Bone and rheumatology Flashcards

1
Q

describe the two types of resorptions we get in the tooth

A

internal and external resorption

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2
Q

how can we tell the difference between internal and external resorption

A

internal = radiolucency is in continum with the canal
externa - radiolucnecy superimposed on the canal

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3
Q

explain the structure of a bone

A

outer layer = periosteum = vascular CT
outer bone = dense, cortical bone
inner bone = trabecular, less dense
inner space = medulla = bone marrow and site of haemapoeisis

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4
Q

what are the functions of bone (3)

A

Mineral homeostasis = calcium and phosphate

Houses haemopoietic system
i.e. the bone marrow

Mechanical
Not a static scaffold - constantly remodelled

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5
Q

when might we get haematopoeisis in other sites

A

if there is dysfunction of bone haematopoiesis, pathology
occurs in spleen = not good

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6
Q

what cells would we see histologically of a remodelling site

A

osteocytes within matrix = calcified osteoblasts
small osteoblasts on margins
large osteoclasts

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7
Q

a pt has blue tinted sclera, what is this a sign of

A

osteogenesis imperfecta

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8
Q

what causes osteogenesis imperfecta and what does it affect

A

collagen 1 mutation
affects most tissues, ears, eyes (blue sclera), bone, teeth

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9
Q

what is achondroplasia

A

Autosomal dominant
Failure of cartilage maturation at the growth plate
Caused by a mutation of fibroblast growth receptor receptor 3 which causes it to be continually activated (it is a negative regulator of bone growth)

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10
Q

where is the mutaiton in pts with achondroplasia

A

FGR3 fibroblast growth receptor 3

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11
Q

what is rickets

A

disorder of bone mineralization
Caused by deficiency in vitamin D or calcium
Can be dietary or metabolic
Failure to mineralise -
>cartilage overgrowth,
failure of longitudinal growth
In the growing skeleton causes rickets due to failure of mineralization of growth plate cartilage
In the mature skeleton, causes bone fragility

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12
Q

what can cause rickets

A

vitamin D or calcium deficiency = dietary
metabolic = increased blood calcium and bone resorption

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13
Q

what is osteoporosis

A

Increased porosity of bone due to a reduction in bone mass

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14
Q

what can cause osteoporosis

A

Age
Hormonal influences
Lifestyle (smoking, alcohol)
Activity = +ve
Genetics
Nutrition (including malabsorption)

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15
Q

why does age affect osteoporosis

A

Sex steroids maintain mass of bone in adulthood, when women go through menopause, there is a sharp decline of oestrogen causing osteoclast activity to increase

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16
Q

what two main types of bone fracture are there

A

fragility = due to weakened bone under normal stress
pathological = due to tumour press

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17
Q

what bone is lost first in osteoporosis and why is this relevent

A

trabecular bone
bones with thin cortical bone and high trabecular bone degrade quickly and become very weak e.g. femoral neck

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18
Q

where are we likely to get fragility fractures with osteoporosis and why

A

vertebrae, femoral neck, distal radius
low cortical bone : trabecular bone
trabecular bon resorbs first so with little cortical bone = fracture

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19
Q

give three ways we coud possibly treat osteoporosis

A

bisphosphonates that kill osteoclasts = MRONJ risk
monoclonal antibodies against cytokines e.g. RANK-L
Increase bone formation (experimental treatments, e.g. parathyroid hormone)

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20
Q

what are the three complications of osteoporosis

A

Fragility fractures (vertebrae, femoral neck, distal radius)
Kyphosis (dowager’s hump)
Loss of height

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21
Q

what is Kyphosis

A

dowagers hump
hunchbacked appearance of the neck caused by osteoporosis which leads to reduced height

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22
Q

if a pt seems to be getting deformation and resorption of particular bones, what is the likely cause

A

Pagets Syndrome

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23
Q

what is and what causes Pagets Disease

A

Cause unknown but there appears to be a genetic component
Characterised by increased bone resorption and poorly- controlled bone formation

