Musculoskeletal Flashcards
what does osteoarthritis cause? what is it an association of?
hands and weight bearing joints - hip,knees,ankles
associated with genetics, obesity, previously damaged joints/bones
pathophysiology of osteoarthritis?
whole joint involved
cartilage damaged - disruption of regeneration and loss
bone beneath is exposed and erosion of bony surface
progressive inflammatory destruction
etiology of osteoarthritis?
risk increases with age
50% of over 60’s xray evidence - only 25% symptomatic
2 x more likely in women
symptoms of osteoarthritis?
pain - worse on movement relieved by rest
immobility - worse in mornings
swelling and deformities
how is osteoarthritis diagnosed?
by clinical exam
bouchards nodes medial, heberdens distal
effusion = swelling b/c of inflammation
radiology and osteoarthritis? MRI? arthroscopy?
radiology useful in advanced conditions does not diagnose
MRI - early cartilage injury/bone changes
arthroscopy visualises joint, aspirates synovial fluid
management of osteoarthritis?
lose weight, physio, analgesia
steroid injections - temp relief
joint replaced
dental relevance of osteoarthritis?
reduced dexterity, reduced mobility, medications
what is rheumatoid arthritis?
an autoimmune disease of unknown aetiology
joint destruction due to synovial inflammation
multi system disease
etiology of rheumatoid?
1-3% of population
3x more in women
onset between 30-50
initially where does rheumatoid begin?
acute rheumatoid?
established rheumatoid?
initially hands and feet, spreads to cervical spine, knees, ankles, elbows, shoulders
hot, swollen, tender joints worse in morning
deformity, restriction, sub laxation
clinical signs of rheumatoid?
ulnar deviation rheumatoid nodule z thumb boutinniere deformity swan neck deficiency
what other body systems can rheumatoid affect?
NS - peripheral neuropathy, cervical cord compression = paralysis
lungs - pulmonary fibrosis
heart failure
kidney disease
eyes inflamed
sjogrens
systemic inflammation - malaise and anemia
how is rheumatoid diagnosed?
clinical exam and blood tests
radiology for destructive arthritis
management of rheumatoid?
analgesic - NSAIDs
disease modifying anti rheumatic drugs e.g sulphasalazine, penicillamine, methotrexate, hydrochloroquinone, gold, azathioprine
corticosteroids - orally/local injection
non pharmacological management of rheumatoid?
surgery - joint replacement, physio - optimise joint function, occ therapy - optimise functional abilities
dental relevance of rheumatoid?
TMJ disease, sjogrens, hands - used to diagnose
already diagnosed - reduced dexterity, manage sjogrens, caution if cervical spine diseased, drug side effetcs esp DMARD’s
what is systemic sclerosis?
autoimmune disease. Skin thickens and binds to underlying structures. Multi organ disease
etiology of systemic sclerosis?
rare
3-5x more common in women
presents in middle age
clinical signs of systemic sclerosis?
telangiectasia - ruptured capillaries sclerodactyly - sclerosis of fingers calcinosis - bony hard deposits beaked nose fixed expressions radial furrowing of lips limitation of mouth movements
how to diagnose systemic sclerosis?
management of?
dental relevance?
clinically/ blood tests for spec. autimmune abs
manage symptoms
oral involvement and loss of dexterity
what is systemic lupus erythematous?
what is discoid lupus?
autoimmune, multi system, uknow aetiology
abs against nuclear cell components
widespread vascular immune complex deposition
confined to head/neck region
etiology of SLE?
0.1% population. young women 20-40
more common if origin african
areas affected?
skin - 75% photosensitivity, butterfly rash
joints - 90% - small joint arthritis
raynauds - 20%
N.S - 60% - fits, paralysis, neuropathy, psychosis
heart - valvular disease, aseptic endocarditis 25%
lungs - 50% effusions
kidney failure - 30%
how to diagnose SLE?
how to treat?
dental relevance?
clinically - blood tests for spec. autoimmune abs
same meds as rheumatoid arthritis
drug side effects, reduced dexterity
what is gout?
accumulation of urate crystals in joints
more common in older men
precipitated by excess alcohol, starvation, certain foods, operations, drugs
acute gout?
chronic gout?
acute - painful joints
chronic - tophi deposition
what is psoriatic arthritis?
destructive arthritis associated with psoriasis
what is hyperparathyroidism?
excess parathyroid hormone
usually an adenoma in gland
0.1% of population
symptoms of hyperparathyroidism?
hypercalcaemia - malaise/depression, kidney stones, constipation, abdominal pains
bone pain
how to diagnose hyperparathyroidism?
how to treat?
blood tests, xrays show sub periostal erosions
parathyroidectomy/ drugs to treat
effects of bone resorption dentally?
giant cell lesions, loss of lamina dura around roots
what is pagets disease?
abnormal bone remodelling - abundant new bone formation, structually abnormal, prone to fracture
age related
10% by 90
symptoms of pagets?
most pt’s totally asymptomatic
bone deformities - enlarged skulls, nerve compression leading to deafness, spinal cord compression
fractures
how to diagnose pagets?
clinically
xrays are characteristic
what is osetocalcaemia?
a vitamin d deficiency - lack of sunlight, poor intake, malabsorption of intestine = fat sol.vitamins
asian origin/ frail elderly
symptoms of osteocalcaemia?
diffuse bony pains, proximal muscle weakness
diagnosis of osteocalcaemia?
treatment?
dental relevance?
history taken, xrays, blood tests
increase uptake of vit d
affects tooth development in children
what is osteoporosis?
loss of bone and increased fracture risk
15% women aged 50, 70% of women aged 80
less common in men
where can fractures happen?
vertebral - pain, loss of height, kyphosis
hip - disabling, high mortality/morbidity 20% of 80 year old women
wrists - less disabling, marker of underlying osteoporosis
risk factors of osteoporosis?
alcohol, smoking, female, white, lack of exercise, steroids, thin, short menstrual history, malabsorption, hyperthyroidism, hypogonadism
management of osteoporosis?
diagnosis by DEXA screening
treated by pharmacological
calcium and vitamin D
side effects of bisphosphonates?
osteonecrosis of the jaw
poor oh
