Rheumatology - Rheumatoid Arthritis Flashcards
What is rheumatoid arthritis initially
a disease of the joint synovium with gradual inflammatory joint destruction
What are the different patterns of joint involvement
sero-positive RA (rheumatoid factor present)
seronegative RA (rheumatoid factor NOT present)
What are the symptoms of RA
slow onset - initially hands and feed, proximal spread and can potentially effect all synovial structures
symmetrical poly arthritis
occasionally has an onset with systemic symptoms such as fever, weight loss, anaemia etc
What are the early signs fo RA
symmetrical synovitis of MCP joints
symmetrical synovitis of PIP joints
symmetrical synovitis of wrist joints
What are late signs of RA
ulnar deviation of fingers at MCP joints hyperextension of PIP joints 'swan-neck' deformity Z deformity of thumb subluxation of the wrist loss of abduction and external rotation of shoulders flexion of elbow and knees deformity of the feet and ankles
What is ‘z’ deformity of the thump
hyper flexion of MCP and hyperextension of IP joint
What are the extra-articular features of RA due to
due to systemic vasculitis (inflammation of blood vessels)
present in 75% of patient
What is the name of psoriasis seen in some patients with RA
give much more aggressive forms of RA and in younger patients psoriatic arthritis
What is the eye involvement seen with RA
scleritis and episcleritis
dry eyes, sjrogens syndrome can be associated with RA
What is the subcutaneous nodules involvement with RA
can see changes in the skin with pressure points
What are the extra auricular features seen in RA
psoriasis eye involvement subcutaneous nodules amyloidosis pulmonary inflammation neurological
What are the investigations for RA
radiographs
blood
What are we looking for int radiographs for RA
erosions, loss of joint space, deformity
joint destruction and secondary osteoarthritis
What are we looking for in the blood
normochomic
normocytic anaemia
What is tx of RA
aim to improve QoL
combination of physiotherapy occupational therapy drug therapy surgery
What is the aim of physiotherapy for RA
keep px active for as long as possible
active and passive exercises
What are the reasons for the active and passive exercises
to maintain muscle activity
to improve joint stability
to maintain joint position
What is the function of occupational therapy
maximizing the residual function
providing aids to independent living
assessment and alteration of home
What are the 4 groups of drug therapy used for RA
analgesics
NSAIDs
disease modifying drugs
steroids
What are the analgesics given for RA
paracetamol, cocodamol
What are the NSAIDs given for RA often combined with
anti PUD agents
What are the disease modifying drugs that are used for RA
hydroxychloroquine
methotrexate
What is the drug therapy given for moderate and severe cases
immune modulators
steroids
What are the steroids used for most cases in drug therapy for RA
intra articular - injected into joint space
What immune modulators are used for severe RA
azathioprine
mycophenolate
biologics
What are the steroids used for drug therapy
oral prednisolone
What are the surgeries done for RA
excision of inflamed tissue
joint replacement
joint fusion
osteotomy
What are the dental aspects of RA
disability from disease sjogrens syndrome joint replacements drug effects chronic anaemia - ga
How does disability of the disease relate to dentistry
reduced dexterity
access to care
What are the drug effects that are relevant to dentistry
bleeding infection risk oral lichenoid reactions oral ulceration oral pigmentation
What is seronegative spondyloarthritides
ankylosing spondylitis (spinal joint arthritis)
renters disease
arthritis of IBD
What is the features of SAs
association with HLA-B27
infection likely as a precipitant
often asymmetrical peripheral arthritis
ocular and mucocutaneous manifestations
What are differences between ankylosing spondylitis and RA
AS more common in men
more common in young
What is the ankylosing spondylitis effect
disabling progressive lack of axial movement
symmetrical other joint involvement e.g hips
What are the result of ankylosing spondylitis
low back pain
limited back and neck movement - turning spine restricted
limited check expansion - breathing compromised
cervical spine tipped forward (kyphosis) - movements restricted
What is the treatment for ankylosing spondylitis
generally same as RA
analgesia (NSAIDS) physiotherapy occupational therapy DMDs immune modulators surgery where appropriate
What are dental aspects for AS
GA hazard
TMJ involvement possible but rare except in psoriatic arthritis
What is GA hazardous for AS
limited mouth opening
limited neck flexion