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24
Q

what is osteomyelitis

A

infection of the bone
that can cause necrosis and become blood borne causing sepsis

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25
what are some common organisms that cause osteomyelitis
Staph aureus M. tuberculosis Salmonella E.Coli
26
where do most bone tumours originate
most are secondary metastases from lung, prostate and breast
27
if a pt has a primary bone tumour, what are the classes they can be
mainly benign Can be: Chondrogenic Osteogenic Others (non-matrix forming)
28
what types of chondrogenic tumour can we get (3)
mainly 60% benign : Osteochondroma – many sites Chondroma – mainly fingers 40% malignant Chondrosarcoma – femur, pelvis, skull base
29
what percent of chondrogenic primary tumours are benign
60
30
where are we likely to find chondroma
type of chondrogenic benign tumour mainly found in fingers
31
where would we usually find chondrosarcoma
femur, pelvis, skull base
32
compare osteogenic and chondrogenic primary tumours
osteogenic are mainly malignant 87% chondrogenic are mainly benign 60%
33
name the three types of osteogenic tumour
13% benign Osteoid osteoma – any site, small tumours in cortex Osteoblastoma – larger tumours, typically spinal 87% malignant Osteosarcoma – most commonly distal femur and tend to affect younger people
34
compare osteoid osteomas and osteoblastomas
both benign Osteoid osteoma – any site, small tumours in cortex Osteoblastoma – larger tumours, typically spinal
35
where and who might get osteosarcomas
87% of osteogenic tumours are malignant osteosarcomas mainly found in the distal femur, affecting younger people
36
what age group are affected by osteosarcomas
15-30 year olds mainly metaphyses in knee
37
how do we treat osteosarcomas
mainly occur in the knee sensitive to chemotherapy to reduce size then surgical removal of tumour hopefully save limb, replace knee
38
what age group are prone to ewings sarcoma
<20
39
what diseases can affect joints
Infections Crystal arthropathies Chronic inflammatory arthritis Osteoarthritis/osteoarthrosis Tumours – these are rare so don’t worry about them
40
what is crystal arthropathies (1) and how are they diagnosed (1)
class of joint disorder that is characterized by accumulation of tiny crystals in one or more joints diagnosed via polarizing light microscopy main culprit is gout
41
what is gout
type of crystal arthropathy Urate crystals secondary to raised serum uric acid Deposited in joints Due to raised uric acid
42
how do we treat gout
Anti-uric acid
43
what demographic is likely to get gout
middle-aged gout
44
what two types of crystal arthropathies are there and compare
gout and pseudogout gout = urate crystals due to high uric acid = treat with anti-uric acids pseudogout = Calcium pyrophosphate crystals = treat symptoms = NSAIDs
45
how might gout present
recurrent attacks of red, tender, hot and swollen joint very painful joints
46
what is rheumatoid arthritis
Mainly Autoimmune Part of rheumatoid disease – a systemic inflammatory disorder Systemic inflammatory disorder Progressive destructive synovitis causing joint deformity Characterised by deformity in joint e.g. small joints in fingers = ulnar deviation
47
what are some types of chronic inflammatory joint arthiritis
mostly autoimmune rheumatoid arthritis HLA B27-associated diseases such as ankylosing spondylitis and psoriatic arthritis
48
what is ankylosing spondylitis
HLA B27-associated diseases Ankylosing spondylitis is an inflammatory disease that, over time, can cause some of the bones in the spine (vertebrae) to fuse. This fusing makes the spine less flexible and can result in a hunched posture. If ribs are affected, it can be difficult to breathe deeply.
49
name a HLA B27-associated disease
ankylosing spondylitis
50
what is a new tx for rheumatoid arthritis and ankylosing spondylitis
methotrexate - Disease-modifying anti-rheumatic drug Anti-TNF treatments are new and effective
51
what is the most common joint disease
osteoarthritis
52
what is osteoarthritis
