Arthritis, Rheumatology Flashcards
define
a. arthritis
b. rheumatology
c. arteritis
define
a. arthritis: inflammation of joint
b. rheumatology: joint problems
c. arteritis: inflammation of blood vessels
4 subtypes of rheumatic disease and examples
- DEGENERATIVE (risk inc with age):
- oseteoarthritis
- cervical spondylosis - INFLAMMATORY:
- rheumatoid arthritis
- seronegative spondyloarthopathies
- crystal arthopathies: gout/pseudogout
- connective tissue disease (autoimmune)
- septic arthritis: infection at joint - SOFT TISSUE:
- tennis/golfers elbow (overextension)
- mechanical back pain (thoracic, improves w exercise)
- repetitive strain - OTHER
- fibromyalgia: chronic widespread pain, allodynia. poorly understood
- osteoporosis: dec mineral bone density –> inc fracture risk. common in all women
why must dentists know about osteoporosis
many pts on bisphosphanates for osteoporosis. Side effect: osteonecrosis –> no healing after tooth extraction
4 examples of seronegative spondyloarthropathies
- ankylosing spondylitis
- reactive arthritis
- psoriatic arthritis
- enteropathic arthritis
what does seronegative spondyloarthropathy mean
no rheumatoid factor in blood
common protein of seronegative spondyloarthropathies
HLA B27
6 examples of connective tissue disorders
- 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
6 examples of vasculitis
- 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
why is prompt treatment of sceleroderma important
risk of internal carotid a bulging –> loss of eyesight
describe structure of a healthy synovial joint
bone –> cartilage –> synovium
where is synovial fluid produced, why is it common place for infection
synovial membrane- has gd blood supply
functions of synovial fluid
- lubrication
- passes nutrients to cartilage (contains no blood vessels or nerve cells)
describe structure of osteoarthritic synovial joint
- 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
5 main groups of arthritis and causes
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)
2 symptoms of osteoarthritis in the hands
painless, firm nodules in finger joints
- Heberden’s node: distal interphalangeal joints
- Bouchard’s node: proximal interphalangeal joints
describe osteoarthritis on x ray
- joint space narrowing
- can see osteophytes, subchondral sclerosis
who is more at risk of Osteoarthritis
elderly, more women than men
describe synovial joint with rheumatoid arthritis (RA)
- 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
antigen in RA
rheumatoid factor (in synovium of joints)
symptoms of RA
fever, weight loss, malaise
symptoms in the hand of RA
- 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
x rays of rheumatoid arthritis
joint space narrowing, erosions juxta-articular osteoporosis
risk group for rheumatoid arthritis
women age 30-50
what is ankylosing spondylitis AS
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
