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Diseases Of Human Systems BDS3 > Rheumatolgy > Flashcards

Rheumatolgy Flashcards

1
Q

What does arthritis mean

A

Inflammation of the joints

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2
Q

What is arthrosis?

A

Non inflammatory joint disease

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3
Q

What is arthralgia

A

Joint pain

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4
Q

When are parathyroid glands at risk

A

During thyroid gland surgery

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5
Q

What is the function of parathyroid hormone

A

Maintains serum calcium level

Increases calcium release from bone

Reduces renal calcium excretion

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6
Q

What do both primary and secondary hyperthyroidism both result in?

A

They both result in increased bone re absorption

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7
Q

Give some reasons that people may experience low vitamin D

A

Low sunlight exposure - housebound, dark skinned in northern country
Poor GI absorption - poor nutrition or small intestinal disease leading to malabsorption
Drug interactions - carbamazepine, phenytoin

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8
Q

Why may people with dark skin in Northern countries experience
vitamin D problems

A

This is because there skin absorbs sunlight less efficiently due to pigment in the skin.

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9
Q

What is osteomalacia?

A

The bone is formed normally, the normal osteiod matrix is formed however it is not calcified properly.

Normal amounts of osteiod but INADEQUATE mineralisation of the tissue making the bone more soft

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10
Q

What is osteoporosis?

A

The mineral and matrix are correct however there is less of it so the correct bone mass is not achieved

The bone that is there is normally mineralised there but there just isn’t enough of it.

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11
Q

Osteomalacia is the term given to this disease after bone formation is completed, what is called if it happens during bone formation and why do the bones bend

A

Rickets

They are both related to calcium deficiency, the serum calcium is preserved at the expense of bone mineralisation.
Therefore when calcium is in short supply during one formation the bones that are formed are soft and tend to bend to pressure

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12
Q

What are three things that are important to test when testing for osteomalacia and how would they present

A

Serum calcium - decreased
Serum phosphate - decreased
Alakaline phosphatase - very high

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13
Q

When is peak bone mass age

A

24-35 years

As grow older bone mass reduces

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14
Q

Why do males have a higher peak bone mass than women

A

Peak bone mass is artificially boosted by oestrogen but as this is los during menopause that protection is lost and there is a rapid decrease in bone mass, it will even out.

Peak with me is higher therefore it takes men longer to loose enough bone mass to reach the osteoporosis point that it does for women.

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15
Q

What is kyphosis and what disease is this a effect of

A

This is the bending forward of the spine and this causes the vertebral bodies to collapse due to the upper body weight.

This can be seen in osteoporosis

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16
Q

What is scoliosis and what can this be seen as an effect od

A

Shifting of the lateral vertebrae caused by the upper weight compression causing them to stoop forward

This can be seen as an effect of osteoporosis

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17
Q

What are two ways to increase your peak bone mass

A

Excercise and high dietary calcium intake

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18
Q

As much as hormone replacement therapy can reduce a persons risk of osteoporosis what can it increase the risk of

A

Breast cancer and endometrial cancer risk

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19
Q

How do biphosphonates prevent osteoporosis

A

They act to prevent osteoclast action by poisoning osteoclasts and reducing their numbers

The reduction in osteoclasts, means there is less bone removed and more bone mass preserved

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20
Q

What is the relevance of bisphophonates to dentistry

A

Must be careful when extracting teeth and must always refer to SDCEP guidelines

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21
Q

What are three symptoms patients may complain of when they experience joint pain?

A

Pain
Immobility stiffness
Loss of function

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22
Q

Why might someone get bony swelling?

A

If the inflammatory process has taken place over many years and caused osteophytes to form at the edges of the joints

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23
Q

What is crepitus

A

Noise made by the bone ends moving usually associated with the loss of normal cartilagenous covering of bone ends

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24
Q

What is arthrogrpahy

A

Radiopaque die is injected into the joint to outline the articular surfaces and the joint capsule

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25
Q

what are two common causes of acute monoarthropathies ( actute arthritis of a single joint)

A

Infection - septic arthritis
Crystal arthopathy - gout

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26
Q

What is gout caused by

A

In gout Uric acid crystals are deposited in the joints and these crystals cause irritation to the joint surface which causes swelling and inflammation

This causes significant pain

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27
Q

Why can gout be seen following chemotherapy

A

Uric acid is a metabolic product from nucleic acid, so following chemotherapy the cancer treatment will have killed cancer cells and the nucleic acid from these cells will be processed producing a large surge in Uric acid in the blood.