most common joint disease Degenerative disease-causing erosion of cartilage with minimal inflammation Leads to changes in underlying bone and reduction of cartilage Bone on bone = not functional and more friction, underlying bone remodells forming deformed joints and only way to treat = replacement
53
what causes osteoarthiritis
joint trauma = running or inflammation, intra- articular fracture or septic arthritis aging
54
compare osteoarthritis and rheumatoid arthritis
osteoarthritis = caused by aging, wear and trauma, leads to reduction in cartilage = friction = treated by replacement of joint, minimal inflammation rheumatoid = autoimmune disorder, inflammation of joints, treated by methotrexate - Disease-modifying anti-rheumatic drug, Anti-TNF, NSAIDs
55
what is septic arthiritis and what are the symptoms
infection of joint synovial cavity sudden onset of pain in 1 joint only general unwell feeling, flu like tiredness skin colour change around joint and pain, hot, swollen
56
how do we treat septic arthitiris
immediately in hospital drain cavity, antibiotics, IV fluids
57
what causes septic arthiritis and what are some risks
joint replacement, dog bites, if inject drugs, injury, weakened immune system caused by bacteria getting into the joint space commonly staph aureus
58
what is rheumatology
medicine with bones, joints and muscle usually inflammatory and auto-immune
59
what is the rule of thirds with fevers
1/3 are infection 1/3 cancer 1/3 rheumatology
60
what are some systemic affects of rheumatology
fever rash pain and stiffness heart and lung involvement
61
how can we tell apart joint pain from inflammatory / non-inflammatory
inflammatory = hot, swollen, painful, hot to touch, better on use of joint non-inflammatory = better with non-use of joint, less swollen
62
what are the three types of auto-immune inflammatory rheumatoid diseases
rhuematoid arthiritis (most common) Spondylo arhtiritis connective tissue disease
63
how many people have rhuematoid arthiritis and why is it decreasing
1% reducing as smoking is reducing
64
what are the symptoms of rheumatoid arthritis
early morning stiffness of joints effected - cannot make fist eases with use/exercise flu like symptoms stiffness after rest help when we have NSAIDs
65
compare a joint with gout/infection and a joint with rheumatoid arthiritis (2)
RA = warm and slightly red infection/gout = very hot and very red
66
give three signs of the hand that = untreated rheumatoid arhtiritis
untreated = deformities Z thumb ulnar deviation of digits (bend towards little finger) subluxation of fingers (fingers lower plane than hand) swan neck deformity
67
what are the non-articular results of rheumatoid arthritis
lung = nodules, lung fibrosis, pleasural effusions heart = myocarditis. pericarditis, valve inflammation kidneys = amyloidosis --> nephrotic syndrome skin = rheumatoid nodules, vasculitis (infalmamtion of vasuclar tissue on skin =black areas of skin) secondary Sjorens Syndrome
68
how might rheumatoid arthiritis effect the lungs and heart
non-articular affects lung = nodules, lung fibrosis, pleasural effusions heart = myocarditis. pericarditis, valve inflammation
69
what is a rheumatoid nodule, including histology
hard lump in skin that is mobile, not fixed central necrotic tissue with a ring of lymphocytes and subcutaneous tissue The nodules are characterized histologically by dense areas of fibrinoid necrosis with basophilic streaks and granules, surrounded by a palisade of cells, mainly fibroblasts and histiocytes.
70
a patient has painful joints and black areas of skina round their fingers. what is the problem
vasculitis on the fingers caused by uncontrolled systemic rheumatoid arthiritis
71
what blood tests are relevant to rheumatoid arthritis
anaemic (normocytic or iron deficient -NSAIDS) high/low plateletes 75% have antibodies: -RF = rheumatoid factor -anti CCP
72
what two atnibodies do we test when diagnosing rheumatoid arthiritis
RF rehuamtoid factor anti CCP
73
compare an early and late xray of a patient's joints living with rheumatoid arthiritis
