Diseases of Human Systems - connective tissue disease (lupus) Flashcards
What are the two subgroups of systemic connective tissue disease?
Multisystem vasculitic inflammatory disease
Vascular vasculitic disease
Name the types of multi system vasculitic vascular disease.
Systemic lupus erythrematosis
Systemic sclerosis
Sjogrens syndorme
Undifferentiated connective tissue disease
Name the types of vascular vasculitic disease.
Giant vessel disease - giant cell temporal arthritis
Medium vessel disease - kawasaki disease
Small vessel disease - weighers granulomatosis
How do we manage connective tissue diseases? (5)
Immunosuppressants
Biological medications - cytokine inhibitors and lymphocyte depleting drugs
Analgesics - NSAIDS
Systemic steroids - prednisolone (short time use only)
Immune modulating treatments - hydroxychloroquine
Name the types of systemic lupus erythrematosis (subtype of multi system vasculitic inflammatory disease)
Discoid lupus
Antiphospholipid antibody syndrome
Who is most at risk of discoid lupus?
Females of child bearing age
What autoantibodies are likely to be present in an individual with SLE? (3)
AntiANA
Anti-double stand DNA
Anti-ro
What are the signs and symptoms of discoid lupus?
Photosensitive butterfly rash
Raynauds
Arthritis
Renal disease
CVD
lung diseases
What are the dental implications of discoid lupus? (5)
High risk when carrying out GA due to the anaemia
Bleeding tendency due to thrombocytopenia
Impaired drug metabolism from the renal disease
Lichenoid reactions
Oral pigmentation
How can you determine is a patient has antiphospholipid antibody syndrome (subgroup of lupus erythematosis) ?
There is the presence of the lupus anticoagulant marker in the blood
What are the type types of antiphospholipid antibody syndrome? (2)
Primary - no associated inflammatory diseases
Secondary - associated with other inflammatory conditions e.g. rheumatoid arthritis, sjogrens
What are the signs and symptoms of patients with APS?
Recurrent thrombosis - venous, arterial, DVT with pulmonary embolism
What autoantibodies are present in a patient with sjogrens syndrome (subtype of multi system vasculitic inflammatory disease)?
Anti-ANA
Anti-la
Anti-ro
What are the 3 main types of sjogrens and what are they characterised by?
Sicca - dry eyes and mouth only
Primary - features of the disease mainly affect the eyes and mouth
Secondary - associated with another connective tissue disease e.g. SLE
What is the guaranteed method of diagnosing patient’s with sjogrens?
Histopathological sample from the labial salivary gland
What are the dental implications of sjogrens?
Oral infections
Caries
Functional loss i.e. swallowing
Problems with denture retention
Sialosis
Salivary lymphoma
What is systemic sclerosis (subtype of multi system vasculitic inflammatory disease)?
Where elastic tissue is replaced by connective fibrous tissue both internally and externally
How can we tell if the systemic sclerosis is localised or generalised?
Local = anticentromere antibodies are present
Generalised = anti scl-70 antibodies are present
Who is most at risk of systemic sclerosis?
Females
What are the associated complications of symptoms of systemic sclerosis? (3)
Raynauds
Renal failure
Malabsorption via the GIT (slow progression)
What are the dental implications of systemic sclerosis? (6)
Limited mouth opening and tongue movement
Patient can also have sjogrens
Dysphagia due to loss of elasticity of the oesophagus
Reflux oesophagitis
Poor drug metabolism
Widening of PDL space
(We must plan treatment for 10 years ahead)
Describe what occurs in vasculitic diseases
There is inflammation of the blood vessels which leads to narrowing and infarction of the tissues.
In giant cell arthritis (large vessel vasculitic disease) what vessels are involved?
The temporal artery
The external carotid artery and its branches
In giant cell arthritis (large vessel vasculitic disease) what will the patient present with?
facial pain
headache
chewing claudication from involvement of the carotid branches
Blindness from occlusion of the central renal artery
How do we treat In giant cell arthritis?
Immunosuppressants e.g. prednisolone
who is affected by poly myalgia rheumatica (large vessel vasculitic disease)?
Those in their 60/70s
What are the sigs and symptoms of poly myalgia rheumatica? (5)
Pain and stiffness of muscles around the shoulder and hip
Restricted range of movement
malaise
weight loss
Fatigue
What is the key indicator of polymyalgia rheumatica?
Rapid response to steroids
Who is affected by Kawasaki disease (medium vessel vasculitic disease)?
Children
How would a child with kawasaki disease present with? (4)
strawberry tongue - crusty and cracked
peeling rash on the hands and feet
fever and lymphadenopathy
Coronary vessel aneurysms
What is wegner’s granulomatosis (small vessel vasculitic disease)?
An inflammatory disease that affects small blood vessels and can lead to the destruction of the hard and soft tissues of the face and oral cavity
What does wegner’s granulomatosis affect?
Starts in the upper respiratory tract and makes its way down the digestive tract to the lungs, heart and kidney.
The skin is also affected.
