Gout and Osteoarthritis

Question 1

What are the symptoms of joint disease?

Answer 1

Pain
Immobility
Stiffness
Loss of function

Question 2

What are the signs of joint disease?

Answer 2

Swelling
Deformity
Redness
Crepitus
Loss of function

Question 3

What investigations are used for joint disease?

Answer 3

Radiographs
Blood - CRP, RF, ENA’s, ANA
Arthroscopy
Biopsy

Question 4

Describe acute monoarthropathies

Answer 4

Acute arthritis of a single joint
Common causes include:
- infection - causes septic arthritis
- crystal arthropathy - causes gout
Can be the initial stage of polyarthritis

Question 5

What is gout?

Answer 5

Uric acid deposition in joints
Significant pain from reactive inflammation
Can be drug induced, genetically predisposed or tumour related
Obesity and alcohol are risk factors

Question 6

Who is affected by gout?

Answer 6

Less common in women until menopause - then it equalises

Question 7

What are the symptoms of gout?

Answer 7

Acute inflammation of a single joint - usually great toe
Usually a precipitating event - trauma, surgery, illness, diet/alcohol excess
Rapid onset - hours

Question 8

How is gout treated?

Answer 8

NSAIDs

Question 9

What are the dental implications of gout?

Answer 9

Avoid aspirin - it interferes with uric acid removal
Drug treatments may give oral ulceration (allopurinol)

Question 10

What is osteoarthritis?

Answer 10

A degenerative bone disease
Weight bearing joints are damaged - predominantly hips and knees
Cartilage repair dysfunction

Question 11

Who is affected by osteoarthritis?

Answer 11

Symptomatic in 10% of population
60% affected show degenerative changes on radiograph

Question 12

What are the symptoms of osteoarthritis?

Answer 12

Pain - improves with rest, worse with activity
Brief morning stiffness
Slowly progressive over years

Question 13

What are the signs of osteoarthritis?

Answer 13

Radiographs - loss of joint space, osteophyte lipping at joint edge, may show asymptomatic changes
Joint swelling and deformity

Question 14

How is osteoarthritis treated?

Answer 14

Nothing alters disease progression
Pain improved by increasing muscle strength around the joint, weight loss and walking aids
NSAIDS
Prosthetic replacement for pain

Question 15

What are the dental implications of osteoarthritis?

Answer 15

TMJ can be involved
Difficulty in dental access
Chronic NSAID use - oral ulceration, bleeding tendency if antiplatelet use
Joint replacement - consider antibiotic prophylaxis - usually not needed