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BDS3 DISEASES OF HUMAN SYSTEMS > 4 - Connective tissue disease > Flashcards

4 - Connective tissue disease Flashcards

1
Q

Describe connective tissue disease.

A
  • multisystem inflammation disease
  • tissues are the target of autoimmune disease
  • complement activation of antibodies (found in healthy individuals) cause the tissue damage, not antibodies themselves
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2
Q

Describe multisystem vasculitic inflammatory disease.

A

Autoimmune disease that targets vessels

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3
Q

What are examples of connective tissue disease?

A
  • systemic lupus erythematosis (SLE)
  • systemic sclerosis (scleroderma)
  • Sjorgen’s syndorme
  • undifferentiated connective tissue disease (UCTD)
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4
Q

What are examples of vasculitic connective tissue disease?

A
  • large vessel disease (giant cell temporal arteritis)
  • medium vessel disease (polyarteritis nodosa, Kawasaki disease)
  • small vessel disease (Wegener’s granulomatosis)
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5
Q

What is the general management of connective tissue disease?

A
  • dependant on disease activity and immune suppression
  • analgesia via NSAIDs for joint/muscle symptoms
  • immune modulating treatment
  • systemic steroids
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6
Q

Give an example of a systemic steroid used to treat connective tissue disease.

A

Prednisolone (short term)

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7
Q

Give an example of immune modulating drugs used to treat connective tissue disease.

A
  • hydroxychloroquine
  • methotrexate
  • axathioprine
  • mycophenolate
  • biologic (cytokine inhibitors or lymphocyte depleting drugs)
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8
Q

What antibodies are associated with SLE and its associated diseases?

A

Overlap symptoms
- anti-nuclear antibody (ANA)
- anti-double-strand DNA (dsDNA)
- anti-Ro antibody (Ro)
- anti-Scl-70 antibody
- anti-neutrophil cytoplasmic antibody (ANCA)
Scleroderma
- anti-La antibody (La)
- anti-centromere antibody

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9
Q

Describe SLE.

A
  • systemic lupus erythematosis
  • circulating imune complexes include ANA, dsDNA and Ro antibodies (most common)
  • multisystem disease affecting joints, skin, kidney, muscles, blood, CVS, RS, CNS
  • renal involvement is major cause of death
  • enhanced CV risk
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10
Q

What is discoid lupus?

A
  • tissues change that are seen without autoantibodies
  • seen in skin and mouth (appearance is similar to lichen planus)
  • localised effect
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11
Q

How does SLE present?

A
  • photosensitivity is common (butterfly zygomatic rash)
  • raynauds phenomenon
  • lupus nephritis
  • CV problems
  • pleural effusions
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12
Q

What are the dental aspects of SLE?

A
  • chronic anaemia results in oral ulceration, can be a GA risk
  • bleeding tendency, thrombocytopenia
  • renal disease impairs drug metabolism
  • steroid and immunosuppressive therapy increases malignancy risk
  • lichenoid reaction presently similarly in the mouth
  • oral pigmentation (hydroxychloroquine)
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13
Q

What is APS?

A
  • antiphospholipid antibody syndrome
  • marker in the blood a subtype of patients with lupus
  • characterised by recurrent thrombosis (DVT with pulmonary embolism)
  • venous and arterial thrombosis therefore patients are anticoagulated (usually warfarin)
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14
Q

What is Sjogren’s syndrome?

A
  • inflammatory disease associated with ANA, Ro and La antibodies (not caused by)
  • can either be primary (only Sjorgens symptoms) or secondary (associated with other connective tissue disease)
  • presents with dry eyes and mouth (Sicca syndrome)
  • major involvement of salivary glands leads to xerostomia and oral disease
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15
Q

How do you diagnose Sjogrens syndrome?

A
  • signs/symptoms and clinical judgement are main diagnostic keys
  • autoantibody findings
  • imaging findings
  • histopathology findings (labial gland biopsy)
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16
Q

What are the oral implications of Sjogrens syndrome?

A
  • oral infection
  • caries risk due to xerostomia
  • functional loss
  • denture retention poor
  • sialosis
  • salivary lymphoma due to chronic activation of lymphoid tissue
17
Q

What is systemic sclerosis?

A
  • excessive collagen deposition
  • connective tissue fibrosis
  • lost of elastic tissue (internally organs are affected eg peristalsis, externally joints and skin are less mobile)
  • localised = anticentromere antibodies
  • generalised = anti-Scl-70 antibodies
18
Q

What are some symptoms of systemic sclerosis?

A
  • can’t straighten fingers
  • occlusion of blood vessels (raynauds) leads to ischaemic necrosis of fingers
19
Q

Describe the progression of systemic sclerosis.

A
  • gradual onset with slow progression but no treatment to prevent
  • raynauds phenomenon
  • renal failure
  • malabsorption (GI involvement)
20
Q

What are the dental aspects of systemic sclerosis?

A
  • limited mouth opening (tissue does not stretch and will tear if retracted too far)
  • progressively poor oral access
  • limited tongue movement
  • plan treatment 10 years ago
  • compounded by sjogrens syndrome (higher caries risk)
  • dysphagia
  • reflux (dental erosion)
  • cardiac and renal vasculitic disease affects drug metabolism
21
Q

What is vasculitis?

A
  • inflammation of blood vessels
  • infarction of tissues occurs when inflammation occludes the vessel
  • can present in oral inflammatory masses or oral ulceration (tissue necrosis)
22
Q

What is giant cell arteritis?

A
  • temporal arteritis (when temporal artery involved)
  • presents with headache or facial pain
  • involves carotid branches, can cause blindness if central retinal artery occluded
  • a facial pain emergency, no specific test but ESR is raised
  • prednisolone should be started asap
23
Q

What is polymyalgia rheumatica?

A
  • disease of elderly that affects large vessels
  • pain and morning stiffness of muscles
  • nonspecific systemic features (malaise, weight loss, fatigue)
  • steroids used to treat
24
Q

What is Kawasaki disease?

A
  • disease of children
  • presents clinically with fever, lymphadenopathy, crusty tongue, strawberry tongue and erythematous mucosa, peeling rash on hands and feet
  • coronary vessel aneurysms that may need antibiotics
25
Q

What is Wegener’s granulomatosis?

A
  • inflammatory condition which can destroy hard and soft tissues of face and oral cavity
  • spongy red tissue (oral ulceration)
  • associated with ANCA
  • renal and respiratory tract most affected
26
Q

What is fibromyalgia?

A
  • non specific collection of musculoskeletal problems
  • joint pain
  • muscle pain
  • functional disorders
  • no active disease or clinical findings
  • pain relief rather than immunosuppression

BDS3 DISEASES OF HUMAN SYSTEMS (16 decks)

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