Rheumatology - Gout and Osteoarthritis

Question 1

What are the symptoms of joint disease

Answer 1

pain
immobility stiffness
loss of function

Question 2

What are the signs of joint disease

Answer 2

swelling
deformity
redness
crepitus
loss of function

Question 3

Describe the swelling

Answer 3

it fluctuates

can be bony or synovial

Question 4

What is the synovial enlargement due to

Answer 4

common in rheumatoid arthritis

enlarged due to excess fluid

Question 5

What is the bony swelling due to

Answer 5

inflammatory process is present over several years causing osteophytes to form at the end of the joints

Question 6

Why does deformity occur

Answer 6

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

Question 7

What is the redness due to

Answer 7

inflammation leading to a high vascular content

Question 8

What is crepitus

Answer 8

noise made by bone ends moving and is due to the loss of the normal cartilaginous covering on bone ends

Question 9

What are the required investigations

Answer 9

radiography
blood
arthroscopy & biopsy

Question 10

What radiographs do we require

Answer 10

plain
MRI
arthrography

Question 11

What are the blood tests required

Answer 11

c reactive protein
rheumatoid factors
extractable nuclear antigens
anti DS-DNA, anti-nuclear antibody

Question 12

What are the crystal arthropathies

Answer 12

joint disorders caused by deposits of crystals in joints and the soft tissues around them

gout, acute monoarthropathies

Question 13

What is acute monoarthropathies

Answer 13

acute arthritis of a single joint

can be initial stage of polyarthritis

Question 14

What are common causes of acute monoarthropathies

Answer 14

infection - septic arthritis

crystal arthropathies - gout

Question 15

What can acute monoarthropathies be the initial stage of

Answer 15

poly arthritis

Question 16

What is gout

Answer 16

uric acid crystal deposition

Question 17

Why does gout result in pain

Answer 17

from reactive inflammation

Question 18

What is typically seen in the blood in gout

Answer 18

high uric acid levels (hyperuricaemia)

Question 19

What are cause gout

Answer 19

can be drug induced (thiazide diuretics)
genetic predisposition
nucleic acid breakdown e.g in chemotherapy
tumor related myeloma
obesity and alcohol enhance

Question 20

What are symptoms of gout

Answer 20

acute inflammation of a single joint
usually great toe
there is usually a precipitating event such as trauma surgery etc
has a rapid onset

Question 21

What is used to tx gout

Answer 21

NSAIDs

Question 22

What are the dental aspects to consider of gout

Answer 22

avoid aspirin
interferes with uric acid removal
drug tx may give oral ulceration (allopurinol)

Question 23

What is osteoarthritis

Answer 23

degenerative joint disease
weight bearing joints / joint damage - predominantly in the hips and knees
NOT wear and tear - it is a cartilage repair dysfunction

Question 24

What are symptoms of osteoarthritis

Answer 24

pain - improves with rest and worsens with activity
brief morning stiffness
slowly progressive over years

Question 25

What are the signs of osteoarthritis on the radiographs

Answer 25

loss of joint space and subchondral sclerosis

osteophyte lipping at joint edge

Question 26

What are the signs of osteoarthritis clinically

Answer 26

joint swelling and deformity

Question 27

What is the tx for OA

Answer 27

pain improved by
increasing muscle strength around the joint
weight loss
walking aids

role of NSAIDs for pain

prosthetic replacement for PAIN (not functional)

Question 28

What are dental aspects of OA

Answer 28

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