early: osteopenia (thinning of bone) around joints and soft tissue swell late: erosions, space narrowing, subluxation, fusion (ankylosis)
74
what are the treatment options for rheumatoid arthritis
immediate releif: NSAIDs, steroids (very effective) injected into joints, orally but lots of side effects control of disease = immunosuppression can be biological or DMARDS DMARDs = disease modifying anti-rheumatic drugs e.g., methotrexate, hydroxychloroquine, sulfasalazine biological = Atni TNF = infliximab, B cell deplition = Rituximab,
75
what are the treatment options for rheumatoid arthritis
immediate releif: NSAIDs, steroids (very effective) injected into joints, orally but lots of side effects control of disease = immunosuppression can be biological or DMARDS DMARDs = disease modifying anti-rheumatic drugs e.g., methotrexate, hydroxychloroquine, sulfasalazine biological = Atni TNF = infliximab, B cell deplition = Rituximab, Jak
76
what are DMARDs
DMARDs = disease modifying anti-rheumatic drugs e.g., methotrexate, hydroxychloroquine, sulfasalazine Methotrexate is most common - know pathwya!
77
if a patient has rheumatoid arthritis and has a prescription, what questions must we ask and why
ask if they have any hospital only prescriptions biological treatment of rheumatoid arthritis is hospital prescription only so will not show on GP prescription ask if they are taking any injections that are not on the list
78
what part of rheumatoid arthiritis treatment will not be found on a GP prescription
biological treatment e.g. Atni TNF = infliximab, B cell deplition = Rituximab, Jak
79
compare Jak to other biological treatments of rheumatoid arthritis
jak is the only pill the rest are injections or IV
80
what risks come with treatment of rehumatoid arthiritis
infection due to potent immunosupression
81
what risks come with treatment of rehumatoid arthiritis
infection due to potent immunosupression espically anti-TNF mabs e.g. infliximab that can cause reucrrent TB
82
what particular rrisk is there with taking infliximab for rheumatoid arthiritis
anti-TNF biological treatment very immunosuppressive and high risk of recurrent TB
83
what is the main side effect of methotrexate
nausea, GI upset and vomiting
84
if a patient is on DMARD or biological rheumatic drug, what must we do if putting them on anti-biotics
take them off their drug for the duration of the antibiotic and for 2 weeks latter
85
what side effects are there from anti-rheumatoid arthiritis treatment (5)
immunosuppressive infection = infliximab = recurrent TB, Hep C/B methotrexate = nausea, GI upset, vomitting hepatoxicity = rise in liver enzymes bone marrow toxicity = leukopenia, thrombopenia, pancytopenia skin rash
86
a patient is being treated for rheumatoid arthiritis and is taking a 2.5mg tablet once a week. what is this
methotrexate
87
what is the frequency and dose of methotrexate
rheumatoid arhtiritis DMARD once a week, 15-25mg a week in 2.5mg tablets
88
what can we never prescribe with methotrexate and why
Trimethoprim and Septrin anti-folate drugs (as is methotrexate) causing bone marrow suppression
89
what lung complications can we get with methotrexate and how can we avoid this
pneumonitis/fibrosis a few months after starting infection of both lungs leading to dry cough usually goes but can stay scan lungs and screen breathing rates before prescription
90
if a patient on methotrexate has recently been diagnosed with renal failure what do we do
take them off methotrexate as it is renally excreted
91
if a patient is wanting to get pregnant and is on anti-rheumatoid drugs, what must we do
check if they are on methotrexate if so they must be off of the drug for 3 months teratogenic and can cause miscarriage
92
what affects can methotrexate have
nausea and mouth ulcers is universal after starting causes marrow toxicity if taken with trimethoprim (GU infection) and septrin can cause pneumonitis/fibrosis a few months after starting teratogenic and cause miscarriage if used 3 months before conception renally excreted so needs good renal function
