Connective tissue disorders Flashcards
What is unique about connective tissue disorders?
they are multi system autoimmune inflammatory diseases
what are the 5 connective tissues disorders?
lupus
sclerosis
sjogrens syndrome
UCTD
raynauds syndrome
do autoantibodies cause connective tissue disorders?
NO- the cause is unknown. They do show a pattern though that indicates the disease caused.
how are CTD’s managed?
aim- suppress disease activity and help pain
-nsaids/analgesics
-immune modulators (hydrochlroquine and methotrexate- 1st line)
-biological modulators
-systemic steroids -prednisolone- reduce inflammation- short term only
what is unique about lupus?
-interlinks all ctd’s
-can have symptoms of all ctd’s
-every possible system involved
what ab’s are found in CTD’s?
ANA
Ro
La
what CTD’s are commonly seen together?
rheumatoid arthritis + sjogrens syndrome
Sclerosis + raynauds syndrome
what form of lupus does not have autoantibodies?
discoid lupus- affects skin and mouth (often looks like lichen planus)
what autoantibodies are found in systemic lupus?
ANA
Ro
La
dsDNA
what symptoms can be seen in someone with systemic lupus and what systems are commonly involved?
butterfly rash
renal disease- major cause of death
CVD- risk of acute CVD
lung disease
raynauds
rheumatoid arthritis
what are the dental aspects of systemic lupus?
-chronic anaemia- oral ulceration
-bleeding tendency
-renal disease-impaired drug metabolism
-photosensitivity
-steroid and immunosuppressants increase risk of malignancy
-discoid lupus (looks like oral lichen planus)
-hydrochloroquine- oral pigmentation
what is lupus anticoagulant?
lupus associated with aPL ab’s and aCL ab’s
what is the risk of lupus anticoagulant?
antiphospholipid ab syndrome=thrombophillic
- risk of deep vein thrombosis and pulmonary embolism without any other risk factors
what are those with lupus anticoagulants likely taking?
-anticoagulants- warfarin
what does sjodrens syndrome most commonly cause?
-dry eyes
-dry mouth
what gland does sjogrens syndrome commonly involve?
salivary glands
what are the 3 forms of sjogrens syndrome?
sicca syndrome- only dry mouth or dry eyes
primary- not associated with another CTD
secondary- association with another CTD e.g raynauds and RA
is there a test for sjogrens syndrome?
NO- normally clinical judgement
-imaging and histopathology can be used but high level of disease needed (salivary and lacrimal gland changes can take 30 years)
what are the dental implications of sjogrens syndrome?
-xerostomia- increase caries risk and oral disease
-denture retention issues
-sialosis (swelling of salivary glands)
-salivary lymphoma- due to chronic activation of lymphoid tissue
what is systemic sclerosis?
causes elastic tissue to be replaced by fibrous tissues- cannot stretch/bend tissue?
what organs does systemic sclerosis normally affect?
-skin
-oesophagus
-gut
what are common symptoms of systemic sclerosis?
-sclerodactaly (fingers cant stretch out)
-raynauds syndrome (bv’s narrow in fingers- ischaemia/infarction)
what are the dental aspects of systemic sclerosis?
-unable to open mouth wide
-limited tongue movement
-taking impressions is difficult (must think of treatment 10-15 years in advance depending on prognosis)
-associated with sjogrens syndrome
-oesophagus cant stretch-swallowing difficulties and acid reflux (dental erosion)
-cardiac and renal involvement- affect drug metabolism
how does CTD’s affect vessels?
-causes inflammation in vessel walls- leading to narrowing-ischaemia
