rheumatology

Question 1

what are seronegative spondyloarthridities/ spondyloarthropathies

Answer 1

range of joint disorders that all test negative for rheumatoid factor
includes ankylosing spondylitis psoriatic arthritis

Question 2

effects of seronegative spondyloarthropathies

Answer 2

lack of axial movement
lower back pain
limited chest expansion

Question 3

ankylosing spondylitis

Answer 3

seronegative spondyloarthropathy that over time can cause vertebrae in spine to fuse

Question 4

dental impacts of ankylosing spondylitis

Answer 4

difficult access - cant lie back in chair
may have limited mouth opening and neck flexion (turning)

Question 5

arthritis vs arthrosis vs arthralgia

Answer 5

arthritis = joint inflammation
arthrosis = non inflammatory joint disease
arthralgia = joint pain

Question 6

what is calcium required for in the body and where is it stored

Answer 6

stored in bone and is required for normal function of nerves and muscles

Question 7

function of parathyroid hormone in relation to calcium

Answer 7

parathyroid hormone triggers release of calcium from bone if serum calcium levels drop i.e bone destruction
parathyroid hormone maintains serum calcium levels

Question 8

function of vitamin D in relation to calcium

Answer 8

vitamin D helps the body effectively absorb calcium
can be produced in body using sunlight or taken in through diet

Question 9

osteomalacia

Answer 9

bone disease
normal osteoid matrix secreted however inadequate calcification/mineralisation so bones are soft and pliable
in children known as rickets

Question 10

osteoporosis

Answer 10

bone disease
correct mineralisation and matrix however less of it - decreased bone mass

Question 11

hypocalcaemia

Answer 11

low serum calcium levels
results in muscle weakness and nerve issues

Question 12

osteomalacia treatment

Answer 12

correct the cause of vit D/ calcium deficiency
malnutrition , control GI disease, more sunlight exposure

Question 13

who gets osteoporosis

Answer 13

inevitable age related change
however some things bring it earlier
females, genetics, smoking, inactivity, drugs, poor diet

(bone mass loss is accelerated during menopause)

Question 14

effects of osteoporosis

Answer 14

height loss
increased bone fracture risk
scoliosis
nerve root compression - back pain
kyphosis - tipping forward of upper body due to vertebrae collapsing

Question 15

preventative measures for osteoporosis

Answer 15

build maximum peak bone mass in 20s/30s - plenty exercise and high calcium/ vit D intake
reduce bone mass loss rate as age by good diet and regular exercise

Question 16

discuss hormone replacement therapy for osteoporosis

Answer 16

oestrogen only
reduces osteoporosis risk however increases risk of breast cancer, endometrial cancer and deep vein thrombosis
bone marrow density benefits are lost 5 years after HRT stopped

Question 17

bisphosphonates

Answer 17

poison osteoclasts and reduce their numbers e.g alendronate, ibandronate
used in individuals with early onset osteoporosis or high genetic predisposition
benefit of bisphosphonates lost immediately if the drug is discontinued
these need to be considered if doing an XLA

Question 18

what investigations are done to check for joint diseases

Answer 18

radiographs
MRI
Arthrography - dye injected into joints
Blood tests to check for markers - rheumatoid factor, C reactive protein
Biopsy

Question 19

rheumatoid factor

Answer 19

blood marker for autoimmune diseases

Question 20

C reactive protein

Answer 20

inflammatory blood marker

Question 21

crystal arthropathy

Answer 21

joint disorders caused by deposition of uric acid crystals in joints resulting in painful reactive inflammation
e.g gout

Question 22

what is gout

Answer 22

Gout is a crystal arthropathy joint disorder caused by uric acid crystal deposition in joints causing painful reactive inflammation
usually affects big toe however can be any single joint
usually a precipitating event e.g trauma, alcohol excess, surgery

Question 23

causes of gout

Answer 23

high uric acid levels in blood (hyperuricaemia) which can be caused by
obesity
alcohol
genetics
certain tumours
some medications

Question 24

dental aspects of gout

Answer 24

avoid prescribing aspirin as this can interfere with uric acid removal
some medications may cause oral ulceration

Question 25

what gene is assosciated with ankylosing spondylitis

Answer 25

HLA-B27