rheumatoid arthritis

Question 1

what is rheumatoid arthritis initially?

Answer 1

disease of synovium with gradual inflammatory joint destruction

Question 2

what is the difference between sero positive RA and sero negative RA?

Answer 2

sero positive RA - rheumatoid factor (autoantibody) is present
sero negative RA - rheumatoid factor is NOT present

Question 3

what is the most common serious joint disease ?

Answer 3

rheumatoid arthritis

Question 4

which sex does RA affect most?

Answer 4

female - peaks 20-50yrs

Question 5

what joints are affected by RA?

Answer 5

all synovial joints
symmetrical poly arthritis

Question 6

what are the symptoms of RA?

Answer 6

joint stiffness
joint pain
morning stiffness
fatigue
minor joint swelling
systemic symptoms - fever, weight loss, anaemia

Question 7

describe the onset of RA

Answer 7

slow onset
initially hands and feet then potentially spreads to all synovial structures - symmetrical poly arthritis

Question 8

what are the early signs of RA

Answer 8

symmetrical synovitis of MCP (metacarpal phalangeal) joints
symmetrical synovitis of PIP (proximal interphalangeal) joint
symmetrical synovitis of wrist joint

Question 9

what are the late signs of RA on hands?

Answer 9

ulnar deviation of fingers at MCP joints
hyperextension of PIP joints
z deformity of thumb - hyperflexion of MCP
subluxation of wrist

Question 10

what are the late signs of RA on elbows, shoulders, knees and feet?

Answer 10

loss of abduction and external rotation of shoulders
flexion of elbows and knees
deformity of feet and ankles

Question 11

how do you investigate RA?

Answer 11

radiographs - show erosions, loss of joint space, deformity
blood tests - show normochromic normocytic anaemia due to failure of RBC stimulation

Question 12

how is RA treated?

Answer 12

improve quality of life
physiotherapy
occupational therapy
drug therapy
surgery

Question 13

what is the aim of physiotherapy?

Answer 13

keep patient active for as long as possible
maintain muscle activity and joint position

Question 14

what is the aim of occupational therapy?

Answer 14

maximise residual function
provide aids to independent living e.g. stair lift

Question 15

what drugs are used to treat RA in most cases?

Answer 15

analgesics for pain relief - paracetamol, NSAIDS, cocodomol
disease modifying drugs to slow down immune response and damage to joints e.g. methotrexate
steroids intra-articular

Question 16

what drugs are used to treat RA in moderate and severe cases?

Answer 16

immune modulators - azathioprine, TNF inhibitors
steroids - oral prednisolone

Question 17

what surgeries can treat RA?

Answer 17

joint replacement
joint fusion
osteotomy
excision of inflamed tissue

Question 18

what percentage of RA patients spontaneously remit?

Answer 18

10%

Question 19

what percentage of RA sufferers become severely disabled?

Answer 19

10%

Question 20

what are the dental aspects of RA?

Answer 20

trouble accessing care
trouble with OH as reduced dexterity
associated with sjrogens syndrome as RA part of autoimmune disease process - dry mouth and increased caries risk
infection risk
chronic anaemia - GA issues
bleeding if taking NSAIDS
ulceration from methotrexate

Question 21

what autoimmune disease is associated with Atlanto-occipital instability?

Answer 21

rheumatoid athritis

Question 22

name three seronegative spondyloarthritides

Answer 22

ankylosing spondylitis - spinal joint arthritis
Reiter’s disease
Arthritis of inflammatory bowel disease

Question 23

in ankylosing spondylitis, fusion of facet joints of vertebrae leads to what?

Answer 23

patient can’t turn twist or bend

Question 24

HLA-B27 is associated with which disease?

Answer 24

ankylosing spondylitis

Question 25

ankylosing spondylitis predominantly affects which sex?

Answer 25

males

Question 26

give an example of a sero positive and a seronegative condition

Answer 26

+ RA
- ankylosing spondylitis

Question 27

what are the effects of ankylosing spondylitis?

Answer 27

progressive lack of axial movement - spine doesn’t flex, bend or twist
have to turn whole body to look behind
low back pain
limited back and neck movement
limited chest expansion
cervical spine tipped fwd - kyphosis

Question 28

what is the treatment for ankylosing spondylitis?

Answer 28

same as RA
analgesia and NSAIDS
physiotherapy
occupational therapy
disease modifying drugs
immune modulators

Question 29

what are the dental aspects of ankylosing spondylitis?

Answer 29

pt cannot lie back in chair
GA is hazardous
limited neck flexion and mouth opening - access issues
TMJ involvement possible but rare