93
if a patient is on biological drugs for rheumatology how does this effect dental procedures
very immunosuppressive so may cause recurrence of TB or hep C/B have to stop before major surgery but dental XLA usually okay if taking off, keep off for 2 weeks to ensure safe healing
94
what disease must we not take methotrexate with
multiple sclerosis due to anti-TNF indications making it worse
95
how does rheumatology effect general anaesthetic
can cause rheumatoid neck erosion of C1 and C2 weakness here can lead to spinal cord injury under GA need xray if not had one in last 5 years before GA
96
what are the dental impications of rheumatoid neck
erosion of C1 and C2 weakness here can lead to spinal cord injury under GA need xray if not had one in last 5 years before GA also effects comfort and stability in dental chair
97
what is rheumatoid neck
erosion of C1 and C2 due to rheumatoid arthiritis leading to subluxation at atlano-axial level, sub axial or both levels and compression on spinal cord
98
what will a pt with rheumatoid neck look like
neck to the side and forward spine is reverse C shaped
99
what are C1 and C2
atlast and axis 1st and 2nd cerebra
100
how might rheumatoid neck cause spinal cord injury
usually, C1 atlas and C2 axis sit together with a ligament separating the 'dens' prominence of C2 interrupting with the spinal cord in rheumatoid arthritis, this ligament degrades, and the dens can put pressure on the spinal cord, possibly injuring the tissue
101
how do we manage a patient with rheumatoid neck
ask if they get neck pain do they know they have 'rheumatoid neck' when positioning the patient, do they get any new neck pain check new neurological symptoms e.g. pins and needles in hands
102
how might rheumatoid arthiritis link to gingivitis
immunosuppressive drugs may increase susceptibility to infection lack of manual dexterity may reduce oral hygiene gingivitis = suspectable individual more likely to get rheumatoid arthritis
103
why might a patient on methotrexate also be on bisphosphonates
methotrexate is a DMARD for rheumatoid arthritis many patients with rheumatoid arthritis also have osteoporosis in which bisphosphonates are tx for
104
what is juvenile idiopathic arthritis
affects under 16-year-olds inflammatory arthritis 50% grow out of it mandible underdevelopment, class III malocclusion, pain, TMJ erosion
105
what does SPondylo Arthritis include
akylosing spondylitis reactive arthiritis = STIs and UTIs Enteropathic Arthiritis = Crohns and UC Psoriatic Arthiritis = skin
106
what is HLA-B27
antigen protein strongly associated with ankylosing spondylitis and other sponylo arthiritis
107
what gene is strongly associated with sponylo arthiritises
HLA-B27
108
what is ankylosing spondylitis
calcific spine fixed spine, cannot move neck, stuck in a slouched position inflammatory spine pain
109
what are the 5 common features of Ankylosing Spondylitis
Enthisitis= inflammation between tendon/ligament and bone e.g. tennis elbow Dactylitis = swollen finger or toe skin/nail psoriasis = rash with itchy, scaly patches, most commonly on the knees, elbows, trunk and scalp Iritis = inflammatory eye disease IBD = Crohn's and UC
110
what is psoriasis
rash with itchy, scaly patches, most commonly on the knees, elbows, trunk and scalp no cure, inflammatory
111
what is another name for Iritis and what is it associated with
anterior uveitis commonly associated with ankylosing spondylitis
112
what is anterior uvitieis
iritis inflammatory eye disease with red sclera and irregular pupil/iris associated with ankylosing spondylitis
113
how do we treat iritis
steroid eye drops
114
how many joints does rheumatoid and sonpylo arthiritis effect
rheumatoid = many around the body spondylo = 1 or 2, oligoarthritic
115
descibr ehte signs of Psoriatic arthiritis
swollen fingers flakey, birttle looking nails red psoriasis around finger bed and finger joints nail pitting in nails = early (more than 6 is abnormal)
116
what might pitting in the nails pre-dispose
