {\bf{Acute form:}} painful, warm \& swollen joint\{\{nl\}\}- {\bf{Chronic tophaceous form:}} top in tendons, bursae \& cartilages} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{8.4cm}}{{\bf{Pathophysiology:}}\{\{nl\}\}- {\bf{Hyperuricaemia}} \& a {\bf{↓ in urinary excretion of uric acid}} → both lead to {\emph{deposition}} \& {\emph{crystallisation}} of uric acid in joints → followed by an inflammatory response with {\bf{{\emph{release of enzymes}}}} in joint space} \tn 
% Row Count 9 (+ 6)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{{\bf{Mechanism:}}\{\{nl\}\}- {\bf{Deposition}} \& {\bf{crystallisation}} occurs in previously traumatised or "cooler" joints. {\emph{Neutrophil disruption}} leads to enzyme release \& inflammatory cascade} \tn 
% Row Count 13 (+ 4)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{8.4cm}}{{\bf{Does the pathophysiology explain/relate to the specific mechanisms of disease, how?}}\{\{nl\}\}- Yes\{\{nl\}\}- Hyperuricaemia leads to deposition of uric acid\{\{nl\}\}- Previous trauma \& location favours crystallisation\{\{nl\}\}- Crystal deposition triggers immune response\{\{nl\}\}- Damage to neutrophils produces the release of enzymes which irritate joints \& cause an inflammation, i.e. arthritis} \tn 
% Row Count 21 (+ 8)
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\mymulticolumn{1}{x{8.4cm}}{{\bf{Do the mechanism explain the clinical signs \& symptoms, how?}}\{\{nl\}\}- Yes\{\{nl\}\}- Inflammation causes painful, warm, swollen joints in the acute form\{\{nl\}\}- In chronic tophaceous form: long term deposition of uric acid crystals in avascular tissues cause tophi in tendons, bursae \& cartilages} \tn 
% Row Count 27 (+ 6)
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\mymulticolumn{1}{x{8.4cm}}{\bf\textcolor{white}{Gout}}  \tn
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\mymulticolumn{1}{p{8.4cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/bee-f_1681387660_Gout.jpeg}}} \tn 
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\mymulticolumn{1}{x{8.4cm}}{\bf\textcolor{white}{Rheumatoid Arthritis}}  \tn
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\mymulticolumn{1}{x{8.4cm}}{{\bf{Signs \& symptoms:}}\{\{nl\}\}- Poly-articular joint pain, swelling \& stiffness\{\{nl\}\}- Most commonly affecting the small joints (wrists, metacarpal-phalangeals)\{\{nl\}\}- Joint involvement is bilaterally symmetrical\{\{nl\}\}- Extra-articular manifestations are often seen} \tn 
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\mymulticolumn{1}{x{8.4cm}}{{\bf{Pathophysiology:}}\{\{nl\}\}- {\bf{Autoimmune activation \& proliferation of T-cells}} → leading to production of {\emph{inflammatory cytokines \& B-cells}} differentiation into plasma cells → there's an {\emph{inflammatory response}} which is systemic \& {\emph{damage of cartilage tissue}} in joints} \tn 
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\mymulticolumn{1}{x{8.4cm}}{{\bf{Mechanism:}}\{\{nl\}\}- The joint damage {\emph{recruits}} more immune cells into joint spaces\{\{nl\}\}- Immune cells infiltrate synovial membrane causing it to {\emph{proliferate \& forming}} new blood vessels\{\{nl\}\}- Swollen \& blood rich synovial (pannus) {\emph{invades \& enzymatically destroys}} joint tissue\{\{nl\}\}- Severe RA will affect the entire body} \tn 
% Row Count 19 (+ 7)
% Row 3
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\mymulticolumn{1}{x{8.4cm}}{{\bf{Does the pathophysiology explain/relate to the specific mechanisms of disease, how?}}\{\{nl\}\}- Yes\{\{nl\}\}- The autoimmune activation of T- \& B- cells with consequent inflammation \& cartilage damage stimulate nerve endings in subchondraln bone \& synovial membrane\{\{nl\}\}- Inflammation of synovial leads to its enlargement with formation of palpable lumps in the affected joints\{\{nl\}\}- Neovascularisation \& synovial enlargement cause physical narrowing of joint space \& a decrease joint mobility\{\{nl\}\}- Neovascularisation \& synovial enlargement erode cartilage \& subchondral bone which may cause joint mal-alignment, subluxation or collapse} \tn 
% Row Count 32 (+ 13)
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\mymulticolumn{1}{x{8.4cm}}{\bf\textcolor{white}{Rheumatoid Arthritis (cont)}}  \tn
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\mymulticolumn{1}{x{8.4cm}}{{\bf{Does the mechanism explain the clinical signs \& symptoms, how?}}\{\{nl\}\}- Yes\{\{nl\}\}- Stimulation of nerve endings in subchondraln bone \& synovial membrane, causes joint pain\{\{nl\}\}- Inflammation of synovial leads to its enlargement with formation of palpable lumps in the affected joints\{\{nl\}\}- Physical narrowing of joint space \& ↓ in joint mobility causes joint stiffness \& a ↓ in the range of movement\{\{nl\}\}- Cartilage \& subchondraln bone erosion causes joint mal-alignment, subluxation or collapse, explaining the various types of joint deformities\{\{nl\}\}- The systemic inflammation explains the various extra-articular signs of the disease} \tn 
