Rhematoid Arthritis Flashcards
what is rheumatoid arthritis?
initially a disease of the synovium with gradual inflammatory joint destruction
what are the different patterns of joint involvement in rheumatoid arthritis?
- sero-positive RA
- sero-negative RA
what is the difference between sero-positive and sero-negative RA?
sero positive = rheumatoid factor present
sero negative = rheumatoid factor not present
who is more likely to develop rheumatoid arthritis?
females > males
(incidence increased after menopause)
what are the symptoms of rheumatoid arthritis?
Slow onset of symptoms =
- fatigue
- morning stiffness
- joint stiffness/pain
- minor joint swelling
- fever
- numbness & tingling
- symmetrical polyarthritis
what are the early signs of RA?
- symmetrical synovitis of metacarpophalangeal joints
- symmetrical synovitis of PIP joints
- symmetrical synovitis of write joints
what are the late signs of RA?
- ulnar deviation of fingers at MCP joints
- hyperextension of PIP joints
- “Z” deforming of thumb
- subluxation of wrist
- loss of abduction & rotations of shoulders
what are the extra-articular features of RA?
- psoriasis
- eye involvement (dry eyes)
- subcutaneous nodules
- amyloidosis
- pulmonary inflammation
- neurological
what investigations are carries out to diagnosis RA?
- radiographs
- blood tests to check for normochromic/normocytic anaemia
how is RA treated?
combination of
- physiotherapy
- occupational therapy
- drug therapy
- surgery
how is physiotherapy used to treat RA?
Active and passive exercises that
- maintain muscle activity
- improve joint stability
- maintain joint position
how is occupational therapy used to treat RA?
- maximise residual function
- providing aids to independent living
how is drug therapy used to treat RA?
- analgesics (paracetamol, cocodamol)
- NSAIDs
- disease modifying drugs (methotrexate, hydroxychloroquine)
- intra auricular steroids
how is drug therapy in moderate to severe cases of RA used?
Immune modulators used
- azathioprine
- mycophenolate
- TNF inhibitors
- Rituximab
how is surgery used to treat RA?
- excision of inflamed tissue
- joint replacement
- joint fusion
- osteotomy
what are the dental aspects of RA?
- disability from disease (poor dexterity & access to care)
- Sjögren’s syndrome causes dry mouth
- joint replacements make it difficult to access care
- drug side effects
- chronic anaemia
what RA drug treatments cause bleeding?
- NSAIDs
- sulphasalizine
what RA drug treatments cause infection risk?
- steroids
- azathioprine
what RA drug treatments cause oral lichenoid reactions?
- gold
- sulphasalizine
- hydroxychloroquine
what RA drug treatments cause oral ulceration?
methotrexate
what RA drug treatments cause oral pigmentation?
hydroxychloroquine
What are examples of seronegative spondyloarthritides?
- ankylosing spondylitis
- reiter’s disease
- arthritis of IBD
What are the features of seronegative spondyloarthritides?
- association with HLA-B27
- infection likely as a precipitant
- often symmetrical peripheral arthritis
- ocular & mucocutaneous manifestations
Who is more likely to develop ankylosing spondylitis?
Male predominance (8:1)
When is the typical onset of ankylosing spondylitis?
Around 20 y/o (rare after 45 y/o)
What are the effects of ankylosing spondylitis?
- disabling progressive lack of axial movement
- symmetrical other joint involvement
What are the symptoms of ankylosing spondylitis?
- low back pain
- limited back & neck movement
- limited chest expansion
- cervical spine tipped forward
What is the treatment for ankylosing spondylitis?
- analgesia & NSAIDs
- physiotherapy
- occupational therapy
- DMDs
- immune modulators
What are the dental aspects of Ankylosing Spondylitis?
- GA hazardous due to limited mouth opening & limited neck flexion
- difficult dental access
