Rheumatology Flashcards
What genetic disposition can someone have to RA?
Tissue type HLA DR4
What disease does HLA - DR3 tissue type predispose to?
Scleroderma, Sjorgens, SLE
What auto-antibodies are found in RA?
Rheumatoid factor, anti CPP
What auto-antibodies are found in SLE?
ana and dsDNA ana
What auto-antibodies are found in SLE?
ana and dsDNA ana
Scl 70 antibodies lead to what disease?
Scleroderma
What auto-antibodies are found in Sjorgens disease?
ENA (extractable nuclear antibodies) and rheumatoid factor
RA:
1) Is it more common in males or females?
2) What % of the population are affected?
1) Females
2) 1%
What are the Symptoms and Signs of RA?
Symptoms:
- patient feels pain
- swelling
- stiffness
- malaise (faintness)
- tired & unwell
Signs:
- swollen and red joints
- limitation of movement
- tenderness
- long term deformity
- ulnar drift
- boutonniere deformity
What is the pathlogy of a RA joint?
Synovial membrane thickening
Influx of inflammatory cells
Overgrowth of the synovial sites
Formation of a pannus (granulation tissue activating osteoclasts)
What are the complications of RA?
- Rheumatoid nodules on hands and elbows
- Tendon rupture leading to subluxation
- Normochromic normocytic anaemia (anaemia of chronic disease)
- Nerve entrapment due to wrist damage
- Vasculitis leading to digital gangrene
- Atlanto-axis subluxation
- Eye complications
What are the 4 treatments for RA?
1) Analgesics (NSAIDS)
2) Immunosuppressants (methotrexate)
3) TNF a blockage (inflammatory cytokine block)
4) Anti B cell antibodies (to kill B cells to prevent antibody production from plasma cells)
What is the dental relevance of RA?
1) Poor oral hygiene: patient may need electric toothbrush and more regular appointments
2) Immunosuppressants (makes them more susceptible to infection)
3) Carpal tunnel syndrome (pressure on wrist nerve causing pain)
4) TMJ dysfunction
5) Secondary sjorgen’s syndrome (oral dryness)
E
Explain what primary and secondary Sjogrens syndrome is
Primary = the disease causes dryness of mouth, eyes and vaginal tracks
Secondary = occurs due to other autoimmune conditions such as RA, scleroderma and SLE
Explain what primary and secondary Sjogrens syndrome is
Primary = the disease causes dryness of mouth, eyes and vaginal tracks
Secondary = occurs due to other sautoimmune conditions such as ra, scleroderma and SLE
What are the symptoms of Sjorgen’s syndrome?
- Sicca symptoms (dry mouth, eyes and skin)
- Patients are often tired
- Arthralgia and myalgia
- Shortness of breath
- Swollen enlarged glands
- Smooth lobulated tongue
- Increased risk of lymphoma/maltoma
How is Sjorgens disease investigated?
- Salivary flow test
- Schirmer test (filter paper to lower lid and measure how far the tear progresses)
- Blood tests (looking for RF and ro and la antinuclear antibodies)
- Ultrasound of salivary glands
- Labial gland biopsy
What is the dental relevance of Sjorgens?
- Dry mouth: increased risk of caries, loss of teeth and candida
- Salivary gland enlargement
- Complications of systemic treatment
What are the main patterns for lupus?
1) Discoid lupus = affects skin of mouth
2) Subacute cutaneous = rashes & some signs of systemic disease
3) SLE = skin rash and affects blood vessels
4) Anti-phospholipid antibodies
5) Drug-induced lupus
What are the main symptoms of SLE?
- Vasculitis widespread
- Photosensitivity rash
- Cerebral micro-infarcts = inflammation of blood vessels lead to lack of blood to brain causing headaches, dizziness)
- Lupus nephritis = foamy urine due to increased protein, brown urine in the blood
- Arthralgia = joint pain
What are the main symptoms of SLE?
- Vasculitis widespread
- Photosensitivity rash
- Cerebral micro-infarcts = inflammation of blood vessels lead to lack of blood to brain causing headaches, dizziness)
- Lupus nephritis = foamy urine due to increased protein, brown urine in the blood
- Arthralgia = joint pain
What happens immunologically with SLE?
- Immunological mechanisms polyclonal B cell activation, production of ANA and other antibodies, impaired T cells function, failure to remove immune complexes
What are the 3 main organs affected by vasculitis?
- Skin, brain and kidney
What are the investigations for SLE?
- Blood test
- Raised ESR (inflammatory cell markers)
- CRP (marker of infection)
- Double stranded DNA antibody
- Rheumatoid factor and reduced complement
- Skin biopsy taken
How do we treat SLE?
- Antimalarials (hydoxycloroquione), prednisolone (steroid medication to reduce inflammation), immunosuppressive
What is anti-phospholipid syndrome?
A type of lupus, autoimmune condition leading to increases blood clot risk. leading to thrombosis and pale skin due to lack of blood flow.
What is the relevance of SLE to dentistry?
- Oral ulceration
- Immunosuppressives leading to increases risk of the infection
- Risk of dry mouth
What auto-antibodies are present in Scleroderma?
Scl 70
What do the autoantibodies in scleroderma attack?
Connective tissue under skin and around internal organs and blood vessels
What are the 3 types of scleroderma?
- Diffuse systemic sclerosis (affecting lungs, kidney arterioles, GI tract (less of villi), skin - thickening of all these)
- CREST (limited to skin and mucous membranes)
- Localised to skin (leading to patches of thickened skin scattered over body)
What does scleroderma skin look like under the microscope?
- Loss of cells and structures
- Reduction in blood vessels
- Thickening of collagen throughout the dermis and into the subcutaneous
What does CREST stand for?
- Calcinosis
- Raynauds syndrome
- Oesophageal involvement
- Scleroderma
- Telangiectasia
How are most of these auto-immune conditions treated?
- Analgesics (paracetamol, ibuprofen)
- Glucocorticoids (steroids)
- Immunosupressives (azithioprine, cyclophosphamide)
- Biologics
How is raynauds treated?
- Heated gloves
- Nifedipine (to increase blood flow to finger tips)
- Angiotensin 2 antagonist (maintain vasodilation)
What is the relevance of scleroderma to dentistry?
- Microstomia (small mouth opening due to skin thickening around mouth)
- Widened periodontal membrane (harder to extract teeth)
- Difficulty with oral hygiene
- Immunosuppressive agents - increase risk of infection
What type of condition is osteoarthritis?
Non autoimmune inflammatory condition due to old age affecting large joints such as back, spine and hips
What happens to the joints in osteoarthritis?
- Degenerative disease of cartilage
- Chondrocytes release enzymes which result in degradation of collagen and proteoglycans
What is the difference between primary and secondary osteoarthritis?
Primary = strong family history predisposition
Secondary = due to trauma, avascular necrosis
What do the joints look like in osteoarthritis?
Hard and bony (RA nodules feel soft and spongey)
No soft tissue swelling
No joint deformity deviations such as swan necking
What are the clinical features of osteoarthritis?
Pain Disability Hard and bony swellings Crepitus of joints Muscle wasting around joints due to lack of use Loss of movement
How is osteoarthritis managed?
Analgesics
Physiotherapy
Surgery
What is the relevance of osteoarthritis to dentistry?
- Reduced mobility (unable to get to appointments)
- Reduced manual dexterity
- TMJ disfunctioning