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\begin{tabularx}{8.4cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{8.4cm}}{\bf\textcolor{white}{Rheumatoid Arthritis}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{8.4cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/bee-f_1681387749_Rheumatoid Arthritis (RA).jpeg}}} \tn 
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\begin{tabularx}{8.4cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{8.4cm}}{\bf\textcolor{white}{Ankylosing Spondylitis}}  \tn
% Row 0
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\mymulticolumn{1}{x{8.4cm}}{{\bf{Signs \& symptoms:}}\{\{nl\}\}- Pain in Lx \& gluteal regions\{\{nl\}\}- ↓ in Lx spine flexion\{\{nl\}\}- ↓ in Lx lordosis\{\{nl\}\}- ↑ in Tx kyphosis\{\{nl\}\}- Asymmetric arthritis \& enthesitis} \tn 
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% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{8.4cm}}{{\bf{Pathophysiology \& mechanism:}} \{\{nl\}\}- {\emph{Autoimmunity}} causes {\bf{{\emph{inflammation}}}} of {\bf{axial}} joints, {\bf{peripheral}} joints \& {\bf{entheses}}} \tn 
% Row Count 7 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{{\bf{Does the pathophysiology explain/relate to the specific mechanisms of disease, how?}}\{\{nl\}\}- {\bf{Yes}}\{\{nl\}\}- Axial joint arthritis (sacroiliac \& vertebral column) causes {\bf{{\emph{release}}}} of {\emph{inflammatory substances}} that stimulate {\bf{{\emph{nociceptors}}}}\{\{nl\}\}- {\bf{Inflammation}} leads to {\bf{osteoclast activation \& erosion of bone}}, which in turn causes {\bf{{\emph{osteoblast activation with new bone formation}}}}\{\{nl\}\}- Leads to an {\bf{{\emph{↑ in spinal rigidity}}}}\{\{nl\}\}- In {\emph{peripheral joints}}, the arthritis causes {\bf{{\emph{release of inflammatory substances}}}} that stimulate {\bf{{\emph{nociceptors}}}}\{\{nl\}\}- There's {\bf{{\emph{infiltration}}}} of the synovium by {\emph{inflammatory cells}} \& {\emph{inflammation of the entheses}} (places of tendon insertions in bone)} \tn 
% Row Count 22 (+ 15)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{8.4cm}}{{\bf{Do the mechanism explain the clinical signs \& symptoms, how?}}\{\{nl\}\}- {\bf{Yes}}\{\{nl\}\}- {\bf{{\emph{Stimulation of nociceptors}}}} causes {\emph{pain in axial \& peripheral joints}}\{\{nl\}\}- {\bf{{\emph{↑ in spinal rigidity}}}} causes a {\emph{↓ in Lx spine flexion}}, {\emph{↓ in Lx lordosis}} \& {\emph{↑ in Tx kyphosis}}\{\{nl\}\}- Late {\bf{complications}} include {\emph{spinal ankylosis}} \& {\emph{fractures}}\{\{nl\}\}- In peripheral joints, {\bf{{\emph{stimulation of nociceptors}} causes }}pain of lower limb joints{\emph{ \& }}knees{\emph{\{\{nl\}\}- {\bf{}}Enthesitis}}{\emph{ causes }} pain in achilles tendon{\emph{, }}plantar fascia{\emph{ \& }}tibial tuberosity*} \tn 
% Row Count 34 (+ 12)
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\begin{tabularx}{8.4cm}{X}
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\mymulticolumn{1}{x{8.4cm}}{\bf\textcolor{white}{Ankylosing Spondylitis}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{8.4cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/bee-f_1681387881_Ankylosing Spondylitis.jpeg}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\begin{tabularx}{8.4cm}{X}
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\mymulticolumn{1}{x{8.4cm}}{\bf\textcolor{white}{Bone Remodelling Cycle}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{8.4cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/bee-f_1681392677_Bone remodelling cycle.png}}} \tn 
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\begin{tabularx}{8.4cm}{X}
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\mymulticolumn{1}{x{8.4cm}}{\bf\textcolor{white}{Osteoarthritis}}  \tn
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\mymulticolumn{1}{x{8.4cm}}{{\bf{Signs \& symptoms:}}\{\{nl\}\}- Joint pain with loading \& motion\{\{nl\}\}- Palpable bone hypertrophy\{\{nl\}\}- ↓ in ROM\{\{nl\}\}- Crepitus (popping/crackling sound)\{\{nl\}\}- Joint effusion} \tn 
% Row Count 4 (+ 4)
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\SetRowColor{white}
\mymulticolumn{1}{x{8.4cm}}{{\bf{Pathophysiology \& mechanism:}}\{\{nl\}\}- Joint cartilage {\bf{{\emph{destruction with inflammation}}}}} \tn 
