Musculoskeletal Flashcards
Define musculoskeletal disease
disorders of joints and bones that may or may not also affect other bodily systems
name the two categories of joint disease
- osteoarthritis
2. connective tissue diseases
name 3 types of connective tissue diseases
- rheumatoid arthritis
- systemic sclerosis
- systemic lupus erythematosus (SLE)
name 4 types of bone disease
- hyperparathyroidism
- paget’s disease
- osteomalacia
- osteoporosis
general symptoms for joint disease is.. 6 things
inflammation - hot - red - swollen - painful destruction - deformity - instability
list the 4 joints that are most likely to be affected by osteoarthritis
- hands
- hips
- knees
- ankles
3 things that predispose a person to osteoarthritis
- genetics
- obesity
- previously damaged joints
which part of the joint does osteoarthritis affect (or all of it)?
whole joint affected
what are 3 pathophysiological changes that occur in osteoarthritis?
- cartilage worn away
- cartilage fragments in synovial fluid
- bone spurs (overgrowth)
what is the full definition of osteoarthritis
progressive destruction of the cartilage due to inflammation which can go on to affect the whole joint
who is most at risk of having osteoarthritis?
women over 60
what % of patients have no symptoms of osteoarthritis?
50% (25% of the 50% of over 60s who have radiographic evidence)
what are 4 symptoms of osteoarthritis
- pain that is worsened by movement and eased by rest
- immobility which is worse in the morning
- deformity
- swelling
which nodes on the hands are closer to where a ring would sit?
heberden’s nodes
what are the nodes closest to your finger nails called?
bouchards nodes
what are 5 ways to manage osteoarthritis
- lose weight
- physiotherapy
- analgesia
- steroid injection (temporary relief)
- joint replacement
what type of disease is rheumatoid arthritis
autoimmune disease with unknown aetiology
what does the immune system do to give rheumatiod arthritis?
makes antibodies against bodies own antibodies - commonly IgM
which part of the joint experiences the most inflammation in rheumatoid arthritis?
synovial inflammation leads to joint destruction
what 3 changes occur to a joint with rheumatoid arthritis?
- inflammed synovium
- generalised bone loss/erosion
- cartilage loss
what % of the population is affected by rheumatoid arthritis
1-3%
rheumatoid arthritis - how many times more common is it in female?
3x
when is the usual onset of rheumatoid arthritis?
30 - 50 years old
what parts of the body are usually initially affected by RA?
hands and feet
what areas are then affected later on by RA?
- cervical spine
- knees
- ankles
- elbows
- shoulders
what are 2 symptoms of established RA?
deformity (restriction)
sub-luxation
give the 5 signs of RA in the hands
- ulnar deviation
- rheumatoid nodule(s)
- Z thumb
- swan neck deformity
- boutonniere deformity
what are 7 systemic issues with RA?
- kidney failure
- nervous system issues
- heart disease
- lung issues
- systemic inflammation
- eye issues
- sjogrens syndrome
what are the 2 nervous system complications with RA?
- peripheral neuropathy
- cervical cord compression (paralysis)
what lung complications can occur with RA?
pulmonary fibrosis
what systemic inflammatory associated issues can occur with RA?
- malaise
- anaemia
what can occur to the eyes in RA pt?
inflammation
what is sjogrens syndrome defined as?
an autoimmune chronic inflammatory condition where the WBCs attack the bodies moisture producing glands (eg salivary & lacrimal)
what 3 ways can RA be diagnosed?
Clinically
- ulnar deviation
- Z-thumb
- rheumatoid nodules
- swan neck deformity
- boutonniere deformity
Blood tests
Radiology (destructive arthritis)
what is the management of RA?
- pharmacologically
- surgery
- physio (to optimise joint function)
- occupational therapy (optimise functional abilities)
name the 3 groups of drugs that will be given to a patient with RA?
- analgesics
- corticosteroids
- disease modifying anti-rheumatic drugs
what 2 ways can corticosteroids be administered?
- systemically
2. local injection into joints
name 6 DMARDs
- sulphasalazine
- penicillamine
- methotrexate
- gold
- hydrochloroquine
- azathioprine
what surgery options are there for RA?
joint replacement
dental aspects of RA?
- reduced dexterity
- TMJ disease
- Sjogrens syndrome
- drug side effects
what are some orally relevant side effects of DMARDs?
- oral ulceration
- stomatitis
- taste loss/disturbance
- vomiting
systemic sclerosis is also called?
scleroderma
systemic sclerosis pathophysiology is…
- autoimmune disease
- multi organs
- skin mainly effected (thickened and bound to underlying structures)
how common is systemic sclerosis?
rare
how many times more is a woman likely to be affected with systemic sclerosis?
