Osteoarthritis

Question 1

symptoms of joint disease

Answer 1

pain
immobility stiffness
loss of function

Question 2

signs of joint disease

Answer 2

swelling - fluctuant/bony/synovial
deformity
redness
crepitus
loss of function

Question 3

synovial

Answer 3

between bone ends and swelling of which is common in rheumatoid arthritis

Question 4

crepitus

Answer 4

associated with loss of cartilaginous covering of bone ends

Question 5

investigations

Answer 5

radiography - plain, MRI, arthrography
blood:
C-reactive protein - CRP = inflammatory marker
rheumatoid factors RF
extractable nuclear antigens ENA’s
anti DS-DNA, anti nuclear antibody - ANA
arthroscopy & biopsy

Question 6

acute monoarthropathies

Answer 6

acute arthritis of a single joint
common causes - infection i.e. septic arthritis // crystal arthropathy i.e. gout
can be the initial stage of polyarthritis (affects more than 1 joint)

Question 7

what is gout

Answer 7

uric acid crystal deposition in joints that causes significant pain from reactive inflammation

Question 8

causes of gout

Answer 8

hyperuricaemia - high uric acid levels in blood
drug induced - thiazide diuretics
genetic predisposition
nucleic acid break down - chemo
tumour related - myeloma
obesity & alcohol increase risk
M>F until menopause then it equalises

Question 9

symptoms of gout

Answer 9

acute inflammation of single joint (usually big toe)
usually a precipitating event i.e. trauma, surgery, illness, diet/alcohol excess
rapid onset - hrs
NSAIDs to treat

Question 10

dental aspects of gout

Answer 10

avoid aspirin - interferes with uric acid removal
drug treatment may give oral ulceration (allopurinol)

Question 11

what is osteoarthritis

Answer 11

degenerative joint disease caused by cartilage repair dysfunction
mostly knees & hips

Question 12

symptoms of osteoarthritis

Answer 12

pain - improves with rest & worse with activity
brief morning stiffness
slowly progressive over years

Question 13

signs of osteoarthritis

Answer 13

from radiographs:
- loss of joint space & subchondral sclerosis (thickening of bone under cartilaginous layer - as bone is having more force transmitted directly to it and less to cartilage)
- osteophytes growing at joint edge due to irritation to bone ends (osteophyte lipping)
joint swelling & deformity

Question 14

treatment of osteoarthritis

Answer 14

• nothing alters disease progression
• pain improved by:
  increasing muscle strength around joint
  weight loss
  walking aids
• role of NSAIDs for pain
• prosthetic replacement for pain

Question 15

dental aspects of osteoarthritis

Answer 15

• tmj can be involved but rare
• difficulty in accessing care
• chronic NSAID use; oral ulceration possible // bleeding tendency (anti-platelet)
• joint replacement; AB prophylaxis (usually not needed)