Rheumatoid Arthritis and Connective Tissue Disease Flashcards
What is rheumatoid arthritis?
Rheumatoid arthritis - a systemic autoimmune disease of unnown aetiology
- joint destruction due to synovial inflammation
- multi-system disease
Is RA or OA more common?
Age of onset?
More common in which gender?
OA is more common than RA
Onset: age 30-50
Women 3x more than men
1-3% of UK population
List some signs and symptoms of RA:
- symmetrical arthritis
- joint stiffness
- may be systemic features and other organs affected
- sjogrens syndrome causes dry mouth and eyes
Nervous System:
- peripheral neuropathy
- atlanto-axial subluxation and cervical spine instability - care with GA
How is RA Diagnosed?
Managed?
Diagnosis:
- clinical features in history
- X-ray features
- blood tests - rheumatoid factor and antinuclear antibodies common
Management:
- analgesia
- disease modifying anti-rheumatic drugs (DMARDs) e.g. penicillamine, methotrexate, gold
- biologics
- corticosteroids - systemic or local joint injection
- physiotherapy - optimise joint function
- surgical joint replacements
List some dental considerations of rheumatoid arthritis:
Making the diagnosis:
- TMJ disease, hands, Sjogrens
Established disease:
- reduced manual dexterity
- managing Sjogrens syndrome
- TMJ and difficult intubation
- C-spine vulnerability
- drug side effects
What is systemic sclerosis (skin and other organs) and scleroderma (skin only)?
Signs and symptoms:
Systemic sclerosis - autoimmune disease characterised by fibrosis of connective tissues
Symptoms: hands and face most common
- sclerodactyly - skin is tight, shiny, reduced mobility
- calcinosis - calcium deposits under the skin
- telangiectasia
Explain the characteristic facial appearance of systemic sclerosis:
- beaked nose
- fixed expression
- radial furrowing of lips
- limitation of mouth movements
What are the multisystem manifestations of systemic sclerosis?
- Raynauds phenomenon
- pulmonary hypertension and pulmonary fibrosis
- renal disease
- cardiac fibrotic disease
- GI - dysphagia and reflux
- Sjogrens syndrome
How is systemic sclerosis diagnosed and managed?
- clinical
- blood tests - specific autoantibodies
Specialist rheumatologists input for management:
- vasodilators for raynauds
- physio/occupational health
- immunosuppressants/biological treatments
- methotrexate, cyclophosphamide
What are some dental considerations for systemic sclerosis?
Mouth care may be limited by:
- limitation of mouth opening (skin tightness and TMJ dysfunction)
- thickened, stiffened tongue
- atrophic mucosa
- loss of dexterity for OH
- side effects of medication
- secondary sjogrens and xerostomia
What is Systemic Lupus Erythematosus - SLE?
List some signs and symptoms:
SLE - autoimmune multi-system disease of unknown aetiology
- antibodies against cell nuclear components (anti nuclear antibodies)
Signs and symptoms:
- aphthous ulcers and sjogrens syndrome
- photosensitivity
- small joint arthritis
- raynauds
How is SLE diagnosed and managed?
Diagnosis:
- clinical, specific auto-antibodies
Management:
- pharmacological: NSAIDs, DMARDs (hydroxychloroquine), steroids, biologics (rituximab)
- psychological/practical support
Dental considerations for SLE?
- recognition of orofacial features - aphthous ulcers, butterfly rash on face, sjogrens syndrome –> refer to GP
Diagnosed disease:
- drug side effects
- reduced dexterity
- secondary sjogrens syndrome
