HUMANS- rheumatology Flashcards
What is rheumatology?
Disorders of the joints, muscles and ligaments?
Compare arthritis to athrosis?
Arthritis- Inflammation of the joint.
Athrosis- Non-inflammatory joint disease.
What is athralgia?
Pain in the joint.
Discuss the formation of bone in osteomalacia and osteoporosis.
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.
What is rickets?
Osteomalacia that happens while the bones are still forming.
How is osteomalacia managed?
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)
Discuss the effects of osteoporosis?
- Skoliosis (bending of the spine into an S shape)
- Kyphosis (bending forward of the spine)
- Increased risk of bone fracture
- Height loss.
How do we prevent Osteoporosis?
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)
What is MRONJ?
Medication related Osteonecrosis of the jaw.
This is when there has been exposed bone does not heal after 8 weeks after the extraction.
Who is at low risk of MRONJ?
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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Who is at high risk of MRONJ
- 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.
What is acute monoarthropathies and what can cause it?
Acute arthritis of a single joint.
It can be caused by infection (e.g. septic arthritis)
Crystal arthropathy (e.g. GOUT)
What is GOUT?
When uric acid crystals are deposited in the joints causing reactive inflammation and pain)
How do we treat GOUT?
NSAIDs (but avoid aspirin as it interfeers with uric acid removal)
Allopurinol (to lower uric acid, but this may give oral ulceration)
Compare osteoarthritis and Rheumatoid arthritis in general.
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.
Compare how to treat osteoarthritis and rheumatoid arthritis?
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)
How does osteoarthritis affect dental patients?
TMJ involvement
Mobility difficulties make it harder to access dental care.
Chronic NSAID use can cause oral ulceraton or a bleeding tendency.
How does Rheumatoid arthritis affect the Dental patient?
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)
What is ankylosing Spondylitis and how does it impact on dentistry?
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.
Compare autoimmune to vasculitic diseases?
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.
How do we treat connective tissue diseases?
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)
What is systemic lupus erythematosis and discuss the medical and dental effects?
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
What is anti-phospholipid antibody syndrome and what are the medical effects of this?
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.
What is Sjorgen’s syndrome and what are the medical and dental impacts?
Sjorgen’s is an inflammatory disease associated with circulating autoantibodies.
It affects the salivary glands causing xerostomia, oral disease and sialosis (swollen salivary glands)
What is systemic scerlosis and discuss its medical and dental effects.
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.
What disease presents as this clinical image?
Kawaski- which is a medium BV vascularitic disease.
This is a strawberry tongue with erythematous mucosa.
Discuss the disease that presents clinically in this picture
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.
