7. Immunological Diseases Flashcards
Rheumatoid Arthritis
- S/sx
- Joint symptoms
- Chest pain when breathing
- Dry eyes/mouth
- Eye burning, itching, discharge
- Nodules under skin
- Numbness, tingling, burning
- Sleep difficulties
Rheumatoid arthritis - how to dx?
- Positive rheumatoid factor in 85% of patients
- Has to last several weeks and have 4 of these symptoms:
a. Morning stiffness
b. Arthritis of 3+ joint areas
c. Arthritis of hand joints
d. Symmetric arthritis
e. Rheumatoid nodules
f. serum rheumatoid factor
g. radiographic changes
Rheumatoid arthritis - tx
- Lifelong treatment of what six items?
Lifelong treatment of:
- Medications
- PT
- Exercise
- Education
- Nutrition
- Early surgery
Rheumatoid arthritis - dental complications
- Joint pain/immobility (no flossing)
- Treatment induced complications like hematological dyscrasia
- TMJ pain/dysfunction
- Xerostomia
Rheumatoid arthritis - dental modifications (9)
- Consult physician
- Adjust chair position
- Short appts
- Xerostomia treatment
- Fluoride supplementation
- Antibiotic prophylaxis
- Soft diet for TMJ pain/dysfunction
- Hygiene aids
- OHI and regular follow-up
Sjogren’s - risk factors
- Female
- Any age (10-50)
- African Americans
- Asians
- Drug-induced
Lupus symptoms (11)
- Arthritis
- Chest pain
- Fatigue
- Fever
- Discomfort
- Uneasiness
- Malaise
- Hair loss
- Mouth sores
- Skin rash
- Swollen lymph notes
Dental complications of lupus
- Consult physician
- Drug induced stomatitis
- Bleeding from NSAIDS/Aspirin
- Leukopenia from corticosteroid therapy lead to infection
- Infective endocarditis
Sjogren’s - Risk factors
- Sex?
- Age?
- Only a primary or secondary disorder?
- Women
- 40-50 age (rare in children)
- Can be either associated with another autoimmune disorder, or just solitary
Sjogren’s - Symptoms
- Dryness of eyes
- Dryness of mouth
- Difficulty swallowing/eating
- Loss of sense of taste
- Difficulty speaking
- Thick/stringy saliva
- Mouth sores/pain
- Hoarseness - Fatigue
- Fever
- Joint pain/swelling
Sjogren’s - Treatment
- Artificial tears/lubrication
- Cyclosporine liquid
- Sipping water
- Sugarfree gum
- NSAIDs for arthritis symptoms
- PT
- Dry mouth protocol (biotene)
Sjogren’s - Dental complications
- Oral candidiasis
- Caries
- Dysgeusia (change in taste)
- Dysphagia (difficulty swallowing)
- Ulcerations
- Malnutrition
Why do you need to refer pemphigus vulgaris asap? And to who?
- Fluid loss and infection are deadly (look like burn patients)
- Dermatology
What percent of pemphigus vulgaris cases involve the mouth and how many limited to only mouth?
- 70% cases involve mouth
2. 50% only in mouth
Pemphigus vulgaris - Treatment
- Topical analgesics
- Adhesive paste
- Benzocaine in orabase
- Soft diets and soft toothbrushes
- Avoid foods that cause irritation
- Toothbrushing and CHX
Pemphigus vulgaris presentation
- Characteristic blistering
2. Bulla production can be ignited just by use of cotton tip application or air water syringe (+ nikolsky sign)
Pemphigus risk factors
- Age
- Region
- Genetics?
- > 60
- Mediterranean or middle eastern
- Strong genetic predisposition
Describe pemphigoid
- Chronic blistering
- Auto antibodies target basement membrane
- Occular manifestations
- “Symblepharons”
Pemphigoid treatment
- Eliminate perio disease
- Fixed > removable
- Palliative mouthwashes okay, but no alcohol in it
- Topical steroids for local control of inflammation
- Benzocaine in orabase
Lichen Planus - Four P’s of presentation
- Purple
- Papular
- Pruritic
- Polygonal
Diagnostic criteria of OLP
- Bilateral, more or less symmetrical lesions
- Lacelike network of slightly raised gray-white lines (reticular pattern)
- Erosive, atrophic, bulls, and plaque-type lesions
Lichen Planus treatment
Symptomatic relief with use of palliative mouth rinses or ointments
- Steroid ointments / creams / gel
Treatment to confirm if lichen planus erosive form is malignant or not?
Biopsy
Erythema migrans
- Treatment
Generally no treatment, but topical steroid if burning sensation is severe
- Reassure patient that condition is benign