more than 6 pits = psoriatic arthiritis
117
what is osteoarthritis
degenerative process, wear and tear thinning of cartilage putting pressure on bones and sclerosis very painful joints related to occupation and sport increases with age
118
what is the commonest cause of joint replacement
osteoarthiritis
119
compare bouchards nodes and heberdens nodes
both occur with osteoarthritis as calcium deposits = osteophytes bouchards = middle joint of finger Heberden's = distal joint
120
on an x-ray of osteoarthiritis joint what would we see (3)
reduced joint space osteophytes = calcium deposits at side of joint sub-chonrdal scelrosis thickeing of underlying bone
121
what is the treatment for osteoarthiritis
phsyiotherapy/exericse weight loss to reduce stress paracetamol, co-codamol, NSAIDs surgery if joint failure or uncontrollable pain
122
what is gout
extremily painful, red swollen joint gout urate crystals precipitate into joint very inflammatory due to high serum uric acid cause neutrophils and inflammatory cytokines
123
what can cause high uric acid in serum
renal impairment genetic predisposition diuretics dehydration high alcohol/red meat part of metabolic syndrome (central obesity, diabetes, high BP, high cholesterol)
124
how do we treat GOUT
NSAIDs, steroids (pain) colchicine anti-inflammatory during attack 2/3 times a day
125
how can we prevent GOUT
lowering uric acid Allopurinol and Febuxostat both xanthine oxidase inhibitors
126
what is connective tissue disease
group of rare autoimmune diseases associated with auto-antibodies
127
what is connective tissue disease
group of rare autoimmune diseases associated with autoantibodies, more common in women
128
why can Ct disease be life threatening
renal failure myocarditis lung fibrosis cerebral involvement - risk factor for stroke, if very young pt has stroke may be CT disease
129
what is the antibody associated with all connective tissue disease
ANA+ anti-nuclear antibody however this is not causative, 10% of people have this but 10% do not have CT disease
130
what is Lupus
type of CT disease
131
name 3 connective tissue diseases
Systemic Lupus Primary Sjogrens Scleroderma Polymyositis Dermatomyositis
132
how can we identify CT tissue disease diagnosis (2)
do an ANA antibody test if positive, do further testing to determine specific genes related to specific disease
133
what are some common features of connective tissue disease
Raynauds mouth ulcers cardiorespiratory disease non-erosive arthiritis butterfly rash/ blistering photosensitivity
134
what are Raynaud's and describe the three phases
common feature of CT disease lack of blood flow in fingers/toes due to CHANGE of temperature 1. fingers go white due to vasoconstriciton extreme 2. build-up of deoxygenated blood = blue 3. overdilute in warm and go warm, enlarge, swell and go red
135
if someone present with very deformed fingers but on x-ray has no erosions, what is the cause
connective tissue disease related to ALA+
136
compare deformed fingers in rheumatoid arthiritis and connective tissue disease
arthiritis = on x-ray = erosive marks and cannot move fingers, they are fixed CT = no erosion and fingers are bendy and can be corrected
137
what can cause and bring on a butterfly rash
caused by connectives tissue disease brought on by sun exposure
138
what is the key feature of sclerodoma (systemic scerlosis)
progressive skin thickening and tightening starting from fingers up
139
what are some features of sclerodoma
skin thickening progressive severe raynauds (colour changing fingers due to temp CHANGE) didgital ulcers
140
what are the two major types of scleroderma
limited systemic sclerosis (LcSSc) = just hands, fingers and feet Diffuse systemic sclerosis (DcSSc) = widespread
141
compare LcSSc and DcSSc
limited systemic slcerodoma = just hands, fingers and feet, pulmanory hypertension and acid reflux , microstomia (tight, tethered skin around mouth) and telangiectasia (small red marks on lips and tongue) diffuse systemic sclerodoma = widespread, pulmanory fibrosis and scleroderma renal crisis - hypertensive acute renal failure
