CT Diseases Flashcards
What is osteoarthritis?
The most common form of arthritis which can affect both larger and smaller joints of the body
What is inflammatory arthritis?
Autoimmune disease in which the body views its own tissue as foreign
Name 2 types of inflammatory arthritis
- Seropositive
2. Seronegative
What is the key feature of seronegative inflammatory arthritis?
Asymmetric joint and axial involvement
Name 4 types of seronegative inflammatory arthritis
- Ankylosing Spondylitis
- Psoriatic Arthritis
- Reactive Arthritis
- Enteropathic Arthritis
What is anklyosing spondylitis?
Fixed and rigid spinal posture with classic presentations of seronegative inflammatory arthritis e.g morning stiffness, cannot fully extend neck
What is reactive arthritis?
Secondary to infection which triggers bodily attacks on itself
Name 2 disease which enteropathic seronegative inflammatory arthritis may be associated with
- Chron’s disease
2. Osteoarthritis
Describe the frequency of RA between men and women
Women are 3 times more frequently affected
At what ages does peak incidence of RA occur?
40 to 60 years
What is the major example of seropositive inflammatory arthritis?
Rheumatoid Arthritis
What is rheumatoid arthritis?
Chronic inflammatory disorder which typically affects small and medium sized joints in a symmetrical fashion
Describe the pathogenesis of rheumatoid arthritis
Primary lesion is synovitis whereby immune cells invade normally relatively acellular synovium, leading to formation of inflammatory pannus
What is sensitivity of an antibody test?
Measured proportion of actual positives which are correctly identified
What is specificity of an antibody test?
Measure proportion of negatives which are correctly identified
What is rheumatoid factor?
Autoantibodies which target the Fc- part of human IgG
How is rheumatoid factor believed to cause rheumatoid arthritis?
Form immune complexes, activating complement in the join, which in turn leads to increased vascular permeability and release of chemotactic factors recruiting immune-competent effectors cells into the joint
What is ACPA?
Anti-Citrullinated Peptide Antibody
Name 2 theories on what causes RA
- Genetics
2. Environment
Name 5 possible triggers which may cause RA
- Infection (bacteria)
- Smoking
- Obesity
- Stress
- Female hormones
Name 4 potential musculoskeletal effects of RA
- Tensynovitis and tendon rupture
- Bursitis
- Myopathy
- Fatigue
Name 2 important joints for a dentist with regards to RA
- Atlanto-axial subluxation
2. Temporomandibular Joint
What type of arthritis is particularly inflammatory for temporomandibular joint?
Seronegative inflammatory arthritis, namely psoriatic arthritis
Describe how RA affects the lungs
Lung fibrosis
Describe how RA affects the heart
Pleural effusions
Describe how RA affects the brain
Peripheral neuropathy
Describe how RA affects the kidneys
NSAID use to treat arthritis
What is Sjorgren’s Syndrome?
Dryness of the eyes and mouth, where exocrine function of tear and salivary glands affected
How is Sjogren’s Syndrome tested for?
Schirmer test performed to test tear production
Describe 5 ways Sjogren’s Syndrome may affect an individual
- Inability to eat dry food
- Tongue sticking to roof of mouth
- Difficult for speaking for long periods of time
- Higher incidence of caries, candida and periodontal disease
- Altered sense of taste
What is the key message when treating RA
Requirement for early recognition and early aggressive intervention
What is first line treatment for RA?
Methotrexate and prednisone
What types of treatment are present for RA if first line treatment with 2 disease modifying treatments (including methotrexate) fail?
Biological Therapies in 3 steps (+/- steroid, namely prednisone)
Describe methotrexate as the anchor drug in RA treatment
- Resembles folic acid and competitive inhibitor of folate dependent enzymes
- Depletion of tetrahydrofolates, essential for protein synthesis
- Combined with folic acid to reduce GI, mucosal and haematological side effects
Name 3 common adverse effects of methotrexate
- Hepatotoxicity
- Interstitial pneumonitis
- Myelosuppression with low platelets
Name 5 common adverse effects associated with biological agents used in treatment of rheumatoid arthritis
- Antinuclear antibody production
- Drug-induced lupus like syndromes
- Infections
- Bone marrow suppression
- Demyelinating disorders
Name 5 adverse effects of steroids
- Increased infection
- Easy bruising
- Increased appetite and weight gain
- Changes in blood sugar levels
- Swelling in hands and ankles from water retention
What is the main skeletal risk of glucocorticoid therapy?
Glucocorticoid induced osteoporosis
How is glucocorticoid induced osteoporosis negated in a patient with rheumatoid arthritis?
Oral or IV bisphosphonates / Denosumab
What is Systemic Lupus Erythematosis (SLE)?
Autoimmune disorder characterized by multisystem microvascular inflammation with generation of antibodies
Name 4 potential factors associated with development of SLE
- Genetic
- Racial
- Hormonal
- Environmental
Describe 4 presenting symptoms of SLE
- Oral ulcers with palatal ulcers being most specific
- Multiple cytopenias (leukopania, lymphopania, anemia)
- Hypocomplementemia may predispose to increased infections
- Secondary Sjogren’s Syndrome
Name 4 potential treatments for SLE
- Anti-malarials
- Immunosuppressants
- Steroids
- Bisphosphonates
What is scleroderma?
A chronic systemic autoimmune disease characterized by fibrosis, vascular alterations and autoantibodies
Describe 2 major forms of scleroderma
Limited Systemic - Cutaneous manifestations mainly affect hands, arms and face
Diffuse Systemic - Rapidly progressing and affects one large area of skin
