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CHHD > Rheumatology I > Flashcards

Rheumatology I Flashcards

1
Q

What are autoimmune diseases

A

When the immune system recognition fails or malfunctions. Antibodies and T cells produced and directed against self

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2
Q

What may initiate autoimmune disease

A
  • Defect in immunological tolerance
  • Presence of sequestrated antigen
  • Infection e.g. viruses
  • Drugs e.g. methyldopa
  • Chemicals
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3
Q

What are the common features of autoimmune disease

A
  • Female pre-disposition
  • Positive family history
  • Response to immunosuppressant treatment
  • Patients often liable to develop other autoimmune diseases
  • Raised ESR and CRP, serum protein levels also usually raised
  • Hypergammaglobulinaemia
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4
Q

What are the general features of non-organ specific autoimmune disease

A
  • Also called ‘connective tissue’ conditions
  • Clinical manifestation is diverse i.e. multi-systemic
  • Unified by the detection of non-specific autoantibodies in serum and various tissues
  • Disease producing process are caused by hypersensitivity reactions to see components
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5
Q

What is rheumatology

A

Branch of medicine concerned with the investigation, diagnosis and management of:

  • Joint disorders
  • Bone diseases
  • Muscles and soft tissues diseases
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6
Q

Gives some examples of rheumatological diseases

A
  • Rheumatoid arthritis
  • Ankylosing spondylitis
  • SLE
  • Sjogren’s syndrome
  • Osteoporosis
  • Carpal tunnel syndrome
  • Paget’s disease
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7
Q

What is rheumatoid arthritis

A

Chronic multisystem autoimmune disease characterised by autoantibody (RF, an IgM) directed against IgG
Immune complex formation leading to complement activation, synovial inflammation and destructive joint disease

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8
Q

What joints tend to be involved with rheumatoid arthritis

A
  • Wrists
  • Index and middle metacarpophalangeal joints
  • Proximal interphalangeal joints
  • Metatarsophalangeal joints
  • Shoulders
  • Elbows
  • Hips
  • Knees
  • Ankles
  • Upper cervical spine
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9
Q

What are the clinical features of acute rheumatoid arthritis

A 
- Insidious onset
Systemic features:
- Early morning stiffness of affected joints
- Generalised afternoon fatigue
- Malaise
- Anorexia 
- Generalised weakness
- Occasionally low-grade fever
Joint Features:
- Pain
- Swelling and stiffness
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10
Q

What are the clinical features of chronic rheumatoid arthritis

A
  • Joints are often held in flexion to minimise pain
  • Joint capsular distension
  • Flexion contractures - fixed deformities
  • Ulnar deviation of the fingers
  • Swan-neck deformities
  • Boutonniere deformities
  • Stretching of the joint capsule - joint instability
  • Wrist synovitis compressing the median curve- carpal tunnel syndrome
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11
Q

What are the pulmonary clinical features of rheumatoid arthritis

A
  • Pulmonary fibrosis
  • Pleurisy
  • Pleural effusion
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12
Q

What are the cardiovascular clinical features of rheumatoid arthritis

A
  • Pericarditis
  • Myocarditis
  • Vasculitis
  • Valvulitis
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13
Q

What are the cervical spine clinical features of rheumatoid arthritis

A
  • Atlantoaxial subluxation

- Spinal cord compression

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14
Q

What are the lymphatic clinical features of rheumatoid arthritis

A

Lymphadenopathy

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15
Q

What are the renal clinical features of rheumatoid arthritis

A

Secondary amyloidosis

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16
Q

What are the ocular clinical features of rheumatoid arthritis

A
  • Scleritis
  • Uveitis
  • Keratoconjunctivitis Wicca
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17
Q

What are the serological findings of rheumatoid arthritis

A
  • RF +ve in ~70%

- Anti-CCP/ACPA +ve ~95%

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18
Q

What inflammatory markers are associated with rheumatoid arthritis

A

Elevated CRP and ESR

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19
Q

What would the X-ray of hands and wrists show in a patient with rheumatoid arthritis