3-5 x more
when will systemic sclerosis present itself?
middle age
what are 7 symptoms of systemic sclerosis?
- sclerodactyly
- telangiectasia
- calcinosis
- beaked nose
- fixed expression
- limited mouth movements
- radial furrowing of lips
what is sclerodactyly?
- thickening/tightness of the skin in fingers and toes
what is telangiestasia?
dilation of capillaries giving spider like appearance (small red or purple blisters
2 ways that systemic sclerosis is diagnosed?
- clinically
- blood tests
what does SLE stand for?
systemic lupus erythematousus
what is SLE?
- an autoimmune multi system disease that has unknown aetiology.
- widespread vascular immune complex deposition
what are antibodies formed against in SLE?
cell nuclear components
how common (in %) is SLE?
0.1%
which 2 groups are at higher risk of SLE?
- african origin
2. women aged 20-40
what are the 6 main areas affected by SLE?
- Joints
- Heart
- Skin
- Nervous system
- Lungs
- Kidneys (failure)
what condition can be associated with SLE?
Raynauds in 20% of cases
what kind of joint issue is associated with SLE?
small joint arthritis (90%)
what kind of heart issues are associated with SLE?
- valve disease
- endocarditis (aseptic)
what kind of skin issues are associated with SLE?
- photosensitivity
- butterfly rash
what kind of nervous system issues are associated with SLE?
- fits
- neuropathy
- psychosis
- paralysis
what kind of respiratory issue can be associated with SLE?
- pleural effusions (fluid in pleural space)
2 ways of diagnosing SLE?
- clinical
- specific auto-antibodies
what is the management of SLE?
- pharmacological (as RA)
- analgesic
- corticosteroids
- DMARDs - psychological/practical support
what is gout?
a form of arthritis caused by the accumulation of urate (uric acid) crystals in joints
which category of people are most likely to have gout?
older men
what is the main symptom of gout in an acute attack?
extremely painful joints
what can cause a gout attack?
- starvation
- alcohol excess
- certain foods (high in uric acid)
how is gout managed?
- drugs
- surgery
what is the chronic symptom of gout?
trophic deposition - usually painless but can get in the way
what is psoriatic arthritis?
arthritis associated with psoriasis
what is hyperparathyroidism?
- excess parathyroid hormone
what is usually the cause of hyperparathyroidism?
adenoma of the parathyroid glands
what % of the population is affected with hyperparathyroidism?
0.1%
what is the 2 main symptoms of hyperparathyroidism?
hypercalcaemia & bone pain
what does hypercalcaemia cause?
- malaise
- depression
- constipation
- abdominal pain
- kidney stones
what is the common saying about hyperparathyroidism symptoms?
“bones, stones and abdominal groans”
what is the management of hyperparathyroidism?
drugs
what are the dental aspects of hyperparathyroidism?
- giant cell lesions
- loss of lamina dura around roots on radiographs
what is the pathophysiology of pagets disease?
- abnormal bone remodelling
- abundant new bone formation
what is the abundant new bone formation like in pagets disease?
- structurally normal
- prone to fracture
what is pagets disease closely related to?
age
what are the possible symptoms of pagets disease?
- bone deformities (skull enlargement/nerve compression)
- fractures
what are the two possible outcomes of nerve compression?
- deafness
- spinal cord compression (paralysis)
define osteomalacia?
a vitamin D deficiency
what are 3 causes of Vit D deficiency?
- lack of sunshine
- poor intake
- malabsorption in intestine (it is a fat soluble vitamin)
what are the 2 at risk groups for osteomalacia?
- asian origin
- frail elderly
what are 2 symptoms of osteomalacia?
- diffuse bony pains
- proximal muscle weakness
what is the treatment fot osteomalacia?
vitamin D replacement
what is the dental relevance of osteomalacia?
affects tooth development in children
what is the definition of osteoporosis?
loss of bone mass with increased fracture risk
what is the % of women affected by osteoporosis aged 50?
15%
what is the % of women affected by osteoporosis aged 80?
70%
where are the 3 most common places to get an osteoporotic fracture?
- vertebral
- hips
- wrist/humerus neck
what will be associated with vertebral fractures?
- pain
- loss of height
- kyphosis
what will be associated with hip fractures?
- disability
- high mortality/morbidity
what are 11 risk factors for osteoporosis?
- female
- white
- smoking
- alcohol
- lack of exercise
- steroids
- thin
- short menstrual history
- malabsorption
- hyperthyroidism
- hypogonadism
what are the 3 treatments of osteoporosis?
- drugs
- calcium and vit d
- risk factor modification
what can be a side effect of bisphosphonates?
osteonecrosis of the jaw
what advice should be given to patients on bisphosphonates?
- good OH to avoid extraction
- new recommended dental assessment pre prescription
