Gout & Osteoarthritis Flashcards
1
Q
What are the symptoms of joint disease?
A
- pain
- immobility stiffness
- loss of function
2
Q
What are the signs of joint disease?
A
- swelling
- fluctuant
- effusion of fluids into joint - bony
- inflammatory processes over many years
- osteophyte formation at the end of joints - synovial
- synovial enlargement
- particularly in rheumatoid
- fluctuant
- deformity
- destructive processes change joint surface and contact
- bones meet differently, altering external appearance
- redness
- indication of infection due to inflammation or high vascular content
- crepitus
- noises made by bone ends moving
- normal cartilaginous coverings that have been lost mute these noises
3
Q
How are joint diseases investigated
A
- radiography
- plain
- normal radiology - MRI
- soft tissues around and inside the joint - arthrography
- injection of radiopaque dye into articular surfaces and joint capsule
- plain
- blood
- C-reactive protein (CRP, inflammatory marker)
- rheumatoid factors (RF, autoimmune marker)
- extractable nuclear antigens (ENAs)
- anti-DS-DNA, anti-nuclear antibody (ANA)
- arthroscopy and biopsy
- arthroscopy allows clinician to look within joint
- biopsy indicated if there is swelling of soft tissue
4
Q
What are acute monoarthopathies?
A
acute arthritis of a single joint
- potentially initial stage of poly arthritis
5
Q
What are the causes of monoarthropathies?
A
- infection
- septic arthritis
- usually after previous trauma
- crystal arthropathy
- gout
- deposition of uric acid crystals in joint
- irritation to joint surface causes swelling and inflammation
6
Q
What are the possible causes of gout?
A
always hyperuricaemia - high uric acid levels
- drug induced
- thiazide diuretics
- genetic predisposition
- nucleic acid breakdown
- chemotherapy cancer treatment
- treatment kills cancer cells involving reprocessing of nucleic acids
- surge of uric acid in blood
- risk reduced by pre-hydrating)
- tumour related
- myeloma
- obesity and alcohol increase risk
7
Q
What are the symptoms of gout?
A
- acute inflammation of a single joint
- usually big toe
- usually as a result of a precipitating event
- trauma
- surgery
- illness
- diet
- alcohol excess
- rapid onset
- within hours
- extreme pain
8
Q
How is hout treated?
A
- NSAIDs
- potent medications needed
- recovery takes time
9
Q
What are the dental aspects of gout?
A
- aspirin should not be prescribed
- interferes with uric acid removal
- not prescribed to anyone with a history of gout
- drug treatments may give oral ulceration
- drugs lower uric acid in the blood but increase oral ulceration
- aphthous pattern
10
Q
What is osteoarthritis?
A
- degenerative joint disease
- weight bearing joints predominantly
- hips and knees
- repair dysfunction over many years thins and removes cartilage
- not wear and tear
11
Q
What are the symptoms of osteoarthritis?
A
- pain
- improves with rest
- worsens with activity
- brief morning stiffness
- slowly progressive over years
12
Q
What are the signs of osteoarthritis?
A
- radiographic changes
- loss of joint space
- subchondral sclerosis
- increased none thickness under cartilaginous layer
- as a result of direct forces being transmitted to the bone - osteophyte lipping and joint edge
- bony spicules
- joint swelling and deformity
- not common
- if present seen in terminal phalanx of hand
13
Q
How is osteoarthritis treated?
A
- no treatment available to alter disease progression
- pain management
- increased muscles strength around joint
- weight loss
- walking aids
- NSAIDs
- prosthetic joint replacement
- when pain becomes unbearable
14
Q
What are the dental aspects of osteoarthritis?
A
- TMJ involvement
- rarely symptomatic
- seen radiographically
- loss of joint space, flattened condylar head and subchondral sclerosis
- difficulty accessing care
- chronic NSAID use
- possible oral ulceration
- bleeding tendancy
- anti platelet use
- joint replacements
- potential antibiotic prophylaxis
- usually not needed
- joints not usually at risk from bacteraemia of oral origin