A
  • Soft tissue swelling
  • Narrowing of joint space
  • Joint erosion, subluxation and deformity
  • Periarticular osteoporosis
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20
Q

What are the FBC findings in a patient with rheumatoid arthritis

A
  • Normocytic anaemia
  • Neutropenia
  • Thrombocytosis
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21
Q

What are the protein electrophoresis findings with rheumatoid arthritis

A

Hypergamma-globulinaemia

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22
Q

What management options can be used to relieve symptoms of rheumatoid arthritis

A
  • Acetaminophen
  • NSAIDs
  • Intra-articular corticosteroids
  • DMARDs - relieve symptoms and slow joint damage
  • Surgery
  • Supportive measures: smoking cessation, rest, splints and appliances, nutrition and exercise
23
Q

Name some DMARDs that can be used to treat rheumatoid arthritis

A

Non-biologic agents - Methotrexate, gold, antimalarials, sulfasalazine, penicillamine, azathioprine, cyclosporin, cyclophosphamide

Biologic agents - adalimumab, certolizumab, etanercept, infliximab, rituximab

24
Q

What is the dental relevance of rheumatoid arthritis

A
  • Medication - ulcerations, lichenoid reactions, thrombocytopenia and neutropenia
  • Sjogren syndrome - xerostemia, candidiasis, caries, sialodenitis
  • Atalanto-axial joint subluxation = sudden extension of neck from headrest adjustment, during endotracheal intubation
25
Q

What does ankylosing spondylitis affect

A

The axial skeleton (spine) and large peripheral joints

26
Q

Describe the early stage clinical presentation of ankylosing spondylitis

A
  • Nocturnal low back pain and morning stiffness relieved by activity
  • Para-spinal muscle spasm
  • Worsening pain and tenderness in the sacroiliac region due to sacroiliitis
27
Q

Describe the late stage clinical presentation of ankylosing spondylitis

A
  • Hip joint involvement - severe hip arthritis
  • Kyphosis
  • Loss of lumbar lordosis
  • Fixed bent-forward posturing
28
Q

What are the ocular clinical presentations of ankylosing spondylitis

A

Recurrent acute uveitis

29
Q

What are the cardiovascular clinical presentations of ankylosing spondylitis

A
  • Aortic insufficiency
  • Aortitis
  • Angina
  • Pericarditis
  • Cardiac conduction abnormalities
30
Q

What are the pulmonary clinical presentations of ankylosing spondylitis

A
  • Compromised pulmonary function

- Limited chest expansion

31
Q

What are the clinical presentations of the tendons in patients with ankylosing spondylitis

A

Achilles and patellar tendinitis

32
Q

What are the early findings of spine x-ray imaging in patients with ankylosing spondylitis

A

Symmetric changes:

  • Subchondral erosions - sclerosis or later narrowing and eventually fusions in the sacroiliac joints
  • Upper lumbar vertebral squaring with sclerosis at the corners
  • Spotty ligamentous calcification
33
Q

What are the late findings of spine x-ray imaging in patients with ankylosing spondylitis

A
  • Bamboo spine appearance, resulting from prominent syndesmophytes
  • Diffuse paraspinal ligamentous calcification
  • Osteoporosis
34
Q

Besides X rays what special investigations are used for patients with ankylosing spondylitis

A

FBC

Inflammatory markets/acute phase reactants

35
Q

What are the management options and treatment goals of ankylosing spondylitis

A 
- Management similar to rheumatoid arthritis
Treatment goals:
- Pain relief
- Maintaining joint range of motion
- Preventing end-organ damage
36
Q

What are the dental relevances of ankylosing spondylitis

A
  • Problems with giving GA due to restricted mouth opening, respiratory and possibly cardiac complications
  • TMJ involvement in 10%
  • Patient may have difficulty placing neck on headrest
37
Q

