Rheumatology - Gout and Osteoarthritis Flashcards
What are the symptoms of joint disease
pain
immobility stiffness
loss of function
What are the signs of joint disease
swelling deformity redness crepitus loss of function
Describe the swelling
it fluctuates
can be bony or synovial
What is the synovial enlargement due to
common in rheumatoid arthritis
enlarged due to excess fluid
What is the bony swelling due to
inflammatory process is present over several years causing osteophytes to form at the end of the joints
Why does deformity occur
when there’s a destructive process underway leading to change in joint surfaces and this causes bones to meet differently changing external appearance of the joint
What is the redness due to
inflammation leading to a high vascular content
What is crepitus
noise made by bone ends moving and is due to the loss of the normal cartilaginous covering on bone ends
What are the required investigations
radiography
blood
arthroscopy & biopsy
What radiographs do we require
plain
MRI
arthrography
What are the blood tests required
c reactive protein
rheumatoid factors
extractable nuclear antigens
anti DS-DNA, anti-nuclear antibody
What are the crystal arthropathies
joint disorders caused by deposits of crystals in joints and the soft tissues around them
gout, acute monoarthropathies
What is acute monoarthropathies
acute arthritis of a single joint
can be initial stage of polyarthritis
What are common causes of acute monoarthropathies
infection - septic arthritis
crystal arthropathies - gout
What can acute monoarthropathies be the initial stage of
poly arthritis
What is gout
uric acid crystal deposition
Why does gout result in pain
from reactive inflammation
What is typically seen in the blood in gout
high uric acid levels (hyperuricaemia)
What are cause gout
can be drug induced (thiazide diuretics)
genetic predisposition
nucleic acid breakdown e.g in chemotherapy
tumor related myeloma
obesity and alcohol enhance
What are symptoms of gout
acute inflammation of a single joint
usually great toe
there is usually a precipitating event such as trauma surgery etc
has a rapid onset
What is used to tx gout
NSAIDs
What are the dental aspects to consider of gout
avoid aspirin
interferes with uric acid removal
drug tx may give oral ulceration (allopurinol)
What is osteoarthritis
degenerative joint disease
weight bearing joints / joint damage - predominantly in the hips and knees
NOT wear and tear - it is a cartilage repair dysfunction
What are symptoms of osteoarthritis
pain - improves with rest and worsens with activity
brief morning stiffness
slowly progressive over years
What are the signs of osteoarthritis on the radiographs
loss of joint space and subchondral sclerosis
osteophyte lipping at joint edge
What are the signs of osteoarthritis clinically
joint swelling and deformity
What is the tx for OA
pain improved by
increasing muscle strength around the joint
weight loss
walking aids
role of NSAIDs for pain
prosthetic replacement for PAIN (not functional)
What are dental aspects of OA
TMJ can be involved
symptoms are rare
difficulty in accessing care
chronic NSAID use - oral ulceration possibly and may cause bleeding tendency
joint replacement don’t usually require AB prophylaxis
