Rheumatoid Arthritis and Seronegative Spondyloarthritides Flashcards
What is rheumatoid arthritis?
Initially a disease of the synovium with gradual inflammatory joint destruction
How common is rheumatoid arthritis?
Most common serious joint disease
1% prevalence
6:1 female pre-menopause
3:1 female post-menopause
Peaks 20-50 years
What are the symptoms of RA?
Slow onset
Initially hands and feet, proximal spread, potentially affecting all synovial structures
Symmetrical poly arthritis
Fever, weight loss and anaemia
What are the early signs of RA?
Symmetrical synovisitis of MCP joints, PIP joints and wrist joints
What are the late signs of RA?
Ulnar deviation of fingers at MCP joints
Swan neck
Z deformity of thumb
Subluxation of the wrist
Loss of abduction and external rotation of shoulders
Flexion of elbows and knees
Deformity of the feet and ankles
What are the extra-articular features of RA?
Inflammation of blood vessels due to systemic vasculitis
Psoriasis
Eye involvement - scleritis, Sjögren’s syndrome
Subcutaneous nodules
Amyloidosis
Pulmonary inflammation
Neurological problems
What investigations are carried out for RA?
Radiographs may show erosions, loss of joint space, deformity, joint destruction and secondary osteoarthritis
Bloods may show normochomic and normocytic anaemia
How is RA treated?
Holistic management
Aim to improve quality of life
Combo of physiotherapy, occupational therapy, drug therapy and surgery
How is physiotherapy used to treat RA?
Aim to keep the patient active for as long as possible
Active and passive exercises to maintain muscle activity, improve joint stability and maintain joint position
How is occupational therapy used to treat RA?
Maximising the residual function
Providing aids to independent living
Assessment and alteration of home
What drugs are used to treat most cases of RA?
Analgesics - paracetamol, cocodamol
NSAIDS
Disease modifying drugs - methotrexate
Intra-articular steroids
What drugs can be used to treat moderate and severe cases of RA?
Immune modulators - azathioprine, biológicas such as TNF inhibitors
Steroids - oral prednisolone
What surgeries can be used to treat RA?
Excision of inflamed joint
Joint replacement
Joint fusion
Osteotomy
What is the prognosis for RA?
10% spontaneously remit
Remainder have fluctuating course
RF and late onset have worse prognosis
10% severely disabled
Remainder have mild/moderate disability
What are the dental aspects of RA?
Disability from disease - reduced dexterity and access to care
Sjögren’s syndrome - association of CT disease and dry mouth
Joint replacements
Chronic anaemia - GA problems
What are the drug effects of RA?
Bleeding - NSAIDS
Infection risk - steroids and azathioprine
Oral lichenoid reactions
Oral ulceration
Oral pigmentation
Give examples of different rheumatology diseases?
Crystal arthropathies
Osteoarthritis
Rheumatoid arthritis
Sero-negative Spondyloarthitides
Give examples of seronegative spondyloarthritides
Ankylosing spondylitis - spinal joint arthritis
Reiter’s disease
Arthritis of IBD
What are the common features of SAs
Associated with HLA-B27 antigens
Infection likely as a cause
often is symmetrical peripheral arthritis
Has ocular and mucotaneous manifestations
How common is ankylosing spondylitis?
95% of cases have HLA-B27
10% Caucasians have this antigen, 0.5% of these get it
8:1 males
Onset about 20 years
20% have large joint disease as well
What are the effects of ankylosing spondylitis?
Disabling progressive lack of axial movement such as hips
What can ankylosing spondylitis result in?
Low back pain
Limited back and neck movement
Limited chest expansion
Cervical spine tipped forward
How is ankylosing spondylitis treated?
Generally same as RA:
- Analgesics and NSAIDS
- Physiotherapy
- Occupational therapy
- Disease modifying drugs
- Immune modulators
- Surgery where appropriate for joint replacement
What are the dental aspects of ankylosing spondylitis?
GA hazardous as limited mouth opening and neck flexion
TMJ involvement possible but rare except in psoriatic arthritis
What is ankylosing spondylitis?
Narrowed and inflamed discs causing fusion of the vertebrae
