Diseases of Human Systems - CTD: Rheumatoid arthritis Flashcards
What are the two types of rheumatoid arthritis?
Seropositive - RH factor present
Seronegative - RH factor absent
What is rheumatoid arthritis?
Symmetrical polyarthritis of synovial joints
(synovial = connective tissue membrane in joint capsules)
with inflammatory joint destruction.
multisystem disease
What are the early symptoms of seropositive rheumatoid arthritis?
Symmetrical synovitis of the joints in the hands and feet
Morning stiffness
swelling of joints
Fever
Decreased range of motion
numbness and tingling
What are the late symptoms of seropositive rheumatoid arthritis? (7)
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
What investigations would indicate seropositive rheumatoid arthritis?
Radiographs
Blood tests - normochomic normocytic anaemia
What do we look for on a radiograph when diagnosing seropositive rheumatoid arthritis? (3)
Erosions & joint destruction
Loss of joint space
secondary osteoarthritis
How do we treat seropositive rheumatoid arthritis? (4)
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
What are the dental implications of seropositive RA? (8)
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
List the types of seronegative spondyloarthritidies? (3)
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
What gene is associated with all of the spondyloarthritidies?
HLA-B27
What effects can be seen from seronegative RA - ankylosing spondylitis? (4)
loss of axial movement;
Lower back pain
Limited movement of back and neck
Limited chest expansion
kyphosis of the cervical spine
what gender is more prone to seronegative RA?
males
how do we treat seronegative ankylosing spondylitis? (4)
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
what are the dental implications of seronegative ankylosing spondylitis? (4)
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