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28
Q

How can gout be prevented in a patient receiving chemotherapy be prevented from developing gout

A

The effects if gout can to some extent be reduced by pre-hydrating the person so their renal flow and renal out put are maximised before the chemo starts and then as nucleic acids are broken down they are washed away before the uric acid blood plasma levels get too high

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29
Q

What kind of drugs can cause hyperuricaemia

A

Thiazide diuretics

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30
Q

What is hyperuricaemia?

A

High uric acid levels in the blood

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31
Q

What drug would the dentist avoid prescribing to a patient that has gout

A

Avoid aspirin

This interferes with uric acid removal

32
Q

Allopurinol is a treatment given to lower uric acid levels in the blood. What dental side affect can this cause

A

This may cause oral ulceration

33
Q

What happens in osteoarthritis

A

As the cartilage does not repair properly over many years the cartilaginous layers on the top of the bone ends becomes thinner and thinner until it disappears all together

34
Q

Radiographically what are the signs of osteoarthritis

A

There will be a loss of joint space - because the cartilaginous layer has been reduced

There will be subdural sclerosis - thickening of the bone under the cartilaginous layer as the bone is having more force transmitted to it because of the less cushioning from the cartilage.

35
Q

For osteoarthritis there is no treatment that can alter the disease progression.

What is prosthetic replacement used for?

A

This is used for PAIN rather than a functional problem

Pain is often the limiting factor in this disease.

36
Q

What is a dental aspect of osteoarthritis

A

These patients may have difficulty in accessing care

Their limited mobility may lead them to have difficulties with oral hygiene and accessing the surgery

37
Q

What are the two different patterns of joint development in rheumatoid arthritis

A

Sero-positive RA — rheumatoid factor preset

And

Sero-negative RA- rheumatoid factor NOT present

This significantly changes the pattern of diease

38
Q

Name three symptoms of rheumatoid arthritis

A

Morning stiffness
Joint stiffness
Minor joint swelling
Numbness and tingling

39
Q

What kind of arthritis is rheumatoid arthritis

A

Symmetrical polyarthritis

40
Q

Why are there sometimes systemic symptoms in rheumatoid arthritis

A

Systemic symptoms are due to the fact that rheumatoid is simply a manifestation of a systemic illness which is being targeted at synovial joints with rather internal tissues

41
Q

What pharyngeal joints are affected in osteoarthritis

A

Distal pharyngeal joints

42
Q

What joints in the fingers can exhibit symmetrical synovitis as an early sign of rheumatiod arthritis

A

Metacarpal pharyngeal and proximal interproximal joints

43
Q

If a patient presents to you with swan neck deformity of the fingers, ulnar deviation of metacarpophalangeal joints and bony deformity of the thumb.

What could this possibility be a late sign of

A

Rheumatoid arthritis

44
Q

What is a late presenting symptom of RA which may be seen to the dentist?

A

Sjögren’s syndrome

45
Q

How is RA treated

A

It is holistic management -aiming to improve the quality of the patients life. Aim to keep the patient active for as long as possible.
Aim to maintain current function of the patient

Drug therapy is also used.

46
Q

What are some dental aspects of RA

A

Disability from disease - leads to reduced dexterity and limited access too care
Sjögren’s syndrome - dry eyes and mouth
Drug effects - bleeding (NSAIDS), oral ulceration from methotrexate

47
Q

What is atlanto-occipital instability

A

Ligaments can become weakened and can lead to slipping of structures in the upper neck.
Sudden trauma to the neck more likely the ligaments will rupture and bones will impinge into space intended for spinal cord causing significant damage.

Must be careful in GA as ligaments don’t provide sufficient support of RA patient

48
Q

What is the difference between ankylosing spondylitis and rheumatoid arthritis.

A

Difference from RA is that the primary focus of the disease is the axial skeleton whereas RA affects peripheral tissues more but it can affect the spine

In ankylosing spondylitis fusion of the vertebrae cause issue to turn and twist and bend.

49
Q

What disease is HLA-B27 associated with

A

Ankylosing spondylitis

50
Q

What is kyphosis

A

Loss of vertebral height anteriorly meaning spine will gradually tip forward- this is due to bone fusion

51
Q

What are the dental aspects of someone with ankylosing spondylitis

A

GA can be hazourdous for these patients as they have limited mouth opening and limited neck flexion.