142
why do we do echocardiograms and breathing function tests in patients with scleroderma
LcSSc limited systemic scleroderma can cause pulmanory hypertension which will only present as breathlessness when very severe so is screened for regularly
143
a patient comes in with thickening skin on their hands and very bad acid erosion, what is a likely diagnosis
LcSSc - limited systemic scleroderma causes pulmanory hypertnesion, skin thickening and acid reflux ALA+ gene
144
what oral manifestations are there of limited systemic scleroderma (2)
acid reflux = acid erosion of teeth, TSL microstomia and skin tethering around mouth, struggle to open mouth wide Telangiectasia = small red marks on lips and tongue
145
why might a patient with LcSSc wear heavy makeup
causes telangiectasia and microstomia small red marks on liops and tongue and also stretching and tethering of skin around mouth
146
compare primary and secondary Sjogren's Syndrome
primary = occurs without rheumatoid or other autoimmunity, caused directly by connective tissue disease secondary = caused by other rhuematoid illness, mainly rheumatoid arthritis or other auto-immune diseases
147
what is Sjogrens syndrome
autoimmune disease affecting fluid producing body parts dry eyes, thin, non-lubricating wetness of the eyes xerostomia diffuclty swallowing difficulty drinking dry foods joint pain
148
what are the two main symptoms of Sjogrens syndrome
dry mouth and dry eyes (streaming eyes in wind, non-lubricating eye fluid)
149
what antibody and proteins are associated with primary Sjogrens syndrome
Ro and La antibodies high immunoglobulins, high ESR and Rheuamtoid factor RF
150
what are the rare but serious complications of primary Sjogrens syndrome
9x more likely LYMPHOMA Vasculitis renal involvement peripheral neuropathy billiary cirrhosis
151
if someone has diangosed sjogrens syndrome, what should we look out for and how (2)
Lymphoma is 9x more likely look out for B symptoms, fever, night sweats and weight loss
152
what would a salivary gland form a patient with Sjogren syndrome look like histologically and clinically
Lymphocytic infiltration of salivary glands that disrupt glandular architecture can cause swelling of parotids and submandibular glands and then atrophy of these glands
153
what oral representations of Sjogrens syndrome are there (3)
dry mouth, diffuclty swallowing swelling of parotis in early days, then atrophy of parotids atrophic 'shiny' glossitis
154
what are polymyositis and dermatomyositis
conntective tissue disease causing muscle inflammation painless wasting of muscles causing weakness of muscles and thighs both associated with lung fibrosis
155
compare polymyositis and dermatomyositis
both conntective tissue disease causing muscle inflammation painless wasting of muscles causing weakness of muscles and thighs both associated with lung fibrosis polymyositis is only muscles dermatomyositis is muscles and skin and involes photosensitivity causing purple rash around eyes with high chance of internal malignancy
156
what are some sing and symptoms and risks of Dermatomyositis
muscle and skin involvement painless wasting of muscles, especially arms and thighs lung fibrosis photosensitivity - purple 'helitrope' rash around eye and periorbital oedema strong association with internal malignancy
157
pt has a purple helitrope rash around eyes and weak thighs, what do they have
dermatomyocitis - connective tissue disease
158
what would histology of muscles be in dermatomyocitis
lymphocytic infiltration of muscle
159
how do we treat connective tissue diseases
NSAIDs and Steroids DMARDS - hydroxychloroquine for life threatening - chemotherapy Biological Atni-TNF drusg e.g. rituximab
160
how do we treat connective tissue diseases
NSAIDs and steroids DMARDs e.g. hydroxychloroquine if life threatening = chemotheraopy biological anti-TNF drusg e.g. rituximab
161
in which connective tissue disease are anti-TNF biological drugs e.g. rituximab contraindicated
Lupus SLE (systemic lupus erythematosus)