Rheumatology

Question 1

Give 4 examples of auto-immune diseases which have significant dental indications.

Answer 1

Rheumatoid Arthritis
Sjogren’s Syndrome
Systemic Lupus Erythematosus
Scleroderma

Question 2

What is the auto-antibody linked to Rheumatoid Arthritis?

Answer 2

Rheumatoid Factor

Question 3

What is the auto-antibody linked to SLE?

Answer 3

ANA-dsDNA

Question 4

What is the auto-antibody linked to Scleroderma?

Answer 4

Scl70

Question 5

What is the auto-antibody linked to Sjogren’s Syndrome?

Answer 5

Ro, La, Rheumatoid factor

Question 6

Which antibody and what area of the antibody is most commonly implicated in rheumatic diseases?

Answer 6

Fractional Crystalline region of IgG antibody

Question 7

What is the female to male ratio distribution of rheumatoid arthritis sufferers?

Answer 7

2.5F:1M

Question 8

Name 3 symptoms of rheumatoid arthritis.

Answer 8

Pain, morning stiffness, malaise

Question 9

Name 3 signs of rheumatoid arthritis.

Answer 9

Swelling
Warmth
Tenderness
Limited movement

Question 10

What is a characteristic sign of relatively advance rheumatoid arthritis?

Answer 10

Ulnar deviation

Question 11

What is the histopathology of rheumatoid arthritis?

Answer 11

Granulation tissue formation at the edge of the synovial lining within a joint resulting in the activation of the complement system and the release of enzymes that destroy cartilaginous tissue

Question 12

Name 3 complication of Rheumatoid Arthritis.

Answer 12

▪ Rheumatoid nodules
▪ Tendon rupture
▪ Normochromic, normocytic anaemia
▪ Nerve entrapment e.g. median nerve
▪ Vasculitis
▪ Atlanto-axial subluxation

Question 13

Name 3 treatments specific to rheumatoid arthritis.

Answer 13

Analgesia - NSAID’s
DMARD’s - Methotrexate
TNFa e.g. infliximab
Anti-B cell MoAb’s - Rituximab

Question 14

Name 3 issues rheumatoid arthritis presents in a dental setting.

Answer 14

Atlanto-axis subluxation - under GA

Sjogren’s Syndrome

Hand deformity - oral hygiene

TMJ dysfunction

Question 15

What is the primary symptom of Sjogren’s Syndrome?

Answer 15

Dryness - mucus-producing regions

Question 16

What is the histopathological cause of Sjogren’s Syndrome?

Answer 16

Autoimmune Sialadenitis (immune response to salivary glands)

Question 17

What is a common presentation of glands with a patient who has Sjogren’s syndrome?

Answer 17

Swelling - salivary/lacrimal glands

Question 18

Name 3 investigations used to diagnose Sjogren’s Syndrome.

Excluding FBC

Answer 18

Unstimulated Whole Salivary Flow - Normal > 0.2ml/min
Stimulated flow >0.4ml/min

Schirmer Test:
Paper strip placed in the pouch of the lower eyelid - checked to see if eye can self-moisten after 5 mins- <4mm wetting = severe dryness
15mm or more = normal

Auto-antibody test:
Testing for Ro and LA (anti-nuclear auto-antibodies)

Question 19

Describe SLE

Answer 19

An auto-immune disease which results in degeneration of multiple systems of the body including skin, muscles, bones, kidneys etc.

Question 20

What investigations are carried out to diagnose SLE?

Answer 20

ANA