Diseases of Human Systems - CTD: Rheumatoid arthritis Flashcards

1
Q

What are the two types of rheumatoid arthritis?

A

Seropositive - RH factor present

Seronegative - RH factor absent

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2
Q

What is rheumatoid arthritis?

A

Symmetrical polyarthritis of synovial joints
(synovial = connective tissue membrane in joint capsules)

with inflammatory joint destruction.

multisystem disease

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3
Q

What are the early symptoms of seropositive rheumatoid arthritis?

A

Symmetrical synovitis of the joints in the hands and feet

Morning stiffness

swelling of joints

Fever

Decreased range of motion

numbness and tingling

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4
Q

What are the late symptoms of seropositive rheumatoid arthritis? (7)

A

Swan neck deformities of the fingers at the PIP joints from Loss of directional integrity of bone

Z boutonniere deformity of the thumb

Ulnar deviation of the fingers at the metacarpophalangeal joints

others:
Loss of;
subluxation of wrist 
external rotation of shoulders 
flexion of elbows and knees 
deformity of feet and ankles
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5
Q

What investigations would indicate seropositive rheumatoid arthritis?

A

Radiographs

Blood tests - normochomic normocytic anaemia

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6
Q

What do we look for on a radiograph when diagnosing seropositive rheumatoid arthritis? (3)

A

Erosions & joint destruction

Loss of joint space

secondary osteoarthritis

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7
Q

How do we treat seropositive rheumatoid arthritis? (4)

A

treat by improving quality of life only;

Physiotherapy
- Used to delay onset of debilitating disease

Occupational therapy

  • Improve residual function
  • Aid independent living

Drugs - analgesics, NSAIDS in combination with anti-PUDs, disease modifying drugs and steroids

Surgery - removing inflamed joint tissue, joint replacement

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8
Q

What are the dental implications of seropositive RA? (8)

A

Disability:
Reduced manual dexterity - cannot grip toothbrush
Poor mobility and access

Dry mouth from sjogrens

Drug Effects:
Increased bleeding from NSAIDS
Increased infection from steroids
ulcers

Atlanto-occipital instability

GA hazard from the chronic anaemia

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9
Q

List the types of seronegative spondyloarthritidies? (3)

A

Ankylosing spondylitis - Arthritis of the spinal joint
- can lead to fusion of the facets between the vertebrate.

Reiters syndrome - ocular and mucocutaneous manifestations

Arthritis of IBD

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10
Q

What gene is associated with all of the spondyloarthritidies?

A

HLA-B27

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11
Q

What effects can be seen from seronegative RA - ankylosing spondylitis? (4)

A

loss of axial movement;
Lower back pain

Limited movement of back and neck

Limited chest expansion

kyphosis of the cervical spine

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12
Q

what gender is more prone to seronegative RA?

A

males

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13
Q

how do we treat seronegative ankylosing spondylitis? (4)

A

same as seropositive

Physiotherapy
- Used to delay onset of debilitating disease

Occupational therapy

  • Improve residual function
  • Aid independent living

Drugs - analgesics, NSAIDS in combination with anti-PUDs, disease modifying drugs and steroids

Surgery - removing inflamed joint tissue, joint replacement

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14
Q

what are the dental implications of seronegative ankylosing spondylitis? (4)

A

Problems with lying back and flat in chair since spine fused = difficult access

Poor mouth opening

(Rarely) TMJ involvement

GA hazards from the limited mouth opening and neck flexion

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