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BDS3 BAMS > Rheumatology - Gout & Osteoarthritis > Flashcards

Rheumatology - Gout & Osteoarthritis Flashcards

1
Q

What are symptoms of joint disease? (3)

A
  • Pain
  • Immobility stiffness
  • Loss of function
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2
Q

What can redness around a joint suggest?

A
  • Can suggest infection due to inflammation and a high vascular content
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3
Q

What are signs of joint disease? (5)

A
  • swelling (fluctuant, bony, synovial)
  • Deformity
  • Redness
  • Crepitus
  • Loss of function
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4
Q

Are all signs of joint disease there all the time?

A
  • These can come and go and not all of them will be present at any one time
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5
Q

What is a fluctuant swelling?

A
  • If there is a lot of fluid/effusion into the joint
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6
Q

What is a bony swelling?

A

If the inflammatory process has taken place over many years and cause osteophytes to form at the edge of the joint

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7
Q

What is a synovial swelling?

A
  • In particular this can happen in RA

- The synovium is the membrane between the bone ends which makes the fluid content of the joints

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8
Q

How can deformity be a sign of joint disease?

A
  • When there is a destructive process underway which leads to changes in the joint surfaces or joint contact and this will cause the bones to meet differently, changing the external appearance of the joint
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9
Q

What is creptius?

A
  • This is the noise made by the bone ends moving and is usually associated with loss of normal cartilaginous covering of the bone ends
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10
Q

What special investigations can we take for joint disease? (3)

A
  • Radiography
  • Blood
  • Arthroscopy & biopsy
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11
Q

What types of radiograph might we take for investigating bone disease? (3)

A
  • Plain
  • MRI
  • Arthrography
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12
Q

What does an MRI look at in relation to joint disease?

A
  • looks at the soft tissues around the inside of the joint
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13
Q

What is Arthrography?

A
  • Where a radiopaque die is injected into the joint to outline the articular surfaces and the joint capsule
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14
Q

When doing blood tests for testing for joint disease what are we looking for? (4)

A
  • C-reactive protein (CRP) (inflammatory markers)
  • Rheumatoid factors (RF) - marker for autoimmune disease
  • Extractable nuclear antigens (ENA’s)
  • Anti DS-DNA, anti-nuclear antibody
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15
Q

What does an arthroscopy allow the clinician to do?

A
  • Allows them to look inside the joint
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16
Q

What does a biopsy allow the clinician to see?

A
  • If any joint swelling or joint tissue can be useful
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17
Q

What is an acute monoarthropathy?

A
  • acute arthritis of a single joint (only one joint in the body is affected)
18
Q

What are common causes of acute monoarthropathies? (2)

A
  • Infection (septic arthritis)

- Crystal arthropathy (gout)

19
Q

What can an acute arthropathy be an initial stage of?

A
  • Can be initial stage of polyarthritis and polyarthropathy but this is just the first joint to be involved
20
Q

If a patient has an acute monoarthropathy but has no history of trauma what would we expect the cause to be?

A
  • Gout
21
Q

What is gout?

A
  • Uric acid crystal deposition in joints - these crystals cause irritation to the joint surface which causes swelling and inflammation
  • Significant pain from reactive inflammation
22
Q

What is hyperuricaemia?

A

High levels of uric acid

23
Q

What can hyperuricaemia/gout be caused by? (4)

A
  • Drug induces
  • Genetic predisposition
  • Nucleic acid breakdown
  • tumour related
24
Q

Which type of drug can induce hyperuricaemia?

A
  • thiazide diuretics
25
Q

Nucelic acid breakdown can cause hyperuricaemia. How is this caused?

A
  • Chemotherapy cancer treatment
  • Uric acid is one of the metabolic products from nucleic acids
  • So after chemotherapy the cancer treatments will have killed a lot of cancer cells and the nucleic acids from these cells will be reprocessed producing a large surge in uric acid in the blood
  • The effects of this can be reduced to some extent by pre hydrating the person so that their renal flow and urine output are maximised before the chemotherapy starts and therefore as the nucleic acids are broken down they are washed away so that the plasma levels do not rise too far
26
Q

Which type of tumour can lead to hyperuricaemia?

A
  • myeloma
27
Q

Which 2 things can enhance the causes of hyperuricaemia?

A
  • Obesity and alcohol
28
Q

Which part of the population is gout less common in?

A
  • Less common in women until menopause then it equalises
29
Q

What are common symptoms of gout? (5)

A
  • Acute inflammation of a SINGLE joint
  • Usually great toe
  • Usually a precipitating event (trauma, surgery, illness, diet/alcohol excess)
  • Rapid onset - hours (and very painful)
  • NSAID’s
30
Q

What medication can we use to treat gout?

A
  • NSAID’s to treat inflammation but this will still take some time to settle
31
Q

What are the dental aspects of gout? (2)

A
  • Avoid aspirin (interferes with uric acid removal)

- Drug treatments (used to lower uric acid levels in the blood) may give oral ulceration (allopurinol)

32
Q

In what % of the population is osteoarthritis symptomatic?

A
  • 10%

- 60% show degenerative changes on radiograph

33
Q

What is osteoarthritis?

A
  • A degenerative joint disease

- Predominantly affects weight baring joints/joint damage - predominantly hips and knees

34
Q

Is osteoarthritis ‘wear and tear’?

A
  • No
  • Cartilage repair dysfunction
  • As the cartilage does not repair properly over many years the cartilaginous layer on top of the bone ends becomes thinner until it completely disappears altogether leading to the symptoms and signs that are seen
35
Q

What are symptoms of osteoarthritis? (3)

A
  • Pain (improves with rest and worse with activity)
  • Brief morning sickness
  • Slowly progressive over years
36
Q

What are signs of osteoarthritis? (3)

A

Radiographs:

  • Loss of joint space & subchondral sclerosis
  • Osteophyte lipping at joint edge (common finding of osteoarthritis)
  • Radiographs MAY show asymptomatic changes - is OA the cause of symptoms
  • Joint swelling and deformity
37
Q

What is subchondral sclerosis?

A
  • This is the thickening of the bone under the cartilaginous layer as the bone is having more of the force transmitted directly to it and less cushioning from the cartilage
38
Q

What are the possible treatments of osteoarthritis? (4)

A
  • Nothing alters disease progression

Pain is improved by:

  • Increasing muscle strength around the joint
  • Weight loss
  • Walking aids
  • Role of NSAID’s to help with the pain
  • Prosthetic replacement for PAIN (for pain and not for function as often the pain is the limiting factor that is preventing walking in the first place)
39
Q

Briefly explain joint replacement?

A
  • These joints are premanufactured to a certain shape
  • The bone is cut using a template to match the shape of the prosthesis which is then cemented into place
  • It is not necessary to do a total joint replacement - sometimes only one compartment of the joint needs replaced because there is only arthritic damage to tone area
40
Q

What are the dental aspects of osteoarthritis? (4)

A
  • TMJ can be involved (symptoms are RARE - this is often seen on radiographs but rarely causes any symptomatic changes but the loss of joint space, flattening of the condylar head and subchondral sclerosis are all common changes)
  • Difficulty in accessing care (limited mobility)
  • Chronic NSAID use (oral ulceration possible and bleeding tendency if it is an antiplatelet)
  • Joint replacements (need to consider AB prophylaxis but usually not needed because the joints are not at risk from bacteraemia from oral region)

BDS3 BAMS (11 decks)

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