Rheumatology I Flashcards
What are autoimmune diseases?
Immune system recognition failure or malfunctions
What occurs during an autoimmune disease?
Antibodies and T cells produced and directed against self
What may initiate autoimmune disease? (5)
- Defect in immunological tolerance
- Presence of sequestrated antigen
- Infection e.g. viruses
- Drugs e.g. methyldopa
- Chemicals
Give 2 common risk factors associated with autoimmune disease
- Being Female
- Positive family history
Give 4 examples of non-organ specific autoimmune diseases
- Rheumatoid arthritis
- Systemic lupus erythematosus (SLE)
- Sjögren’s syndrome
- Systemic sclerosis
Give 4 examples of organ specific autoimmune diseases
- Pernicious anaemia
- Hashimoto’s thyroiditis
- Myasthenia gravis
- Diabetes Mellitus
What is another name for non-organ specific autoimmune diseases?
Connective tissue conditions
What occurs to ESR, CPR and Serum protein levels in autoimmune diseases?
They all raise
How are non-organ specific autoimmune diseases detected?
Non-specific antibodies found in serum and various tissues
Rheumatology is a branch of medicine concerned with the investigation, diagnosis and management of what? (3)
- Joint disorders
- Bone diseases
- Muscles and soft tissues diseases
What are the 5 main types of rheumatological diseases
- Inflammatory arthritis
- Connective tissue disease
- Metabolic bone disorders
- Musculoskeletal disorders
- Degeneratory arthritis
What is Rheumatoid Arthritis?
Chronic multisystem autoimmune disease characterised by autoantibody directed against IgG
What is the peak onset of Rheumatoid Arthritis?
Peak age of onset 35 – 50 years
What genotype is more susceptible to Rheumatoid Arthritis?
HLA-DR4 genotype
What affect can smoking have on Rheumatoid Arthritis?
Triggers and maintains joint inflammation
What are some systemic features of Rheumatoid Arthritis? (6)
- Early morning stiffness of affected joints
- Generalised afternoon fatigue
- Malaise
- Anorexia
- Generalised weakness
- Occasionally low-grade fever
Why are joints of patients with Rheumatoid Arthritis often held in flexion?
To minimise pain
What are flexion contractures?
Give 3 examples of these?
- Fixed deformities resulting from long periods of rheumatoid arthritis
- Ulnar deviation of the fingers
- Swan-neck deformities
- Boutonnière deformities
What are some pulmonary manifestations of Rheumatoid Arthritis? (3)
- Pulmonary fibrosis
- Pleurisy
- Pleural effusion
What are some cardiovascular manifestations of Rheumatoid Arthritis? (4)
- Pericarditis
- Myocarditis
- Vasculitis
- Valvulitis
What are some cervical spine manifestations of Rheumatoid Arthritis? (2)
- Atlantoaxial subluxation
- Spinal cord compression
What are some eye manifestations of Rheumatoid Arthritis? (3)
- Scleritis
- Uveitis
- Keratoconjuctivitis sicca
What 5 special investigations can be carried out to investigate Rheumatoid Arthritis?
- Serology
- Inflammatory markers
- Xrays
- Full blood count
- Protein electrophoresis
What findings will you get from serology if someone has rheumatoid arthritis? (2)
- Rheumatoid factor (RF) positive
- ACPA positive
What findings will you get from inflammatory markers if someone has rheumatoid arthritis? (2)
Elevated CRP & ESR
What findings will you get from Xrays if someone has rheumatoid arthritis? (4)
- Soft tissue swelling
- Narrowing of joint space
- Joint erosion
- Periarticular osteoporosis
What findings will you get from a full blood count if someone has rheumatoid arthritis? (3)
- Normocytic anaemia
- Neutropenia
- Thrombocytosis
What finding will you get from Protein electrophoresis if someone has rheumatoid arthritis?
Hypergamma-globulinaemia
How can you manage rheumatoid arthritis? (2)
- Manage symptoms with DMARDs
- Surgery for severely damaged joints
What is the dental relevance of rheumatoid arthritis? (5)
- Cant suddenly move the neck as could be spinal problems
- Restricted manual decertify so bad OH
- Drugs taken can have oral side effects
- TMJ could have reduced motility
- Sjogren syndrome could cause other diseases such as xerostomia or candidiasis
What is the most affected group for Ankylosing Spondylitis?
Males aged 20-40
Which ethnics groups are most affected by Ankylosing Spondylitis? (2)
- Blacks
- Caucasians
What are some early clinical presentations of Ankylosing Spondylitis? (3)
- Nocturnal low back pain
- Morning stiffness
- Para-spinal muscle spasms
What are some late stage clinical presentations of Ankylosing Spondylitis? (3)
- Kyphosis
- Loss of lumbar lordosis
- Fixed bent-forward posturing
What is an eye manifestation of Ankylosing Spondylitis?
Recurrent acute uveitis
What are some cardiovascular manifestation of Ankylosing Spondylitis? (4)
- Aortic insufficiency
- Angina
- Pericarditis
- Cardiac conduction abnormalities
What are some pulmonary manifestation of Ankylosing Spondylitis? (2)
- Compromised pulmonary function
- Limited chest expansion
What are some tendon manifestation of Ankylosing Spondylitis? (2)
- Achilles tendinitis
- Patellar tendinitis
What are some investigations that can be carried out to determine Ankylosing Spondylitis? (3)
- Spine Xray
- Full blood count
- Inflammatory markers
What are the treatment goals of both rheumatoid arthritis and ankylosing spondylitis? (3)
- Pain relief
- Maintaining joint range of motion
- Preventing end-organ damage
What is Psoriatic Arthritis?
Arthritis occurring in about 20% of patients with psoriasis
