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Systemic Disease > 7. Immunological Diseases > Flashcards

7. Immunological Diseases Flashcards

1
Q

Rheumatoid Arthritis

- S/sx

A
  1. Joint symptoms
  2. Chest pain when breathing
  3. Dry eyes/mouth
  4. Eye burning, itching, discharge
  5. Nodules under skin
  6. Numbness, tingling, burning
  7. Sleep difficulties
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2
Q

Rheumatoid arthritis - how to dx?

A
  1. Positive rheumatoid factor in 85% of patients
  2. 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
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3
Q

Rheumatoid arthritis - tx

- Lifelong treatment of what six items?

A

Lifelong treatment of:

  1. Medications
  2. PT
  3. Exercise
  4. Education
  5. Nutrition
  6. Early surgery
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4
Q

Rheumatoid arthritis - dental complications

A
  1. Joint pain/immobility (no flossing)
  2. Treatment induced complications like hematological dyscrasia
  3. TMJ pain/dysfunction
  4. Xerostomia
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5
Q

Rheumatoid arthritis - dental modifications (9)

A
  1. Consult physician
  2. Adjust chair position
  3. Short appts
  4. Xerostomia treatment
  5. Fluoride supplementation
  6. Antibiotic prophylaxis
  7. Soft diet for TMJ pain/dysfunction
  8. Hygiene aids
  9. OHI and regular follow-up
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6
Q

Sjogren’s - risk factors

A
  1. Female
  2. Any age (10-50)
  3. African Americans
  4. Asians
  5. Drug-induced
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7
Q

Lupus symptoms (11)

A
  1. Arthritis
  2. Chest pain
  3. Fatigue
  4. Fever
  5. Discomfort
  6. Uneasiness
  7. Malaise
  8. Hair loss
  9. Mouth sores
  10. Skin rash
  11. Swollen lymph notes
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8
Q

Dental complications of lupus

A
  1. Consult physician
  2. Drug induced stomatitis
  3. Bleeding from NSAIDS/Aspirin
  4. Leukopenia from corticosteroid therapy lead to infection
  5. Infective endocarditis
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9
Q

Sjogren’s - Risk factors

  • Sex?
  • Age?
  • Only a primary or secondary disorder?
A
  1. Women
  2. 40-50 age (rare in children)
  3. Can be either associated with another autoimmune disorder, or just solitary
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10
Q

Sjogren’s - Symptoms

A
  1. Dryness of eyes
  2. Dryness of mouth
    - Difficulty swallowing/eating
    - Loss of sense of taste
    - Difficulty speaking
    - Thick/stringy saliva
    - Mouth sores/pain
    - Hoarseness
  3. Fatigue
  4. Fever
  5. Joint pain/swelling
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11
Q

Sjogren’s - Treatment

A
  1. Artificial tears/lubrication
  2. Cyclosporine liquid
  3. Sipping water
  4. Sugarfree gum
  5. NSAIDs for arthritis symptoms
  6. PT
  7. Dry mouth protocol (biotene)
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12
Q

Sjogren’s - Dental complications

A
  1. Oral candidiasis
  2. Caries
  3. Dysgeusia (change in taste)
  4. Dysphagia (difficulty swallowing)
  5. Ulcerations
  6. Malnutrition
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13
Q

Why do you need to refer pemphigus vulgaris asap? And to who?

A
  1. Fluid loss and infection are deadly (look like burn patients)
  2. Dermatology
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14
Q

What percent of pemphigus vulgaris cases involve the mouth and how many limited to only mouth?

A
  1. 70% cases involve mouth

2. 50% only in mouth

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15
Q

Pemphigus vulgaris - Treatment

A
  1. Topical analgesics
  2. Adhesive paste
  3. Benzocaine in orabase
  4. Soft diets and soft toothbrushes
  5. Avoid foods that cause irritation
  6. Toothbrushing and CHX
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16
Q

Pemphigus vulgaris presentation

A
  1. Characteristic blistering

2. Bulla production can be ignited just by use of cotton tip application or air water syringe (+ nikolsky sign)

17
Q

Pemphigus risk factors

  • Age
  • Region
  • Genetics?
A
  1. > 60
  2. Mediterranean or middle eastern
  3. Strong genetic predisposition
18
Q

Describe pemphigoid

A
  • Chronic blistering
  • Auto antibodies target basement membrane
  • Occular manifestations
    • “Symblepharons”
19
Q

Pemphigoid treatment

A
  1. Eliminate perio disease
  2. Fixed > removable
  3. Palliative mouthwashes okay, but no alcohol in it
  4. Topical steroids for local control of inflammation
  5. Benzocaine in orabase
20
Q

Lichen Planus - Four P’s of presentation

A
  1. Purple
  2. Papular
  3. Pruritic
  4. Polygonal
21
Q

Diagnostic criteria of OLP

A
  1. Bilateral, more or less symmetrical lesions
  2. Lacelike network of slightly raised gray-white lines (reticular pattern)
  3. Erosive, atrophic, bulls, and plaque-type lesions
22
Q

Lichen Planus treatment

A

Symptomatic relief with use of palliative mouth rinses or ointments
- Steroid ointments / creams / gel

23
Q

Treatment to confirm if lichen planus erosive form is malignant or not?

A

Biopsy

24
Q

Erythema migrans

- Treatment

A

Generally no treatment, but topical steroid if burning sensation is severe
- Reassure patient that condition is benign

25
Q

Aphthous stomatitis

  • Where are minor aphthous ulcerations found?
  • How long do these lesions last?
  • Symptoms?
A
  1. Movable and nonkeratinized mucosa
  2. Buccal and labial mucosa
  • Last 7-14 days and then heal without scarring
  • Prodromal symptoms - burning, itching, stinging
26
Q

Aphthous stomatitis - treatment

A
  1. Minor or herptiform - topical gel

2. Major - more potent corticosteroids

27
Q

Aphthous stomatitis - s/sx (6)

A
  1. Deep ulcers (1-3 cm)
  2. Normally movable mucosa (soft palate and tonsillar folds)
  3. Severe pain
  4. Up to 6 weeks
  5. Can occur as complication of AIDS
  6. Heal with possible scaring

Systemic Disease (7 decks)

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