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BDS3 BAMS Diseases of Human Systems > 1. Connective Tissue Diseases > Flashcards

1. Connective Tissue Diseases Flashcards

1
Q

What is arthritis ?

A

Inflammation of joints - i.e. inflammatory joint disease.

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2
Q

What is arthrosis ?

A

Non-inflammatory joint disease.

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3
Q

What is arthralgia ?

A

Joint pain.

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4
Q

What is the main role of parathyroid hormone ?

A

Maintains serum calcium level.

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4
Q

How does the parathyroid hormone maintain serum calcium levels ?

A

Increases calcium release from bone - increased bone loss.
Increases active vitamin D - increased intestinal calcium resorption.
Decreases urinary calcium output - conserves dietary calcium.

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5
Q

Patient has osteoporosis as a result of hypothyroidism. What will be the signs of their condition ?

A

Low PTH - which maintains low calcium level.

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6
Q

Why does hypothyroidism result in osteoporosis ?

A

Low bone turnover with a prolonged bone remodelling cycle - caused by reduced osteoclastic bone resorption together with decreased osteoblastic activity.

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7
Q

Patient has osteoporosis as a result of hyperthyroidism due to a primary cause. What will be the signs of their condition ?

A

High PTH - higher than normal bone turnover.

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8
Q

What is an example of a condition which results in hypothyroidism ?

A

Hashimoto’s disease - autoimmune condition affecting thyroid gland leading to underactive thyroid.

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9
Q

What is an example of a condition which results in primary hyperthyroidism ?

A

Graves disease - autoimmune condition affecting thyroid gland leading to overactive thyroid.

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10
Q

Why does hyperthyroidism result in osteoporosis ?

A

High bone turnover with fast bone remodelling cycle - causing increased osteoclastic bone resorption.

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11
Q

Patient has osteoporosis as a result of hyperthyroidism due to secondary cause. What will be the signs of their condition ?

A

High PTH.

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12
Q

What are examples of secondary causes for hyperthyroidism ?

A

Increased urinary output of calcium - hypercalciuria.
Vitamin D deficiency - vitamin D required for uptake of dietary calcium in GI system - can be dietary or GI problem.

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13
Q

What are the symptoms of adult osteomalacia post formation ?

A

Vertebral compression.
Bone ache and muscle weakness.
Carpal muscle spasm.
Facial twitch (CNVII).

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14
Q

What are the symptoms of childhood osteomalacia during formation ?

A

Rickets - bow shaped legs.

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15
Q

What is the difference between osteomalacia vs. osteoporosis ?

A

Osteomalacia - poor mineralisation of normal osteoid matrix.
Osteoporosis - reduced quantity of normally mineralised bone i.e. increased osteoclastic activity.

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16
Q

What are the symptoms of osteoporosis ?

A

Reduced height.
Back pain through lumbar nerve compression.
Scoliosis.
Kyphosis.
Increased fracture risk (hip fracture - risk of fatality).

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17
Q

What are the risk factors for osteoporosis ?

A

Age.
Post-menopausal females.
Cushings disease.
Antiepileptic drugs.
Patient factors - alcohol, smoking, lack of exercise.

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18
Q

Why are females at greater risk of osteoporosis ?

A

Oestrogen artificially boosts bone density.
When oestrogen levels drop during menopause, bone density is lost.

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19
Q

What two types of medication can be given for a patient with osteoporosis ?

A

HRT (hormone replacement therapy).
Bisphosphonates i.e. alendronate.

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20
Q

How does HRT reduce risk of osteoporosis ?

A

Maintains oestrogen levels, maintaining bone density post-menopause.

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21
Q

How does bisphosphonate slow progression of osteoporosis ?

A

Reduce osteoclastic activity, slowing bone loss.

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22
Q

What is the dental implications of bisphosphonate treatment for osteoporosis ?

A

Risk of MRONJ due to reduced osteoclastic activity causing reduced bone remodelling - prevents successful healing of wounds.

Dentists can be asked to do initial dental assessment prior to patient starting bisphosphonate therapy i.e. render patient dentally stable.

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23
Q

How do you treat a patient on bisphosphonates ?

A

Continue treatment but receive adequate consent making the patient aware of this risk. Review patient after XLA or implants - if no healing after 8 weeks, refer to MRONJ specialist i.e. oral surgery or SCD.

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24
Q

What are examples of acute monoarthropathies ?

A

Gout - if no trauma.
Septic arthritis - if infection.
Initial stage of osteoarthritis.

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25
Q

What is gout ?

A

Crystal arthropathy caused by uric acid deposition in joint causing irritation to single joint surface.

26
Q

What treatment is commonly given for gout ?

A

Potent NSAIDs i.e. naproxen and steroid prednisolone.

27
Q

What are the risk factors for gout ?

A

Chemotherapy treatment for myeloma.
Obesity.
Alcohol.
Thiazide diuretics - increased uric acid in blood.

28
Q

What dental considerations should be given for patient with gout ?

A

Avoid aspirin as it interferes with uric acid removal in the body.
Use of potent NSAIDs - risk of oral ulceration.

29
Q

What is an example of a polyarthropathy ?

A

Osteoarthritis.

30
Q

What is osteoarthritis ?

A

Degenerative cartilage repair dysfunction.

31
Q

What are risk factors for osteoarthritis ?

A

Obesity.
Traumatic injury to joint.
FH of osteoarthritis.
Aging.