What is affected by psoriatic arthritis

A
  • Distal interphalangeal joints of fingers and toes
  • Can also affect spine and sacroiliac joints
  • Resembles RA but usually milder
  • Psoriasis of the skins/nails may precede or follow joint involvement
38
Q

What is needed for psoriatic arthritis diagnosis

A
  • Usually based on clinical findings
  • ESR is often normal
  • Radiograph may help but routine blood tests are unhelpful
39
Q

What are the management options of psoriatic arthritis

A
  • Treat with drug therapy similar to RA and sometimes with phototherapy
  • Analgesia, NSAIDs and intra-articular corticosteroids can be used
  • Anti TNF drugs control both arthritis and the skin lesions
40
Q

What are the dental relevances of psoriatic arthritis

A
  • May rarely affect TMJ
  • Oral mucosa psoriasis lesions are occasionally seen on histology
  • Methotrexate or anti-TNF agents may cause oral ulcers
41
Q

What is reactive arthritis (reiter’s syndrome)

A
  • A triad of arthritis, urethritis, conjunctivitis
42
Q

What may reactive arthritis follow on from and who is usually affected by it

A
  • Typically affects males
  • May follow gut infections like salmonella or sexually transmitted infections
  • Reactive arthritis usually begins 1-2 weeks after infection
43
Q

What are the management options of reiter’s syndrome (reactive arthritis)

A
  • No specific diagnostic test
  • WCC and ESR raised
  • Antibiotics, NSAIDs, steroids injections physiotherapy
44
Q

What are the dental relevances of reactive arthritis

A
  • Migratory glossitis-like pattern lesion on the oral mucosa

- Oral ulcerations may also be frequent

45
Q

What is sjogren’s syndrome characterised by

A

Autoimmune exocrinopathy characterised by lymphocyte infiltration and progressive acinar destruction into the salivary and lacrimal glands

46
Q

What are the 2 classifications of sjogren’s syndrome and the symptoms associated with each

A 
Primary (sicca syndrome):
- Dry mouth
- Dry eyes (keratoconjunctivitis sicca)
Secondary:
- Dry mouth and eye
- Connective tissue disease
47
Q

Who is most commonly affected by sjogren’s syndrome

A

Male:Female = 1:9

48
Q

What is the dental relevance of sjogren’s syndrome

A
  • Xerostemia: candidiasis, caries, denture issues, disturbed taste, ascending sialodenitis
  • Early onset lymphocytic infiltration: swelling of parotid gland
  • Late onset lymphocytic infiltration: indicative of progression to lymphoma
  • Secondary sjogren syndrome: anaemia
49
Q

How is sjogren’s syndrome managed

A
  • Dry mouth: sipping sugar free drinks, salivary substitutes
  • Oral candidiasis: Nystatin rinses/amphocterin mix
  • Ascending parotitis: antibiotic therapy
  • Preventative dental care
50
Q

What are the ocular clinical features of sjogren’s syndrome

A

Keratoconjunctivitis Sicca

51
Q

What are the oral clinical features of sjogren’s syndrome

A
  • Xerostemia
  • Lobulated tongue
  • Infections - sialadenitis, caries, candidiasis
52
Q

What serological findings indicate Sjogren’s syndrome

A
  • Antinuclear antibodies
  • Anti-Ro (SS-A) or La (SS-B)
  • Increased ESR
  • Hypergammaglobulinaemia (RF)
53
Q

What oral findings indicate Sjogren’s syndrome

A
  • Sialometry (<1.5ml/15min without stimulation)
  • Estimation of parotid salivary flow rate (>1ml/min without stimulation)
  • Labial gland biopsy
54
Q

What ocular findings indicate Sjogren’s syndrome

A

Schimer test (Impaired lacrimation)

CHHD (27 decks)

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