Connective Tissue Diseases Flashcards
What are connective tissue diseases?
Multisystem vasculitic inflammatory diseases
They have associated blood autoantibodies
Complement activation causes tissue damage
Give examples of vasculitic diseases
Large vessel disease - giant cell arteritis
Medium vessel disease - Kawasaki disease
Small vessel disease - Wegener’s Granulomatosis
How are connective tissue diseases managed?
Analgesic NSAIDS
Immune modulating treatment eg Methotrexate and Biologics
Systemic steroids - prednisolone
Give examples of lupus overlap diseases
Sclerodoma
Rheumatoid arthritis
Mixed connnective tissue disease
Raynaud’s
Sjogren’s
Give examples of common antibodies found in autoimmune diseases
Anti-nuclear antibody (ANA)
Anti-double-strand DNA (dsDNA)
Anti-Ro antibody (Ro)
Anti-La antibody (La)
What is systemic Lypus Erythematosis?
Tissue changes without blood autoantibodies called Discoid Lupus
Seen in the skin and mouth
Affects multiple systems
Who does systemic lupus erythematosis affect?
12-64/100,000
Affects females of child bearing age
Butterfly zygomatic rash commonly seen as photosensitivity is common
What is the dental relevance of SLE?
Chronic anaemia - oral ulceration and GA risk
Bleeding tendency
Renal disease from impaired drug metabolism
Drug reactions
Steroid and immunosuppressive therapy can increase malignancy risk
Lichenoid oral reactions
Oral pigmentation
What is Lupus Anticoagulant?
A marker found in the blood of some patients with Lupus
Antibodies aPL and aCL
What is antiphospholipid antibody syndrome (APS)?
Patients are hypercoagulated and so have arterial and venous thrombosis
Characterised by DVT with pulmonary embolism
What is Sjögren’s syndrome?
Inflammatory disease associated with circulating antibodies ANA, Ro and La
Can lead to dry eyes, dry mouth and oral disease
Major involvement in salivary glands
What are the signs and associations of Sjogren’s syndrome?
Sicca syndrome - dry eyes or mouth
Primary Sjogren’s - not associated with any other disease
Secondary Sjogren’s - associated with RA and SLE
How is Sjogren’s diagnosed?
No one test
Dry eyes/mouth
Autoantibody findings
Imaging findings
Histopathology findings
Often a clinical judgement
What are the dental implications of Sjogren’s?
Oral infection
Caries risk
Functional loss
Denture retention
Sialosis
Salivary lymphoma
Describe systemic sclerosis
Excessive collagen deposition
Connective tissue fibrosis
Loss of elastic tissue
How can systemic sclerosis present?
Local - anticentromere antibodies
Generalised - anti Scl-70 antibodies
Who does systemic sclerosis affect?
Predominantly women
Describe the onset and treatment of systemic sclerosis
Gradual onset - may see Raynaud’s, renal failure and malabsorption
Slow progression with no treatment to prevent
What are the dental implications of systemic sclerosis?
Involvement of perioral tissues so limited mouth opening, poor access and limited tongue movement
Dysphagia so swallowing difficulty and erosion likely
May have cardiac and renal vasculitic disease which will affect drug metabolism
Widening of periodontal ligament space
What is vasculitis?
Inflammation of blood vessels and infarction of tissue
May present as oral inflammatory masses or as ulcers
Vessel wall thickens with inflammation, narrowing the lumen, reducing blood flow
Describe giant cell arteritis?
Known as temporal arteritis as the temporal artery is commonly involved
May present with headache/facial pain
A facial pain emergency
If occluding central retinal artery can cause blindness
Describe Polymyalgia Rheumatica
Affects the elderly 60-70
Signs include pain and morning stiffness of muscles, malaise, weight loss and fatigue
Responds well to steroids
Describe Kawasaki disease
Mainly affects children
Also called mucocutaneous lymph node syndrome
Signs include fever, lymphadenopathy, crusting/cracked tongue, strawberry tongue and erythematous mucosa
May need antibiotics to prevent coronary vessel aneurysms
Describe Wegener’s Granulomatosis
Inflammatory condition which can lead to the destruction of hard and soft tissues of the face and oral cavity
Tissue is spongy red
Associated with ANCA
Renal and respiratory tract most affected
Describe fibromyalgia
Non-specific collection of musculoskeletal symptoms
Joint pain, muscle pain and functional disorders
What are the dental implications of vasculitides?
Steroid precautions may be needed
May present to the dentist:
- Giant cell arteritis
- Wegener’s Granulomatosis
- Kawasaki Disease
