Rheumatologic Disorders

Question 1

rheumatic disease

Answer 1

nearly 100 disorders including

• rheumatoid arthritis
• osteoarthritis
• systemic lupus erythematosus
• scleroderma
• Sjogren syndrome
• gout

Question 2

rheumatoid arthritis

Answer 2

autoimmune disease of unknown origin causes microvascular endothelial cell injurry

Question 3

pathophysiology of RA

Answer 3

inflammation of synovium of joints leading to cartilage and subchondral bone destruction

Question 4

complications of RA

Answer 4

new bone/fibrous tissue laid down resulting in loss of mobility

Question 5

RA clinical presentation

Answer 5

• multiple SYMMETRIC joint involvement
• morning joint stiffness >1 hr
• systemic manifestations

Question 6

which areas of the body does RA commonly affect?

Answer 6

• hands
• feet
• knees
• TMJ

Question 7

T/F: men are affected by RA more often than women

Answer 7

false

*women:men 3:1

Question 8

what are some systemic manifestations of RA?

Answer 8

• fatigue
• weakness
• malaise

Question 9

med management of RA

Answer 9

control disease and limit joint damage

Question 10

overall goal of med management of RA

Answer 10

disease remission and regain fxn

Question 11

drugs used to manage RA

Answer 11

• antiinflammatory drugs
• disease-modifying antirheumatic drugs (DMARDs)
• biologics-highly targeted DMARDs

Question 12

which anti-inflammatory drugs are used for long term management of RA?

Answer 12

NSAIDs

Question 13

pts with RA are typically given what first for faster pain relief?

Answer 13

corticosteroids

Question 14

what is used as a last resort to txt RA?

Answer 14

biologics-highly targeted DMARDs

Question 15

why is biologics-highly targeted DMARDs used as a last resort to txt RA?

Answer 15

• a lot of adverse effects
• costly
• has to be injected
• significantly suppress immune system so good for controlling disease but bad for any surgeries

Question 16

what is the end-stage disease of RA?

Answer 16

alloplastic joint replacement

Question 17

dental management of RA pts

Answer 17

immunosuppressive agents can cause bone marrow suppression thus affecting WBCs and platelets

Question 18

is elective or restorative dental care indicated for RA pts?

Answer 18

yes, won’t be a problem unless RA is in TMJ and possibly chair positioning (sore joints)

Question 19

most common form of arthritis?

Answer 19

osteoarthritis

Question 20

osteoarthritis

Answer 20

non-inflammatory degenerative disease that begins in cartilage

Question 21

complications of OA

Answer 21

secondary to cartilage loss, subchondral new bone formation and marginal bony overgrowth

Question 22

is RA or OA are more favorable prognosis?

Answer 22

OA

Question 23

does RA or OA have less serious complications?

Answer 23

OA

Question 24

clinical presentations of OA

Answer 24

• pain localized to one or two joints

- stiffness in the morning or after inactivity that subsides in less than 15 minutes

Question 25

common areas affected by OA

Answer 25

• hips
• knees
• feet
• spine
• hands
• TMJ

Question 26

med management of OA pts

Answer 26

• symptomatic relief
• drug therapy limited to analgesics
• intraarticular steroid injections intermittently to reduce acute pain and inflammation
• possible joint replacement

Question 27

what is the first line of analgesics for OA pts?

Answer 27

acetaminophen

Question 28

dental management of OA pts

Answer 28

pts can have limited, painful opening so have shorter appts (don’t fatigue joint which can cause acute flare up)