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3rd Year > HUMANS- rheumatology > Flashcards

HUMANS- rheumatology Flashcards

1
Q

What is rheumatology?

A

Disorders of the joints, muscles and ligaments?

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2
Q

Compare arthritis to athrosis?

A

Arthritis- Inflammation of the joint.

Athrosis- Non-inflammatory joint disease.

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3
Q

What is athralgia?

A

Pain in the joint.

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4
Q

Discuss the formation of bone in osteomalacia and osteoporosis.

A

Osteomalacia- The bone forms but is not fully mineralised. This causes soft bone.

Osteoporosis- All the bone is formed and mineralised but there isn’t enough of the bone.

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5
Q

What is rickets?

A

Osteomalacia that happens while the bones are still forming.

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6
Q

How is osteomalacia managed?

A

By controlling the cause of the vitamin D deficiency :

Malnutrition (control the GI disease)

Get dietary vitamin D (e.g. oily fish)

Sunlight exposure (aim for 30 minutes 5x weekly)

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7
Q

Discuss the effects of osteoporosis?

A
  • Skoliosis (bending of the spine into an S shape)
  • Kyphosis (bending forward of the spine)
  • Increased risk of bone fracture
  • Height loss.
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8
Q

How do we prevent Osteoporosis?

A

Build maximal peak bone mass (Exercise and high calcium intake)

Reducing the rate of bone mass loss (e.g. hormonal loss using oestrogen hormone replacement therapy, Osteoporosis prevention drugs- bisphopshonates)

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9
Q

What is MRONJ?

A

Medication related Osteonecrosis of the jaw.

This is when there has been exposed bone does not heal after 8 weeks after the extraction.

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10
Q

Who is at low risk of MRONJ?

A

Patients who are not taking Glucocorticoids and:

  • Have taking oral bisphosphonates for less than 5 years.
  • Been taking infusions of IV bisphosphonates for less than 5 years.
  • Treated with denosumab.
    *
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11
Q

Who is at high risk of MRONJ

A
  • Patients who have been on bisphosphonates for more than 5 years.
  • Patients who are on bisphosphonates or denosumab combined with glucocorticoids.
  • Patients being treated with anti-resorptive or anti-angiogenic drugs as part of cancer management.
  • Patients with a previous MRONJ diagnosis.
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12
Q

What is acute monoarthropathies and what can cause it?

A

Acute arthritis of a single joint.

It can be caused by infection (e.g. septic arthritis)

Crystal arthropathy (e.g. GOUT)

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13
Q

What is GOUT?

A

When uric acid crystals are deposited in the joints causing reactive inflammation and pain)

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14
Q

How do we treat GOUT?

A

NSAIDs (but avoid aspirin as it interfeers with uric acid removal)

Allopurinol (to lower uric acid, but this may give oral ulceration)

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15
Q

Compare osteoarthritis and Rheumatoid arthritis in general.

A

Osetoarthritis- A cartilage repair dysfunction causing the cartilage layer to get thinner and thinner.

Rheumatoid arthritis- A disease of the synovium with gradual joint destruction. The joints involved depends on the presence of the rheumatoid factor in the blood.

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16
Q

Compare how to treat osteoarthritis and rheumatoid arthritis?

A

Nothing will alter the disease progression for osteoarthritis (you can only reduce the pain- weight loss/ NSAIDs/prosthetic replacement of joints when pain is the problem.

Rheumatoid arthritis:

holistic treatment (phsyio/ occupational therapy/ Drug therapy/ Surgery)

Anaglesics (paracetamol and cocodamol

Disease modifying drugs

Surgery (excision of inflamed tissue or a joint replacement)

17
Q

How does osteoarthritis affect dental patients?

A

TMJ involvement

Mobility difficulties make it harder to access dental care.

Chronic NSAID use can cause oral ulceraton or a bleeding tendency.

18
Q

How does Rheumatoid arthritis affect the Dental patient?

A

There is reduced dexterity (affecting ability to complete oral hygiene)

Can cause sjogrens syndrome

Methotrexate treatment can cause oral ulceration.

Hydroxychloroquine (can cause oral pigmentation)

19
Q

What is ankylosing Spondylitis and how does it impact on dentistry?

A

A disease causing some of your small vertebrae to fuse. This causes:

Limited back and neck movement- causing difficulty flexing the neck to change position.

Limited chest expansion- making GA hazardous.

Kyphosis- preventing people from lying back on a chair.

20
Q

Compare autoimmune to vasculitic diseases?

A

Autoimmune diseases- A multisystem inflammatory disease where the tissue is the target for inflammation.

Vasculitic disease- Where the blood vessel is the target for inflammation. This causes narrowing of the vessel and reduced blood flow.

21
Q

How do we treat connective tissue diseases?

A

We can only supress the disease activity through:

NSAIDs for joint/ muscle symptoms

Immune modulating treatments (e.g. Hydroxychloroquine)

Biologic medications- to disrupt the immune process of inflammation.

Systemic steroids (Prednisolone)

22
Q

What is systemic lupus erythematosis and discuss the medical and dental effects?

A

When the body attacks its own healthy tissue.

This can be localised to the skin and mouth or systemic with widespread oragn changes.

Medically- Chronic anaemia, bleeding tendency, renal disease, treatments of steroid and immunosuppressants.

Dental -

Lichenoid oral reactions

oral Pigmentation from the hydroxychloroquine

23
Q

What is anti-phospholipid antibody syndrome and what are the medical effects of this?

A

This is when the patient has the lupus anticoagulant (this is hyper-coaguable- causes blood clots)

Medical- this causes venous thrombosis, arterial thrombosis and recurrent thrombosis.

24
Q

What is Sjorgen’s syndrome and what are the medical and dental impacts?

A

Sjorgen’s is an inflammatory disease associated with circulating autoantibodies.

It affects the salivary glands causing xerostomia, oral disease and sialosis (swollen salivary glands)

25
Q

What is systemic scerlosis and discuss its medical and dental effects.

A

When the elastic tissue is replaced by connective fibrous tissue (losing the ability to stretch)

Medical- malabsorption if GI is involved. Dyspahgia. Reflux oseophagitis (erosion)

Dental- Limited mouth opening, limited tongue movement, poor oral access. Widened PDL as no dental mobility (You need to plan treatment 10 years ahead.

26
Q

What disease presents as this clinical image?

A

Kawaski- which is a medium BV vascularitic disease.

This is a strawberry tongue with erythematous mucosa.

27
Q

Discuss the disease that presents clinically in this picture

A

Wegner’s Granulomatosis, this is a small BV vascularitic disease which can lead to destruction of the soft and hard tissues of the face and oral cavity.

It leaves spongy red tissue.

3rd Year (63 decks)

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