Arthritis, Rheumatology, Disease and Treatment Flashcards
What are the 4 classes of rheumatic disease?
DEGENERATIVE - osteoarthritis, cervical spondylosis
SOFT TISSUE - tennis elbow, repetitive strain injury
INFLAMMATORY - rheumatoid arthritis, connective tissue disease
OTHER - fibromyalgia, osteoporosis
What is seronegative spondyloarthropathies and name some examples?
Includes joint involvement of vertebral column from any type of joint disease.
Ankylosing, spondylytis, reactive and psoriartic arthritis
Name some connective tissue disorders?
SLE, sjogrens syndroms, sclerodema, polymyositis, dermatomyositis vasculitis
What is inside the capsule of a joint?
enthesis and the synovium full of synovial fluid which produces lubricating fluid, which passes nutrients to the cartilage because the cartilage contains no blood vessel or nerve endings
What are the 5 main causes of arthritis?
Cartilage death - osteoarthritis
Synovial inflammation and overgrowth - rheumatoid arthritis
Inflammation and new bone formation at enthesis - ankylosing spondylitis
Crystals in synovial fluid - gout
Infection - septic arthritis
Describe osteoarthritis?
AFFECTS THE CARTILAGE
Cartilage dies in patches and so the bones sit more closely together and rub against each other.
Bone under cartilage (subchondral) becomes thick and sclerotic.
Bone at the edges of the joint grows outwards (osteophytes) to support the joint.
Joint capsule becomes thick and fibrotic and synovium may develop small areas of inflammation.
excess synovial fluid is produced.
F>M, >50yrs
Describe Rheumatoid arthritis?
AFFECTS THE SYNOVIUM
Synovium is inflamed and overgrown with a mix of acute and chronic changes.
Leads to pain, stiffness and destruction
Persistent inflammation causes generalised cartilage loss and so joint space narrows and the bone thickens (juxta articular osteoporosis)
Synovial cells get overgrown and invasive and destroy the bone
Joint and capsule become deformed
F>M, 30 - 50yrs
Describe Ankylosing spondylitis?
“inflamed spine stick together”
AFFECTS ENTHESIS
Inflammation and new bone formation at the enthesis
Main site is the spine, can be foot
Enthesis go through phases of inflammation and healing with bone formation
After inflammation, new bone forms little spurs (syndesmophytes) which grow out into the area of the ligaments
Recurrent attacks - spurs lengthen and can grow into each other to form a bony bridge across intervertebral discs
Discs are usually damaged and so progressive loss of range of motion.
M>F, 15 -30 yrs
Describe Gout?
CRYSTALS IN SYNOVIAL FLUID
Sodium urate crystals form in synovial fluid and attract onslaught of polymorphonuclear leukocytes which migrate into joint and cause acute inflammatory response.
Urate is a normal product of purine metabolism (gout if levels are high).
50% pts the 1st synovial joint involved is interpharlangeal in big toe.
If no treatment it will settle in 2 - 3 weeks but is very painful
M>F, 40 yrs, F after menopause
Describe Septic Arthritis?
Inflammation of a joint caused by a bacterial infection, most commonly staph or strep.
If untreated it will destroy the joint.
Systemic symptoms - night sweats , pyrexia (raised body temp), increased WBC
Most common in joint already affected by arthritis
How does arthritis affect the dental practice?
Manual dexterity Opening mouth Lying in chair Mobility Anesthesia Access Sjogrens Syndrome Stomatitis Medications
What drugs are used to treat arthritis?
NSAIDs
INFLAMMATORY ARTHRITIS - corticosteroids, diease modifying agents, anti TNF, bisphosphonates
GOUT - colchicine, xanthine oxidose inhibitors
What are the effects of rheumatological drugs on the oral cavity?
Methotrexate - stomatitis, red patches, ulcers, peeling, swelling, oral dysaethesia, burning mouth syndrome
Bisphosphonates - osteonecrosis of the jaw, exposed bone in the oral cavity >6 weeks, increased risk after invasive procedures including extractions.
