Other Rheumatic Conditions Flashcards
(24 cards)
Define ‘psoriasis’
Systemic chronic inflammatory disease involving hyperproliferation of epidermal keratinocytes
Aetiology of psoriasis
- Genetic factors
- Environmental factors
- Immunological factors
Histopathology of psoriasis
Key: altered epidermis cell cycle:
- improper cell maturation -> Epidermal hyperplasia
- increased cell turnover - 3 to 5 days
Stratum granulosum become parakeratinized
- low lipid release = low adhesion
- Stratum corneum is flakey and scaly
Patient population targeted by psoriasis
- All ages (mean 28 years)
- Females slightly more affect than males
Describe chronic stationary psoriasis (psoriasis vulgaris)
- Most common - 80% of all psoriasis
- Lesions are red, inflamed, and raise with white scales
- Affect scalp, knee, elbows, and genital region
- Lesions are itchy
Describe psoriatic arthritis
- 10-30% of people with skin symptoms
- Manifest >10 years of skin symptoms
- Inflammatory arthritis of hands and feet joints (sometimes larger joints)
Describe nail psoriasis
- 50% of people with skin condition and 90% with psoriatic arthritis
- Nails are yellow/brown and pitted, and tender
- Separation form nail bed
Describe inverse psoriasis
- Smooth, shiny, red lesions (no scales)
- Affects armpits, groin, under breast, and in skinfolds
Describe oral psoriasis
- uncommon
- affects angle of mouth and crosses lips to surround skin
Treatments for the various rheumatic arthritic conditions
Same as other inflammatory rheumatic conditions:
e.g. corticosteroid and DMARDs
Describe Sjogren’s Syndrome
- Slowly progressing autoimmune disease
- Lymphatic infiltration of exocrine glands, especially lacrimal and salivary glands: secretions stopped by lymphocyte infiltration and glandular fibrosis
- Secondary Sjogren - occurs with another autoimmune or connective tissue disease: e.g. with Rheumatoid arthritis
Describe affected population of Sjogren’s syndrome
- 1-3% of adult population
- Females 9x more than males
Clinical manifestations of Sjogren’s Syndrome
- Fatigue
- Salivary gland enlargement
- Dry eyes (Xerophthalmia): conjunctivitis and irritation
- Dry mouth (Xerostomia): difficulty swallowing and dental caries risk.
Diagnosis/Investigations of Sjogren’s Syndrome
Salivary glands test:
- Salivary flow test
- Sialography (X-ray)
- Salivary gland biopsy
Blood test
- Elevated erythryocyte sedimentation rate (ESR)
- Anemia
- Presence of antinuclear antibodies (ANA)
- Presence of Rheumatoid factor (RF)
Orofacial problems of Sjogren’s syndrome
- Risk of severe dental caries: especially cervical and root surface lesions
- Difficulty eating/swallowing
- Poor retention of complete dentures (need surface tension)
Describe SLE (Systemic lupus erythematosis)
- autoimmune disease
- causes chronic inflammatory injury to blood vessels and organ systems
- Typically presented as episodic symptoms
Affected population of SLE
- Mean diagnosis at age 30
- Female»_space; male
Clinical features of SLE
- Arthritis in 90% of SLE
- Skin - SLE specific rashes (e.g. Butterfly rash on face)
- General - headache and fatigue
- Lung - pleural disease
- Kidney - renal disease
- Cardiovascular - heart disease
- Neurological - seizures and brain disease
- Haematological disorders - anaemia and thrombocytopaenia
- Reynaud’s phenomenon - vascular occlusion in digits
- GIT - Oral ulcers
Investigations/diagnosis of SLE
- Above features
- Anti-nuclear antibodies
- Biopsy
Describe gout
- Acute rheumatoid mono-arthritis
- Crystal-induced inflammation in synovial joints, usually big toe
Affected population of gout
- More common in men (only syndrome studied in class that is more common in male)
- > 50% of cases involve big toe
Pathology of gout
- Purine breakdown leads to uric acid waste
- When plasma (urate) > saturation (>0.42 mmol/L), sodium urate crystals MAY form
- Nucleating factors are important for urate crystal growth: only 20% of hyperuricaemia people form crystals
- Crystals form mainly in joints
- Acute gout attack caused by interaction between inflammatory system and crystals: swelling/redness, intense pain, only short duration
- Chronic gout occurs after year of acute attacks: joint destruction due to infection of synovial membrane and urate crystals in bones (intraosseous tophi)
Risk factors for gout:
- Obesity
- Hypertension
- Excess alcohol
Diagnosis for gout
- Monosodium urate crystals found in synovial fluid: identified with polarized light microscopy
