Connective Tissue Disease Flashcards
2 main types of CT disease
- multisystem vasculitic inflammatory disease - where tissues are the target of inflammation e.g. systemic sclerosis, sjogrens syndrome, systemic lupus erythematosis
- Vascular vasculitic disease - where blood vessels are the target for inflammation e.g. large vessel - giant cell arteritis, medium vessel - kawasaki disease, small vessel - wegeners granulomatosis
general management of CT disease
dependent on disease activity i.e. immune suppression
analgesic NSAIDs for joint/muscle symptoms
immune modulating treatment
systemic steroids - prednisolone
egs of immune modulating treatment for CT disease
hydroxychloroquine
methotrexate
azathioprine
biologic medication - cytokine inhibitors & lymphocyte depleting drugs
key fact about CT disease
it is a spectrum disorder with overlapping problems
antibodies in autoimmune diseases
anti-nuclear antibody ANA
anti-double strand DNA dsDNA
anti-Ro
Anti-La
systemic lupus erythematosis
tissue changes without blood autoantibodies called discoid lupus
circulating immune complexes = ANA dsDNA, Ro antibodies
multi system
renal involvement = major cause of death
butterfly zygomatic rash - photosensitivity
dental aspects of SLE
chronic anaemia = oral ulceration, GA risk
bleeding tendency = thrombocytopenia
renal disease = impaired drug metabolism
drug reactions = photosensitivity
steroid & immunosuppressive therapy = increased risk of malignancy
lichenoid oral reactions
oral pigmentation from hydroxychloroquine use
what is the lupus anticoagulant
marker found in the blood of some patients with lupus
anticoagulates blood in test tube but not in a ptx
indicates a subtype of lupus ptx
these ptxs are termed antiphospholipid antibody syndrome
2 types of APS
primary form - no other associated disease
secondary form - found in some ptx with chronic inflammatory disease e.g. SLE
antibodies = antiphospholipid aPL/anticardiolipin aCL
antiphospholipid antibody syndrome
characterised by recurrent thrombosis; can get DVT with pulmonary embolism
venous & arterial thrombosis so ptx anticoagulated
never stop anticoagulant without consulting physician
sjogrens syndrome
inflammatory disease associated with circulating antibodies ANA, Ro, La
mainly associated with dry eyes & dry mouth
multisystem in some
major impact on salivary glands
difficult to diagnose often a clinical judgement
types of sjogrens
sicca syndrome - dry eyes or mouth
primary sjogrens - not associated with any other disease
secondary sjogrens - associated with another CT disease e.g. SLE / rheumatoid arthritis
dental impact of sjogrens
oral infection, caries risk, functional loss, denture retention, sialosis (swelling of salivary glands), salivary lymphoma - unilateral gland size change usually after yrs
systemic sclerosis
excessive collagen deposition, CT fibrosis, loss of elastic tissue - replaced by fibrous tissue
F>M
slow progression
signs & symptoms of systemic sclerosis
gradual onset
raynouds phenomenon
renal failure
malabsorption
no elasticity in skin to straighten fingers
ischaemic necrosis of fingers from raynouds aspect