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\mymulticolumn{1}{x{8.4cm}}{{\bf{Does the pathophysiology explain/relate to the specific mechanisms of disease, how?}}\{\{nl\}\}- {\bf{Yes}}\{\{nl\}\}- Cartilage {\bf{inflammation}} in weight bearing joints {\bf{(knee,hip)}} \& smaller joints stimulates {\emph{nociceptors}}\{\{nl\}\}- Joint cartilage loss causes {\bf{{\emph{wear}}}} of exposed subchondral bone, which induces {\bf{defective new bone formation}} leading to the appearance of {\bf{{\emph{osteophytes}}}} \& {\emph{subchondral bone}} {\bf{{\emph{sclerosis}}}} leading to {\emph{changes}} in joint architecture\{\{nl\}\}- During movement osteophytes \& subchondral sclerosis are firmly pressed against normal joint structures\{\{nl\}\}- Cartilage loss brings joint bones into direct contact between themselves with {\bf{{\emph{reduction}}}} in {\emph{joint movement}} \& stimulation of {\emph{nociceptors}}\{\{nl\}\}- {\bf{Joint inflammation}} leads to {\bf{{\emph{chemical changes}}}} within the joint causing a ↓ in {\emph{synovial fluid viscosity}} \& an ↑ in joint {\emph{fluid production}}} \tn 
% Row Count 24 (+ 18)
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\mymulticolumn{1}{x{8.4cm}}{{\bf{Do the mechanism explain the clinical signs \& symptoms, how?}}\{\{nl\}\}- {\bf{Yes}}\{\{nl\}\}- Stimulation of joint {\emph{nociceptors}} causes {\bf{{\emph{joint pain}}}} whether upon {\bf{loading}} or during {\bf{motion}}\{\{nl\}\}- Change in {\emph{joint architecture}} consists of the appearance of {\emph{palpable}} bone {\bf{{\emph{hypertrophy}}}}, i.e. {\bf{Bouchard's nodes}}\{\{nl\}\}- {\emph{Osteophytic}} \& {\emph{subchondral sclerosis}} impaction against normal joint structures causes {\bf{{\emph{pain \& ↓ joint ROM}}}}\{\{nl\}\}- Joint bones into direct contact causes {\bf{friction}} \& {\bf{crepitus}}, {\bf{pain}} \& further {\bf{↓ in ROM}}\{\{nl\}\}- {\bf{↓ in synovial fluid viscosity}} \& an {\bf{↑ in joint production}} produce joint {\bf{{\emph{effusions}}}}} \tn 
% Row Count 38 (+ 14)
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\mymulticolumn{1}{x{8.4cm}}{\bf\textcolor{white}{Osteoarthritis}}  \tn
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\mymulticolumn{1}{p{8.4cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/bee-f_1681389120_Osteoarthritis (OA).jpeg}}} \tn 
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\begin{tabularx}{8.4cm}{X}
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\mymulticolumn{1}{x{8.4cm}}{\bf\textcolor{white}{Polymyalgia Rheumatica}}  \tn
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\mymulticolumn{1}{x{8.4cm}}{{\bf{Signs \& symptoms:}} \{\{nl\}\}- Morning stiffness\{\{nl\}\}- Aching of pectoral \& pelvic girdle muscle structures\{\{nl\}\}- Malaise\{\{nl\}\}- Weight loss} \tn 
% Row Count 3 (+ 3)
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\SetRowColor{white}
\mymulticolumn{1}{x{8.4cm}}{{\bf{Pathophysiology \& mechanism:}}\{\{nl\}\}- Aging combined with systemic (auto) immunologic/inflammatory process targeting structures in the walls of arteries with activation of macrophages} \tn 
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\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{{\bf{Does the pathophysiology explain/relate to the specific mechanisms of disease, how?}}\{\{nl\}\}- More challenging to connect pathophysiology \& mechanism\{\{nl\}\}- The {\bf{{\emph{inflammation of arteries}}}} may lead to their {\bf{obstruction}} potentially causing {\bf{{\emph{hypoxia, ischemia \& necrosis}}}} of affected tissues\{\{nl\}\}- This include muscles in the {\bf{shoulder girdle}} \& {\bf{pelvic girdle}}} \tn 
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\mymulticolumn{1}{x{8.4cm}}{{\bf{Do the mechanism explain the clinical signs \& symptoms, how?}}\{\{nl\}\}- {\bf{Yes}} but challenging\{\{nl\}\}- It's plausible that the {\bf{arteritis}} \& consequent {\bf{hypoxia}} \& {\bf{ischemia}} of affected muscles together with the {\bf{systemic inflammation{\emph{ lead to }}}}stiffness, aching, malaise \& weight loss{\emph{*}}} \tn 
% Row Count 21 (+ 6)
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\begin{tabularx}{8.4cm}{X}
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\mymulticolumn{1}{x{8.4cm}}{\bf\textcolor{white}{Polymyalgia Rheumatica}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{8.4cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/bee-f_1681389950_Polymyalgia Rheumatica (Giant Cell Arteritis).png}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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% That's all folks
\end{multicols*}

\end{document}