32
Q

What treatment is commonly given for osteoarthritis ?

A

Potent NSAIDs - naproxen.
Prosthetic replacement of joint.

33
Q

What dental considerations should be given for patient with osteoarthritis ?

A

Long term NSAID use - oral ulceration, bleeding tendency.
Access to dental services.

34
Q

What is rheumatoid arthritis ?

A

Gradual autoimmune inflammatory joint destruction affecting all synovial joints - symmetrical.

35
Q

What are extra-radicular symptoms of rheumatoid arthritis ?

A

Inflammation of blood vessels and respiratory.
Psorasis.
Sjorgens syndrome affecting eyes, mouth.

36
Q

What are significant of rheumatoid arthritis in blood test ?

A

High RA factor >15IU/ml.
Normocytic anaemia - fewer normal RBC count.

37
Q

What medications are used in early-moderate rheumatoid arthritis therapy ?

A

Analgesics - for pain management.
NSAIDs - pain management and anti-inflammatory.
Intra-articular steroid injections - anti-inflammatory.
Disease modifying anti-rheumatic drug (DMARD) - slows progression of disease i.e. mild immunosuppression.

38
Q

What are examples of analgesics a patient would take for RA ?

A

Paracetamol, cocodamol.

39
Q

What are examples of NSAIDs a patient would take for RA ? And what would be combined with this treatment and why ?

A

Naproxen, ibuprofen.
Combined with anti-PUD drug e.g. omeprazole due to NSAID risk of causing gastric bleeding.

40
Q

What are examples of disease modifying anti-rheumatic drugs (DMARDs) a patient would take for RA ?

A

Methotrexate.
Hydroxychloroquinoine.

41
Q

How does methotrexate treat RA ?

A

Antimetabolite drug prevents inflammation and immunosuppressant preventing disease progression.

42
Q

How does hydroxychloroquinoine treat RA ?

A

Immunosupressant preventing disease progression.

43
Q

What medications are prescribed in moderate-severe rheumatoid arthritis therapy ?

A

Prednisolone.
TNF inhibitors e.g. ifliximab, adalimumab.
Azathioprine.

44
Q

How does prednisolone help treat RA ?

A

Oral corticosteroid to treat acute inflammation flare up caused by RA.

45
Q

What are the dental considerations which must be given to patients suffering with RA ?

A

Disability - access to dental chair, dental practice, manual dexterity.
Chronic anaemia - oral ulceration, compromised immune system so presdisposition to periodontal disease, poor wound healing.
Sjorgens - xerostomia - increased caries risk.
Drug therapy.

46
Q

What RA drugs pose risk to bleeding ?

A

NSAIDs and sulphasalazine.

47
Q

What RA drugs pose infection risk ?

A

Immune modulating drugs i.e. methotrexate, hydroxychloroquinoine, TNF inhibitors.
Steroids i.e. prednisolone.

48
Q

What RA drug poses risk of oral ulceration ?

A

Methotrexate.

49
Q

What RA drugs pose risk of lichenoid reaction ?

A

Hydroxychloroquinoine and sulphasalazine.

50
Q

What RA drug poses risk of oral pigmentation ?

A

Hydroxychloroquinoine.

51
Q

What should be considered about RA patient undergoing GA ?

A

Atlante-occipital instability causing compression of spinal cord where no muscle control due to poor ligaments.

52
Q

What is the main difference between RA vs. ankylosing spondylitis and where in the body it tends to affect most ?

A

RA - more peripheral.
Ankylosing spondylitis - focuses on vertebrae and neck.

53
Q

What is the main difference between the types of people RA vs. ankylosing spondylitis tend to affect ?

A

RA - young-middle aged women - 20-40 years old.
Ankylosing spondylitis - young men - 20 years old.

54
Q

What gene is ankylosing spondylitis correlated with ?

A

HLA-B27 gene.

55
Q

What are the symptoms of ankylosing spondylitis ?

A

Lower back pain.
Limited movement.
Limited chest expansion with compromised breathing.

56
Q

What is the main dental consideration concerned with ankylosing spondylitis which is not drug related ?

A

GA risk - limited mouth opening and neck flexion.

57
Q

What are the two types of connective tissue disease ?

A

Autoimmune.
Vasculitic.

58
Q

What is the cause of systemic lupus erythematosus ?

A

Genetic predisposition with environmental trigger - infection.

59
Q

What are the symptoms of systemic lupus erythematosus ?

A

Photosensitivity, buffered zygomatic rash, Raynauds, arthritis.

60
Q

What is the difference between systemic lupus erythematosus and discoid lupus ?

A

Discoid lupus - tissue changes without blood autoantibodies.
Systemic lupus erythematosus - organ changes with autoantibodies.

61
Q

What are the dental considerations for patient with SLE ?

A

Chronic anaemia - oral ulceration and GA risk.
Bleeding tendency - thrombocytopenia - check platelet count.
Renal disease - impaired drug metabolism.
Immunosuppressive therapy - infection risk.
Pre-malignancy risk.
Lichenoid oral reactions.

62
Q

What is important about primary antiphospholipid antibody syndrome or secondary with SLE ?

A

Hypercoagulable so tend to be on warfarin - bleeding risk - check INR.

63
Q

What autoantibodies are associated with SLE ?

A

ANA, dsDNA, Ro antibodies.

BDS3 BAMS Diseases of Human Systems (6 decks)

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