Bone Disease Flashcards
What do the following terms mean- Arthritis, Arthrosis and arthralgia?
Arthritis- inflammation of joints
Arthrosis- non-inflammatory joint disease
Arthralgia- joint pain
What is the role of parathyroid hormone in bone resorption and formation?
If calcium levels in the blood drop- PTH is released from the parathyroid gland.
Activates osteoclasts to resorb more bone- more calcium available in the blood now.
- also acts to reduces calcium waste in the urine by the kidneys and resorbs calcium in the intestines.
How does vitamin D influence bone health?
Vit D from the diet is converted eventually to 1,25-dihydroxycholecalciferol and this is required for calcium absorption in the GIT.
What factors can cause vitamin D problems?
Lack of dietary vitamin D
Lack of sunlight
Gut absorption issues
Drug interactions- carbamazepine, phenytoin
What is osteomalacia and Rickets?
Both related to calcium deficiency
Rickets- occurs during bone formation
Osteomalacia- occurs after bone formation completed
What is Osteoporosis?
Reduced quantity of normally mineralised bone.
- bone quantity is normal but it has reduced mineralisation.
What are the risk factors for osteoporosis?
Age
Females
Endocrine issue- oestrogen and testosterone deficiency
Genetics
Patient factors= inactivity, smoking, excess alcohol use, poor dietary calcium.
What considerations must be made for someone who has osteoporosis?
Mobility might be an issue
Might not be able to walk a long way- access to practice, transport
Medications- Bisphosphonates
What is the action of bisphosphonates?
Inhibits the enzyme Farsenyl pyrophosphate synthase.
Osteoclasts can no longer bond to the bone to resorb it.
Give some examples of bisphosphonates.
Alendronate
Zolendronate (most potent)
Ibandronate
What is Rheumatoid Arthritis?
Inflammatory destruction of the synovial within a joint cavity.
What autoantibody may or may not be present in RA?
Rheumatoid factor- auto-antibody.
What are the symptoms of RA?
Slow onset- initially hands and feet, proximal spread, potentially all synovial structures.
Symmetrical polyarthritis
Systemic symptoms- fever, weight loss, anaemia
What are the early signs of RA?
Symmetrical synovitis of MCP joints, PIP joints and wrist joints.
What are the late signs of RA?
Ulnar deviation of fingers at MCP joints.
Hyperextension of PIP joints
Z-deformity of the thumb.
Subluxation of the wrist
What are the dental implications for RA?
Poor mobility for getting into practice
Painful to lie in the chair
Manual dexterity compromised for carrying out OH
May be related to Sjogrens- dry mouth
Patient mill probably already be on a lot of pain medications- be wary of this in post-op instructions.
Risk of infection- from steroids and azothioprine
Oral ulceration- methotrexate
Oral lichenoid reactions- Sulphasalazine
Chronic anaemia- GA problems
What other extra-oral effects does RA have in the body?
Amyloidosis
Psoriasis
Systemic vasculitis
Eye involvement- scleritis and episcleritis
Dry eyes
Sjogren’s
What disease-modifying drugs might someone be on for RA?
Methotrexate
Hydroxychloroquine
Sulphasalazine
Steroid injections
What immune modulators might someone be on if they have RA?
Azothioprine
Mycophenolate
Biologics- Infliximab, adalimumab, Rituximab.
What is the mechanism of action of methotrexate?
Immunosuppressant- promoted adenosine release and inhibits transmethylation reactions.
