rheumatology Flashcards
what are seronegative spondyloarthridities/ spondyloarthropathies
range of joint disorders that all test negative for rheumatoid factor
includes ankylosing spondylitis psoriatic arthritis
effects of seronegative spondyloarthropathies
lack of axial movement
lower back pain
limited chest expansion
ankylosing spondylitis
seronegative spondyloarthropathy that over time can cause vertebrae in spine to fuse
dental impacts of ankylosing spondylitis
difficult access - cant lie back in chair
may have limited mouth opening and neck flexion (turning)
arthritis vs arthrosis vs arthralgia
arthritis = joint inflammation
arthrosis = non inflammatory joint disease
arthralgia = joint pain
what is calcium required for in the body and where is it stored
stored in bone and is required for normal function of nerves and muscles
function of parathyroid hormone in relation to calcium
parathyroid hormone triggers release of calcium from bone if serum calcium levels drop i.e bone destruction
parathyroid hormone maintains serum calcium levels
function of vitamin D in relation to calcium
vitamin D helps the body effectively absorb calcium
can be produced in body using sunlight or taken in through diet
osteomalacia
bone disease
normal osteoid matrix secreted however inadequate calcification/mineralisation so bones are soft and pliable
in children known as rickets
osteoporosis
bone disease
correct mineralisation and matrix however less of it - decreased bone mass
hypocalcaemia
low serum calcium levels
results in muscle weakness and nerve issues
osteomalacia treatment
correct the cause of vit D/ calcium deficiency
malnutrition , control GI disease, more sunlight exposure
who gets osteoporosis
inevitable age related change
however some things bring it earlier
females, genetics, smoking, inactivity, drugs, poor diet
(bone mass loss is accelerated during menopause)
effects of osteoporosis
height loss
increased bone fracture risk
scoliosis
nerve root compression - back pain
kyphosis - tipping forward of upper body due to vertebrae collapsing
preventative measures for osteoporosis
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
discuss hormone replacement therapy for osteoporosis
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
bisphosphonates
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
what investigations are done to check for joint diseases
radiographs
MRI
Arthrography - dye injected into joints
Blood tests to check for markers - rheumatoid factor, C reactive protein
Biopsy
rheumatoid factor
blood marker for autoimmune diseases
C reactive protein
inflammatory blood marker
crystal arthropathy
joint disorders caused by deposition of uric acid crystals in joints resulting in painful reactive inflammation
e.g gout
what is gout
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
causes of gout
high uric acid levels in blood (hyperuricaemia) which can be caused by
obesity
alcohol
genetics
certain tumours
some medications
dental aspects of gout
avoid prescribing aspirin as this can interfere with uric acid removal
some medications may cause oral ulceration
