Gout and Oestoarthritis

Question 1

3 symptoms of joint disease

Answer 1

• pain
• immobility/stiffness
• loss of function

Question 2

5 signs of joint disease

Answer 2

• swelling
  
  • fluctuant, bony, synovial
• deformity
• redness - infection, inflammtion
• crepitus - noise made when lost cartilaginous covering
• loss of function

Question 3

investigation for joint disease

3

Answer 3

• Radiography
  
  • Plain, MRI, Arthrography (radiopaque dye to see cartilage covering)
• Blood
  
  • C-reactive protein (CRP)
  • Rheumatoid factors (RF)
  • Extractable Nuclear Antigens (ENA’s)
  • Anti DS-DNA, Anti-Nuclear Antibody(ANA)
• Arthroscopy (look inside joint) & Biopsy

Question 4

rheumatology

4 types

Answer 4

• Crystal Arthropathies
• Osteoarthritis
• Rheumatoid arthritis
• Sero-negative Spondyloarthritides

Question 5

acute monoarthropathies

Answer 5

• acute arthritis of a single joint
• common causes
  
  • infection - septic arthritis
  • crystal arthropathy - gout
• can be initial stage of polyarthritis

Question 6

gout

Answer 6

• Uric acid crystal deposition in joints
• Significant pain from reactive inflammation
• hyperuricaemia - high uric acid levels
• less common in women until menopause - then equalises

Question 7

5 causes of hyperuricaemia

Answer 7

Drug induced - thiazide diuretics

genetic predisposition

nucleic acid breakdown - chemotherapy cancer treatment (can be prevented by water

Tumour related - myeloma

obesity and alcohol enhance – fat wealthy alcoholic men

Question 8

gout symptoms

Answer 8

• acute inflammation of SINGLE joint
• usually great toe
• usually a precipitating event
  
  • trauma, surgery, illness, diet/alcohol excess
• rapid onset – hours
• NSAIDs to treat

Question 9

dental aspect of gout

Answer 9

• avoid aspirin
  
  • interferes with uric acid removal
• drug treatments may give oral ulceration (allopurinol)

Question 10

osteoarthritis

prevalence

Answer 10

• symptomatic in 10% population
• 60% show degenerative changes on XR
  
  • degenerative joint disease

Question 11

osteoartritis effects

Answer 11

weight bearing joints/joint damage

• predominantly hips & knees

NOT wear and tear

• cartilage repair dysfunction – doesn’t repair, cartilage becomes thinner and thinner till clinical issue

Question 12

symptoms of osteoarthritis

3

Answer 12

• pain
  
  • improves with rest
  • worse with activity
• brief morning stiffness
• slowly progressive over years

Question 13

signs of osteoarthritis

Answer 13

• Radiographs
  
  • loss of joint space & subchondral sclerosis (thickening of bone under cartilaginous layer – more force on it and less cushioning of cartilage)
  • osteophyte lipping at joint edge
  • radiographs may show ASYMPTOMATIC changes - is OA the cause of symptoms?
• Joint swelling & deformity – not common

Question 14

treatment for osteoarthritis

Answer 14

• nothing alters disease progression – treat symptomatically
• Pain improved by
  • increasing muscle strength around the joint
  • weight loss
  • walking aids (stick/frame, transfer force from legs to shoulders and arm)

role of NSAIDs

Prosthetic replacement for PAIN not function

Question 15

joint replacement

Answer 15

in osteoarthritis for pain not function (RA)

pre-manufactured

• Bone cut to match shape of prosthesis to match pre-made prosthesis

Can do area of joint (not necessary to replace whole sometimes)

Question 16

dental aspects of OA

Answer 16

• TMJ can be involved
  
  • symptoms RARE!
• Difficulty in accessing care
• chronic NSAID use
  
  • oral ulceration possible
  • bleeding tendency - anti-platelet
• Joint replacements - AB prophylaxis?
  
  • Usually not needed