Connective Tissue Diseases

Question 1

What are connective tissue diseases?

Answer 1

Multisystem vasculitic inflammatory diseases
They have associated blood autoantibodies
Complement activation causes tissue damage

Question 2

Give examples of vasculitic diseases

Answer 2

Large vessel disease - giant cell arteritis
Medium vessel disease - Kawasaki disease
Small vessel disease - Wegener’s Granulomatosis

Question 3

How are connective tissue diseases managed?

Answer 3

Analgesic NSAIDS
Immune modulating treatment eg Methotrexate and Biologics
Systemic steroids - prednisolone

Question 4

Give examples of lupus overlap diseases

Answer 4

Sclerodoma
Rheumatoid arthritis
Mixed connnective tissue disease
Raynaud’s
Sjogren’s

Question 5

Give examples of common antibodies found in autoimmune diseases

Answer 5

Anti-nuclear antibody (ANA)
Anti-double-strand DNA (dsDNA)
Anti-Ro antibody (Ro)
Anti-La antibody (La)

Question 6

What is systemic Lypus Erythematosis?

Answer 6

Tissue changes without blood autoantibodies called Discoid Lupus
Seen in the skin and mouth
Affects multiple systems

Question 7

Who does systemic lupus erythematosis affect?

Answer 7

12-64/100,000
Affects females of child bearing age
Butterfly zygomatic rash commonly seen as photosensitivity is common

Question 8

What is the dental relevance of SLE?

Answer 8

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

Question 9

What is Lupus Anticoagulant?

Answer 9

A marker found in the blood of some patients with Lupus
Antibodies aPL and aCL

Question 10

What is antiphospholipid antibody syndrome (APS)?

Answer 10

Patients are hypercoagulated and so have arterial and venous thrombosis
Characterised by DVT with pulmonary embolism

Question 11

What is Sjögren’s syndrome?

Answer 11

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

Question 12

What are the signs and associations of Sjogren’s syndrome?

Answer 12

Sicca syndrome - dry eyes or mouth
Primary Sjogren’s - not associated with any other disease
Secondary Sjogren’s - associated with RA and SLE

Question 13

How is Sjogren’s diagnosed?

Answer 13

No one test
Dry eyes/mouth
Autoantibody findings
Imaging findings
Histopathology findings
Often a clinical judgement

Question 14

What are the dental implications of Sjogren’s?

Answer 14

Oral infection
Caries risk
Functional loss
Denture retention
Sialosis
Salivary lymphoma

Question 15

Describe systemic sclerosis

Answer 15

Excessive collagen deposition
Connective tissue fibrosis
Loss of elastic tissue

Question 16

How can systemic sclerosis present?

Answer 16

Local - anticentromere antibodies
Generalised - anti Scl-70 antibodies

Question 17

Who does systemic sclerosis affect?

Answer 17

Predominantly women

Question 18

Describe the onset and treatment of systemic sclerosis

Answer 18

Gradual onset - may see Raynaud’s, renal failure and malabsorption
Slow progression with no treatment to prevent

Question 19

What are the dental implications of systemic sclerosis?

Answer 19

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

Question 20

What is vasculitis?

Answer 20

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

Question 21

Describe giant cell arteritis?

Answer 21

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

Question 22

Describe Polymyalgia Rheumatica

Answer 22

Affects the elderly 60-70
Signs include pain and morning stiffness of muscles, malaise, weight loss and fatigue
Responds well to steroids

Question 23

Describe Kawasaki disease

Answer 23

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

Question 24

Describe Wegener’s Granulomatosis

Answer 24

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

Question 25

Describe fibromyalgia

Answer 25

Non-specific collection of musculoskeletal symptoms
Joint pain, muscle pain and functional disorders

Question 26

What are the dental implications of vasculitides?

Answer 26

Steroid precautions may be needed
May present to the dentist:
- Giant cell arteritis
- Wegener’s Granulomatosis
- Kawasaki Disease