Workshop PIT 2013 Dr Deddy

Deddy Nurwachid Achadiono Rheumatology sub department Department of Internal Medicine Sardjito General Hospital

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Synarthrosis : stability (Skull) Amphiarthrosis : flexible fibrocartilage movement (symphisis pubis, disc) Diarthrosis: ( most mobile, important) synovial. • • • •

Hinge Saddle Ball and socket Plane

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Articular cartilage Intra-articular disc Synovial membrane    

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Blood supply & limphatic drainage Synovial membrane nerve supply Exchange of substance across synovial barrier Sinovial fluid

Joint capsule Joint lubrication

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Extra Cellular Matrix & Chondrocyte Avascular, aneural, alymphatic ECM: 

Collagen (II,IX, and XI):  Ability to resist tension

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Proteoglycan:  Neg chargeattract Na+ + water tension collagen 

resist compression.

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Water (60-80%) MMP enzyme

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Cartilage constant turn over by balance synthesis & degradation ECM Loading: 

Dynamic: chondrocyte volume regulation, interplay 2 pathway:  Na-K-2Cl cotransporter: recovery RVIncrease  Act osmolyte channel: RVDecrease

 Increase matrix synthesis 

Static :  Slowly, fluid expression, raises osmotic pressure ICF,

swelling cell  matrix degradation (OA)

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Cover all joint surface except cartilage-cover weight bearing area. Very thin, surface: celular, internal surface (delicate villi & fold) Quality & quantity connective tissue below determine mobility of SM:  

Articular margin & lining ligament: dense collagenous  restrict mobility Loose areolar (elsewhere)  free movement

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Fat pad: affect distribution of synovial fluid More mobile area: abundance elastic fiber, elastic laminae, prevent nipped artic surf Nutritive function, produce synovial fluid Capillaries form a fine network close to joint surface Limphatic vessel not as numerous & superficial as blood vessel Nerve destined for blood vessel.

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Transudate of plasma Hyaluronan: a glycosaminoglycan that is a major matrix element of synovial fluid (made by type B synovial cells) 

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High viscosity

Celluler content low 

WBC < 200 cells/ mm3

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Pathway: synovial capillary synovial interstitium synovial fluid hyaline cartilage Features include:   

Capillaries are fenestrated (small solute, water) Glucose has transport system into joint Protein enter inversely proportional to size  Albumin>globulin (healthy joint)  Hyaluronan plays major filter role for large proteins

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Boundary lubrication

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Lubrication at contact points of cartilage on cartilage The glycoprotein lubrican the major element

Hydrodynamic lubrication 

Lubrication where film of fluid remains between cartilage layer.

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Function: attach bone to bone, strength, stability, keep the joint move too far side to side Strong, tough bands, not too flexible. Once stretch, tend to stay stretch, too far they snap

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Elastic tissue, part of the muscle, connect muscle to bone Stabilize, give power for straightening

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Thick, fibrous structure Mianly type 1 collagen Some thin fibrillar type III Inn by mechanorec & free nerve terminals Wraps the joint Inside the capsule is synovial membrane: 

Secrete synovial fluid when joint get inflammed & lubrication

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Fluid filled sacs Cushion the joint Reduced friction between muscles, bones, tendons, ligaments In addition, there are fat pad that help cushion the joint