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BDS3 - BAMS > Rheumatoid Arthritis > Flashcards

Rheumatoid Arthritis Flashcards

1
Q

What is rheumatoid arthritis?

A

Initially is a disease of the synovium with gradual inflammatory joint destruction

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2
Q

There are different patterns of joint involvement in rheumatoid depending on what?

A

if the patient is sero-positive (rheumatoid factor present) or sero -negative (no rheumatoid factor present)

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3
Q

Rheumatoid affects what sex more?

A

Females

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4
Q

What joints does rheumatoid arthritis affect?

A

Synovial joints

It is a symmetrical polyarthritis (affects more than one joint and symmetrical joints)

Note: the changes in the joint are diff from osteoarthritis

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5
Q

What are the symptoms of rheumatoid arthritis?

A
  • slow onset (initially hands and feet then proximal spread then potentially all synovial joints)
  • joint pain
  • joint stiffness
  • minor joint swelling
  • fatigue
  • morning stiffness
  • numbness and tingling
  • decrease in range of motion
  • occasionally systemic symptoms such as fever, weight loss and anaemia
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6
Q

Whata are some early signs of RA?

A
  • Symmetrical synovitis of the metacarpal pharyngeal joints (MCP)
  • Symmetrical synovitis of the proximal interpharyngeal joint (PIP)
  • Symmetrical synovitis of the wrist joints
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7
Q

What are some late signs of RA to do with the hand?

A
  • ulnar deviation of fingers at MCP joints (tendons pull fingers to ulnar side of the hand)
  • hyperextension of PIP joints
    • “swan-neck” deformity
  • “Z” deformity of thumb
    • hyperflexion of MCP
    • hyperextension of IP joint

The bones are no longer restricted in the way in which they can move - can hyperextend

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8
Q

Why is it harder for patients with RA to grip?

A

tendons arent pullings the fingers in the right direction to allow it

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9
Q

What are some late symptoms of RA (not to do with the hand)?

A
  • subluxation of the wrist
    • Pull of tendons move them out of position
  • loss of abduction and external rotation of shoulders
  • flexion of elbows and knees
  • deformity of the feet & ankles

Patient would have significant loss of function - can’t grip, lift or walk

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10
Q

What’s the diff in why patients with RA get joint replacement than patients with osteoarthritis?

A

OA is for the pain

RA is to replace function

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11
Q

What are some extra-articular features of RA?

A
  • •Eye involvement
  • •scleritis & episcleritis,
  • •dry eyes, Sjögrens syndrome
  • •Subcutaneous nodules
  • •pressure points
  • •Amyloidosis
  • •Pulmonary inflammation
  • •Neurological
  • Inflammation of blood vessels
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12
Q

What investigations can be done for RA?

A
  • Radiographs
    • erosions, loss of joint space, deformity
    • joint destruction & secondary osteoarthritis
    • CT and MRI increasingly used
  • Blood
    • normochomic, normocytic anaemia
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13
Q

What treatments are there for RA? What is the aim of these treatments?

A

Aim to improve quality of life and maintian current function of joints as much as possible to keep P independent.

Treatment is a holistic management with combo’s of:

  • physiotherapy
  • occupational therapy
  • drug therapy
  • surgery
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14
Q

What is done in physio as treatment for RA and why? What is the aim of this treatment?

A

Aim is to keep the patient active for as long as possible!

  • active and passive exercises
    • to maintain muscle activity
    • to improve joint stability
    • to maintain joint position
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15
Q

What is done with occupational therapy for patients with RA?

A
  • maximising the residual function
  • providing aids to independent living
  • assessment & alteration of home
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16
Q

What drugs are RA patients on in most cases?

A
  • analgesics
    • paracetamol, cocodamol
  • NSAIDs
    • Often combined with anti-PUD agents
  • Disease Modifying Drugs
    • hydroxychloroquine, methotrexate,
    • Less commonly now: sulphasalzine, penacillamine, gold,
  • Steroids - intra-articular (into the joint space that has inflammation)
17
Q

In more severe RA cases, what other drugs might the P be on?

A
  • Immune modulators
    • Azathioprine
    • Mycophenolate
    • Biologics
      • TNF inhibitors - infliximab, adalimumab, entanercept
      • Rituximab (CD20) & tocilizumab (IL6r)
  • Steroids – oral prednisolone
18
Q

What are the surgery options for patients with RA?

A
  • excision of inflamed tissue
  • joint replacement
  • joint fusion
  • osteotomy

Note: Remember that the patients often have a poor medical condition for surgery

19
Q

Whats the prognosis for patients with RA?

A
  • 10% spontaneously remit
  • remainder have fluctuating course
  • RF and late onset have worse prognosis
  • 10% severely disabled
  • remainder have mild/moderate disability
20
Q

What complications of RA should you remember?

A
  • infection
  • peptic ulcer disease
  • extra-articular
  • Drugs
21
Q

What are the dental aspects of the disease?

A
  • disability from the disease
    • reduced dexterity
    • access to care
  • Sjögren’s syndrome
  • Joint replacements
    • multiple - large & small joints
    • dont normally need prophylaxis
  • Drug effects
    • Chronic anaemia (GA problems and dont give sedation outwith hospital)
22
Q

What drug effects of RA should we be aware of as dentists?

A
  • bleeding - NSAIDs & sulphasalazine
  • infection risk - steroids, azathioprine
  • oral lichenoid reactions
    • gold, sulphasalazine, hydroxychloroquine
  • oral ulceration - methotrexate
  • oral pigmentation – hydroxychloroquine
23
Q

Patients with RA may have atlanto-occipital instability, what does this mean?

A

Theres damage to the ligaments in the neck which connect the face to the upper cervical vertebrae

If there was a sudden big trauma to the bck bigger chance of lgament rupture and cuase spinal damage

24
Q

What is sero-negative spondyloarthritides?

A

Range of diff conditions that overlap .

Primary focus of the disease is on the axial skeleton

ankylsing spondylitis - The joints of the spine become inflamed and there is fusion of the vertebrae

25
Q

What are the effects of ankylosing spondylitis?

A
  • Disabling progressive lack of axial movement
  • symmetrical other joint involvement – e.g.hips

Results in:

  • low back pain
  • limited back and neck movement – turning spine restricted (bone fusion)
  • limited chest expansion – breathing compromised (bone fusion)
  • cervical spine tipped forward (Kyphosis)
  • movements restricted
26
Q
A
27
Q

How is ankylosing spndylitis treated?

A
  • Generally the same as Rheumatoid Arthritis:
    • Analgesia &NSAIDs
    • Physiotherapy
    • Occupational therapy
    • DMDs
    • Immune modulators
  • Surgery where appropriate for joint replacement
28
Q

What are the denta aspects of ankylosing spondylitis?

A
  • GA hazardous
  • limited mouth opening
  • limited neck flexion
  • TMJ involvement possible, but rare except in Psoriatic Arthritis

BDS3 - BAMS (9 decks)

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