They can be difficult to treat as they cannot lie flat in the chair due to the curvature of their spine and access to the patients mouth can be tricky

52
Q

Why would drugs such as hyrdoxychloroquine and methotrexate ( disease modifying drugs) be used in the treatment of rheumatoid arthritis?

A

This is because it is an immune based diease
These drugs will slow down the immune process and slow the destruction of the joints

53
Q

Why s the gender predomiance in ankylosing spondylitis unusual?

A

Because it is predominantly males that are affected by this disease which is unusual in autoimmune diseases

54
Q

What is the main affect of ankylosing spondylitis?

A

Disabling progressive lack of axial movement

The patients spine does not flex and bend and twist.

This results in low back pain, limited back and neck movement and often there breathing can be compromised

55
Q

What are vasculitic diseases and how are they categorised?

A

They are problems within the blood vessel wall and it is categorised by the size of the verse

56
Q

Generally how are connective tissue diseases managed

A

They are managed dependant on disease activity - mainly through immune suppression - through immune modulating treatment such as hydroxychloroquine and methotrexate.

57
Q

What is the connective tissue disease that has every system involved?

A

Lupus

58
Q

How does systemic lupus erthymatosis present in the mouth

A

Looks similar to lichen planus

59
Q

What diease would butterfly zygomatic rash be seen in?

A

Systemic lupus erythematosis

This is photosensive reaction and it affects this area as it is the most exposed to sunlight

60
Q

What are some dental aspects of SLE?

A

Chronic anemia - leading to an oral ulcerations risk
Lichenoid oral reactions
Bleeding tendency - thrombocytopenia ( check platelet count)

61
Q

Why is GA a risk in patients with SLE

A

Due to their risk of chronic anaemia

62
Q

What is an oral consequence of hydroxychloroquine use

A

It can cause oral pigmentation on the palate

Looks like Black shadow on roof of mouth

63
Q

What is the lupus anticoagulant

A

This is a marker found in the blood of some patients with lupus. It anticoagulates blood in a test tube but not in a patient.

It indicates a ‘subtype’ of lupus patient

64
Q

What is antiphospholipid antibody syndrome characterised by?

A

Recurrent thrombosis.

These patients are anticoagulated with warfarin and tend to deal well

65
Q

Why should anticoagulant treatment never be stooped in anti-phospholipid antibody syndrome

A

Because the thrombosis risk will quickly come back and the patient will be at risk of a fatal Pulmonary embolism

66
Q

What are the three associated ( not causing) antibodies of Sjögren’s syndrome

A

ANA,Ro and La

67
Q

What are the main systems associated with Sjögren’s syndrome

A

Dry eyes and dry mouth

Major involvement of salivary glands and can lead to xerostomia and oral disease

68
Q

What is systemic sclerosis

A

It is when the elsastic tissue of the body is replaced by connective fibourus tissue - excessive collagen deposition

Therefore loosing the ability to be able to stretch and bend tissues.

69
Q

What are some hidden interaction problems that can happen in systemic sclerosis

A

Elastic tissue has been lost internally.
The oesphagous will not be able to allow the food bolus to pass
The gut will not allow the easy peristalsis of food

70
Q

What are some dental aspects of systemic sclerosis?

A

Limited mouth opening - not possible to do most resortative work or extractions
Limited tongue movement
Due to the connective tissue changes there will be widening of the periodontal ligament space and therefor no dental mobility

71
Q

How may giant cell arteritis present to the dentist

A

Headache/facial pain

It affects distribution of ECA up the side of the neck and also inside face and into the central artery of the retina ( blindness)

72
Q

What is poly myalgia rheumatica?

A

It is a diesease of the elderly with affects large blood vessels. It affects mainly around the shoulder hip and joint region

Pain and morning stiffness

73
Q

What kind of blood vessel disease is Kawasaki disease

A

Medium vasculitic disease

74
Q

What would you see clinically in Kawasaki diease and who does it mainly affect?

A

It is mainly a disease of children

Fever and lymphadenopathy
Crusting cracked tongue
Strawberry tongue
Peeling rash on hand and feet

75
Q

What is wegeners granuloatosis and how does it present orally

A

It is an inflammatory condition of the small blood vessels

It can lead to destruction of hard and soft tissues of teh face and oral cavity

76
Q

When is fibromyalgia used as a diagnosis

A

Used by rheumatologists when there are symptoms without any evidence of active diease

Systems would be muslce and joint pain but there is nothin found on examination

Diseases Of Human Systems BDS3 (5 decks)

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