2 - Osteoarthritis

Question 1

What are the symptoms of joint disease?

Answer 1

• pain
• immobility / stiffness
• loss of function

Question 2

What are signs of joint disease?

Answer 2

• fluctuant fluid swelling
• long term, bony swelling
• synovial enlargement swelling (RA)
• deformity
• redness (inflammation)
• crepitus
• loss of function

Question 3

What investigations can be used to investigate joint disease?

Answer 3

• radiography (plain, MRI, anthrography)
• blood tests (C-reactive protein, rheumatoid factors, extractable nuclear antigens, anti DS-DNA, anti-nuclear antibody)
• anthroscopy
• biopsy

Question 4

What is anthrography?

Answer 4

Radiography where dye is injected into the joint

Question 5

What is acute monoanthropathy?

Answer 5

• acute arthritis of a single joint
• can be the initial stage of polyarthritis

Question 6

What are common causes of acute monoarthropathy?

Answer 6

• infection (septic arthritis)
• crystal arthropathy (gout)

Question 7

What is gout?

Answer 7

• uric acid crystal deposits in joints
• significant pain from active inflammation

Question 8

What are common causes of hyperuricaemia?

Answer 8

Hyperuricaemia can be caused by many factors
- drug induced (thiazide diuretics)
- genetic predisposition
- nucleic acid breakdown from chemo tx
- tumour related myeloma

Obesity and alcohol enhance the effects of gout

Question 9

Describe the symptoms of gout.

Answer 9

• acute inflammation of a single joint
• usually great toe
• rapid onset
• often a precipitating event (trauma, surgery, illness, diet/alcohol excess)

Question 10

How do you treat gout?

Answer 10

NSAIDs

Question 11

How does gout affect dentistry?

Answer 11

• avoid prescribing aspirin as this interferes with uric acid removal
• drugs used to treat gout may result in oral ulceration (allopurinol)

Question 12

What is osteoarthritis?

Answer 12

• degenerative joint disease
• typically affects weight bearing joints (hips/knees)
• cartilage repair dysfunction

Question 13

What are the symptoms of osteoarthritis?

Answer 13

• pain (improves with rest, worsens with activity)
• brief morning stiffness
• slowly progressive

Question 14

What are signs of osteoarthritis?

Answer 14

Radiographs
- loss of joint space and subchondral sclerosis
- ostseophyte lipping at joint edge

Joint swelling and deformity (usually seen in hand)

Question 15

Describe subchondral sclerosis.

Answer 15

Thickening of bone under cartilage layer, seen on a radiograph

Question 16

Describe osteophyte lipping.

Answer 16

Bony projections at the joint edge, seen on a radiograph

Question 17

How do you manage osteoarthritis?

Answer 17

• nothing can present progression
• pain can be improved by increasing muscle strength, weight loss and walking aids
• NSAIDs
• prosthetic replacement for PAIN

Question 18

How does osteoarthritis affect dentistry?

Answer 18

• TMJ involvement is rare
• difficulty accessing care
• chronic NSAID use can cause oral ulceration
• bleeding tendency when on anti-platelets
• joint replacement may require AB prophylaxis (not common as joint is not at risk from oral bacteraemia)