Connective Tissue Disorders and Xerostomia Symposium Notes Flashcards
Aims To give an overview of connective tissue diseases including Sjogren’s syndrome and describe the involvement of the salivary glands To review the anatomy and physiology of salivary glands To describe the causes, investigation and management of xerostomia and its impact on the orofacial tissues Objectives By the end of the two lectures students should: Be able to distinguish between the different connective tissue disorders Have a basic knowledge of Sjogren’s syndrome an
What are the main five connective tissue disorders to be aware of in Dentistry? (5)
- Rheumatoid arthritis
- Lupus erythematous
- Systemic sclerosis
- Sjogren’s syndrome
- Mixed connective tissue disorders
Describe Rheumatoid Arthritis (3, 1+1, 5)
- Autoimmune
- HLA-DR4 (70%)
- Multisystem inflammatory disease primarily affecting the synovium & adjacent tissues
- Rheumatoid arthritis-associated autoantibodies
- IgM class antibodies to the Fc protein off IgG are not disease specific
- Affects 1-2% off UK population – different degrees off severity
- Females > males (3:1)
- Peak incidence 30-40 years
- Often familial
- 50% off individuals unable to work 10 years post onset
What are the clinical signs and symptoms of rheumatoid arthritis? (11)
- Insidious onset
- Pain and stiffness of small joints
- Fatigue and malaise
- Anaemia
- Weight loss
- Muscle weakness and wasting
- Neurological effects – carpal tunnel syndrome
- Lymphadenopathy
- Lung problems - pleural effusion
- 15% cases have Sjogren’s syndrome
- TMJ damage in juvenile R
What joints are most commonly affected in rheumatoid arthritis? (10)
- Metacarpophalangeal/proximal interphalangeal 90%
- Metatarsophalangeal 90%
- Wrist 80%
- Ankle 80%
- Knee 80%
- Shoulder 60%
- Elbow 50%
- Hip 50%
- Cervical spine 40%
- TMJ 30%
What are the extra-articular manifestations of rheumatoid arthritis? (8)
- Weight loss
- Malaise
- Fever
- Lymphadenopathy
- Rheumatoid nodules
- Felty’s syndrome
- Amyloidosis
- Sjogren’s syndrome
What is Amyloidosis?
Amyloidosis is a group of rare but serious diseases caused by deposits of abnormal protein, called amyloid, in tissues and organs throughout the body. Amyloid proteins are abnormally folded, which causes them to build up in tissues and organs, leading to organ failure. A particular type of amyloid protein also occurs in the brain of people with Alzheimer’s disease
What is considered in the diagnosis of Rheumatoid Arthritis?
- Clinical
- Radiographic changes
- Anaemia
- Raised ESR, CRP
- Rheumatoid factor positive (80%)
- ANA positive (30%)
What is an ANA test?
A positive ANA test means autoantibodies are present. By itself, a positive ANA test does not indicate the presence of an autoimmune disease or the need for therapy
What are the general (conservative) measures in management of Rheumatoid Arthritis? (4)
- Education - Empowers
- Exercise - Maintenance of general fitness & maintain muscle bulk
- Physiotherapy
- Dietary advice - Weight reduction, 3 omega fatty acids
Describe the pharmacotherapy in the management of rheumatoid arthritis (3, 1+2)
- Non-steroidal anti-inflammatory drugs
- Disease modifying anti-rheumatic drugs
- Corticosteroids
- Biological agents
- TNF biological response modifiers
- etanercept & infliximab
9) Give five examples of DMARDs (Disease modifying anti-rheumatic drugs) and their uses (table)
Methotrexate»_space; Ulceration;
Gold»_space; Lichenoid reactions;
Penicillamine»_space; Loss of taste,
Lichenoid reactions, Severe ulceration;
Hydroxychloroquine »_space; Lichenoid reactions; Ciclosporin»_space; Gingival hyperplasia;
What are the orofacial aspects of rheumatoid arthritis? (1+1, 1+1, 1+1, 1+2, 1, 1+4)
- Access
> Individual with RA less likely to visit dentist (Pokrajc-Zirojevic et all 2002) - Atlanto-axial joint dislocation
> Physical comfort – pillows, short appointments - Impaired manual dexterity
> Electric toothbrush more effective than manual (Risheim et all 1992) - TMJ
> Commonly affected but one of the last joints involved
> May lead to open bite - Secondary Sjogren’s syndrome
- Felty’s syndrome
> RA & splenomegaly and lymphadenopathy
> Increased risk of infection (chronic sinusitis)
> Oral ulceration
> Angular cheilitis
What is Lupus Erythematosus? How many forms are there? (2)
- Immunologically mediated condition
- 2 forms: DLE, SLE
What is the aetiology of Lupus Erythematosus? (4)
- Genetic predisposition
- Environmental trigger
- Increase in B-cell activity
- Abnormal function of T-cells
Describe Discoid Lupus Erythematosus (5)
- Affects skin & oral mucosa
- F>M
- peak incidence 40 years
- Oral lesions similar to LP in appearance
- Diagnosis based on clinical/biopsy/immunology
How does Discoid Lupus Erythematosus affect the skin? (4)
- Scaly, erythematous patches
- Atrophic, hypo-pigmented areas
- Occur on exposed surfaces
- May be premalignant
What is involved in the diagnosis of DLE? (3)
- Clinical appearance
- Biopsy
- Circulating immunological profile
How is DLE managed? (1)
- Treat as for lichen planus
Describe Systemic Lupus Erythematosus (9)
- Age of onset ~ 30yrs
- F:M 8:1
- Systemic features
- Malar rash
- Polyarthritis
- Photosensitivity
- Oral lesions
- Renal/cardiac/haematological/neurological
- Up to 40% with oral lesions
