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Year 3 Human Disease > Arthritis, Rheumatology > Flashcards

Arthritis, Rheumatology Flashcards

1
Q

define

a. arthritis
b. rheumatology
c. arteritis

A

define

a. arthritis: inflammation of joint
b. rheumatology: joint problems
c. arteritis: inflammation of blood vessels

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2
Q

4 subtypes of rheumatic disease and examples

A
  1. DEGENERATIVE (risk inc with age):
    - oseteoarthritis
    - cervical spondylosis
  2. INFLAMMATORY:
    - rheumatoid arthritis
    - seronegative spondyloarthopathies
    - crystal arthopathies: gout/pseudogout
    - connective tissue disease (autoimmune)
    - septic arthritis: infection at joint
  3. SOFT TISSUE:
    - tennis/golfers elbow (overextension)
    - mechanical back pain (thoracic, improves w exercise)
    - repetitive strain
  4. OTHER
    - fibromyalgia: chronic widespread pain, allodynia. poorly understood
    - osteoporosis: dec mineral bone density –> inc fracture risk. common in all women
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3
Q

why must dentists know about osteoporosis

A

many pts on bisphosphanates for osteoporosis. Side effect: osteonecrosis –> no healing after tooth extraction

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4
Q

4 examples of seronegative spondyloarthropathies

A
  • ankylosing spondylitis
  • reactive arthritis
  • psoriatic arthritis
  • enteropathic arthritis
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5
Q

what does seronegative spondyloarthropathy mean

A

no rheumatoid factor in blood

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6
Q

common protein of seronegative spondyloarthropathies

A

HLA B27

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7
Q

6 examples of connective tissue disorders

A
  • SLE (dsDNA): malar rash, inflamed kidneys
  • Sjogren’s syndrome: anti-Ro. against exocrine glands (less saliva and tears)
  • scleroderma: hardened blood vessels –> tight waxy face, can’t open mouth, dysphasia, constipation, hypertension
  • polymyositis (below)
  • dermatomyositis: both attac on striated muscle eg thighs, sign of underlying malignancy. dermatomyositis only: panda eyes
  • vasculitis
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8
Q

6 examples of vasculitis

A
  • giant cell arteritis: medium to large aa eg aorta –> infarction of end organ
  • polymyalgia rheumatica (PMR): stiffness/pain in shoulders/thighs
  • Takayasu’s arteritis: inflammation of large aa eg aorta
  • polyarteritis nodosa: affects medium-sized vessels, associated with hep B
  • Wegener’s granulomatisis: small aa
  • Behcet’s syndrome: oral/ genital ulcers, thrombotic probs
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9
Q

why is prompt treatment of sceleroderma important

A

risk of internal carotid a bulging –> loss of eyesight

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10
Q

describe structure of a healthy synovial joint

A

bone –> cartilage –> synovium

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11
Q

where is synovial fluid produced, why is it common place for infection

A

synovial membrane- has gd blood supply

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12
Q

functions of synovial fluid

A
  • lubrication

- passes nutrients to cartilage (contains no blood vessels or nerve cells)

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13
Q

describe structure of osteoarthritic synovial joint

A
  • cartilage dies in patches
  • ->joint space narrows, bones rub together
  • -> subchonral bone thick and sclerotic
  • -> lips of bone grow out OSTEOPHYTES
  • capsule becomes thick, fibrotic
  • synovium may develop areas of inflammation
  • additional synovial fluid produced
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14
Q

5 main groups of arthritis and causes

A

O RAGS

  • osteoarthritis (cartilage death)
  • rheumatoid arthritis (synovial fluid and overgrowth)
  • ankylosing spondylitis (inflammation/new bone formation at entheses where ligaments and tendons join bone)
  • gout (crystals in synovial fluid)
  • septic arthritis (infection)
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15
Q

2 symptoms of osteoarthritis in the hands

A

painless, firm nodules in finger joints

  • Heberden’s node: distal interphalangeal joints
  • Bouchard’s node: proximal interphalangeal joints
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16
Q

describe osteoarthritis on x ray

A
  • joint space narrowing

- can see osteophytes, subchondral sclerosis

17
Q

who is more at risk of Osteoarthritis

A

elderly, more women than men

18
Q

describe synovial joint with rheumatoid arthritis (RA)

A
  • synovium inflamed
  • -> generalised cartilage loss (–> narrowed joint space)
  • -> thinning of bone close to joint (JUXTA-ARTICULAR OSTEOPOROSIS)
  • synovial cells hypertrophy, invasive –> EROSIONS in corners of bone
  • -> joint capsule deformed
19
Q

antigen in RA

A

rheumatoid factor (in synovium of joints)

20
Q

symptoms of RA

A

fever, weight loss, malaise

21
Q

symptoms in the hand of RA

A
  • metacarpophalangeal joint
    acute: red, soft
    chronic: deformed
  • ulnar deviation, swan-neck fingers, Boutonniere bc ligaments displaced by inflammation
  • muscle atrophy bc muscles not used due to pain
22
Q

x rays of rheumatoid arthritis

A

joint space narrowing, erosions juxta-articular osteoporosis

23
Q

risk group for rheumatoid arthritis

A

women age 30-50

24
Q

what is ankylosing spondylitis AS

A

ankylosing: sticking together
spondylitis: inflamed spine/ vertebrae
inflammation, new bone formation at entheses (little spurs called SYNDESMOPHYTES)
mainly in spine but can also be far from joints eg where plantar region of foot joins anterior margin of calcaneus

25
Q

most common joint for AS

A

sacro-ileac joint

26
Q

at risk group for AS

A

men aged 15-30

27
Q

SEE TABLE

most common drug used for arthritis

A

NSAIDS

28
Q

drugs for inflammatory arthritis4

A
  • corticosteroids
  • disease modifying agents (DMARDS) eg methotrexate, sulphasalazine, leflunamide
  • newer biological agents eg TNF
  • osteoporosis protection eg bisphosphanates
29
Q

drugs for gout 2

A

acute attacks –> colchicine

long term –> xanthine oxidase inhibitors eg allopurinol

30
Q

2 side effects of arthritis drugs on oral cavity

A
  • methotrexate –> stomatitis: red patches, mouth ulcers, peeling, swelling, oral dysaesthesia (numbness), burning mouth syndrome
  • bisphosphanates –> osteonecrosis: exposed bone in oral cavity for >6 weeks , can be spontaneous or after tooth extraction
31
Q

difference between gout and pseudogout

A

gout: sodium urate crystals (negatively birefringent)
pseudogout: calcium pyrophosphate crystals (positively birefringent)

32
Q

define birefringent

A

refraction of light in 2 slightly different directions to form 2 rays

33
Q

4 signs of septic arthritis

A
  • severe inflammation at joint
  • night sweats
  • pyrexia (fever)
  • raised white blood cell count
34
Q

how to diagnose septic arthritis

A

microscopy

culture of synovial fluid

35
Q

most common bacterial cause for joint infection in

a. UK
b. USA

A

a. UK: staph

b. USA: gonococci

36
Q

5 reactions in osteoarthritis

A
  • subchondral bone becomes thickened and sclerosed
  • osteophytes grow
  • capsule becomes thickened and fibrotic
  • synovium develops areas of inflammation
  • additional synovial fluid often produced

Year 3 Human Disease (28 decks)

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