Rheumatoid Arthritis

Question 1

what is rheumatoid arthritis

Answer 1

disease of the synovium with gradual inflammatory joint destruction

Question 2

what are the 2 types of RA

Answer 2

sero-positive and sero-negative

Question 3

what kind of joints does RA affect

Answer 3

synovial

Question 4

what are the symptoms of RA

Answer 4

slow onset, hands and feet, occasional systemic symptoms (fever, weight loss, anaemia)

Question 5

what are the early signs of RA

Answer 5

symmetrical synovitis of MCP, PIP, wrist joints
swelling, stiffness and pain

Question 6

what are the late signs of RA

Answer 6

ulnar deviation of fingers at MCP joint
hyperextension of PIP joints
Z deformity of thumb
subluxation of wrist

Question 7

what are the extra-articular features of RA

Answer 7

inflammation of blood vessels, psoriasis, sjogrens, amyloidosis, pulmonary inflammatory, neurological

Question 8

what do you use radiographs to view for RA

Answer 8

erosions, loss of joint space, deformity, joint destruction and secondary arthritis

Question 9

what do you look for in blood tests for RA

Answer 9

normochromic, normocytic anaemia (failure of red blood cell stimulation)

Question 10

what are the types of therapy used for RA treatment

Answer 10

physiotherapy, occupational therapy, drug therapy, surgery

Question 11

what are the aims of physiotherapy for RA

Answer 11

maintain muscle activity, improve joint stability, maintain joint position

Question 12

what does occupational therapy for RA do

Answer 12

maximise residual function, providing aids to independent living, assessment and alteration of home

Question 13

what drugs are used for RA

Answer 13

analgesics, NSAIDs, disease modifying drugs (methotrexate), steroids (injection)

Question 14

what drugs are used for moderate and severe cases of RA

Answer 14

immune modulators (azathioprine) - biologics (TNF inhibitors and leukocyte modulators), steroids

Question 15

what are the complications of RA

Answer 15

infection/PUD/extra-articular features

Question 16

what are the dental aspects of RA

Answer 16

sjogrens, disability causing reduced dexterity, anaemia causing GA problems

Question 17

what are the oral effects of the drugs used for RA

Answer 17

bleeding, infection risk, oral lichenoid reactions, ulceration, pigmentation

Question 18

what joint near the head can be damaged with RA preventing turning of the head

Answer 18

atlanto-occipital joint

Question 19

what are the types of seronegative spondyloarthritides

Answer 19

ankylosing spondylitis, reiter’s disease, arthritis of IBD

Question 20

what does seronegative spondyloarthropitides result in

Answer 20

fusion of facet joints and anterior aspects of vertebrae so they are stiff and cannot move making it hard to turn and twist

Question 21

what are the features of SAs

Answer 21

association with HLA-B27
infection
symmetrical peripheral arthritis
ocular and mucocutaneous manifestations

Question 22

what do most people with ankylosing spondylitis have

Answer 22

HLA-B27

Question 23

what are the effects of ankylosing spondylitis

Answer 23

disabling progressive lack of axial movement with involvement of symmetrical joints resulting in:
- lower back pain
- limited back and neck movement
- limited chest expansion
- cervical spine tipped forward

Question 24

what is the treatment for ankylosing spondylitis

Answer 24

analgesia and NSAIDs, physiotherapy, occupational therapy, DMDs, immune modulators, surgery where appropriate for joint replacement

Question 25

what are the dental aspects of ankylosing spondylitis

Answer 25

GA hazards: limited mouth opening, limited neck flexion, TMJ involvement sometimes