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BDS3 BAMS Diseases of Human Systems > Rheumatology - Rheumatoid Arthritis > Flashcards

Rheumatology - Rheumatoid Arthritis Flashcards

1
Q

What is rheumatoid arthritis initially

A

a disease of the joint synovium with gradual inflammatory joint destruction

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2
Q

What are the different patterns of joint involvement

A

sero-positive RA (rheumatoid factor present)

seronegative RA (rheumatoid factor NOT present)

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3
Q

What are the symptoms of RA

A

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

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4
Q

What are the early signs fo RA

A

symmetrical synovitis of MCP joints
symmetrical synovitis of PIP joints
symmetrical synovitis of wrist joints

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5
Q

What are late signs of RA

A 
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
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6
Q

What is ā€˜zā€™ deformity of the thump

A

hyper flexion of MCP and hyperextension of IP joint

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7
Q

What are the extra-articular features of RA due to

A

due to systemic vasculitis (inflammation of blood vessels)

present in 75% of patient

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8
Q

What is the name of psoriasis seen in some patients with RA

A

give much more aggressive forms of RA and in younger patients psoriatic arthritis

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9
Q

What is the eye involvement seen with RA

A

scleritis and episcleritis

dry eyes, sjrogens syndrome can be associated with RA

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10
Q

What is the subcutaneous nodules involvement with RA

A

can see changes in the skin with pressure points

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11
Q

What are the extra auricular features seen in RA

A 
psoriasis
eye involvement
subcutaneous nodules
amyloidosis 
pulmonary inflammation
neurological
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12
Q

What are the investigations for RA

A

radiographs

blood

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13
Q

What are we looking for int radiographs for RA

A

erosions, loss of joint space, deformity

joint destruction and secondary osteoarthritis

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14
Q

What are we looking for in the blood

A

normochomic

normocytic anaemia

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15
Q

What is tx of RA

A

aim to improve QoL

combination of 
physiotherapy
occupational therapy
drug therapy
surgery
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16
Q

What is the aim of physiotherapy for RA

A

keep px active for as long as possible

active and passive exercises

17
Q

What are the reasons for the active and passive exercises

A

to maintain muscle activity
to improve joint stability
to maintain joint position

18
Q

What is the function of occupational therapy

A

maximizing the residual function
providing aids to independent living
assessment and alteration of home

19
Q

What are the 4 groups of drug therapy used for RA

A

analgesics
NSAIDs
disease modifying drugs
steroids

20
Q

What are the analgesics given for RA

A

paracetamol, cocodamol

21
Q

What are the NSAIDs given for RA often combined with

A

anti PUD agents

22
Q

What are the disease modifying drugs that are used for RA

A

hydroxychloroquine

methotrexate

23
Q

What is the drug therapy given for moderate and severe cases

A

immune modulators

steroids

24
Q

What are the steroids used for most cases in drug therapy for RA

A

intra articular - injected into joint space

25
Q

What immune modulators are used for severe RA

A

azathioprine
mycophenolate
biologics

26
Q

What are the steroids used for drug therapy

A

oral prednisolone

27
Q

What are the surgeries done for RA

A

excision of inflamed tissue
joint replacement
joint fusion
osteotomy

28
Q

What are the dental aspects of RA

A 
disability from disease
sjogrens syndrome
joint replacements
drug effects
chronic anaemia - ga
29
Q

How does disability of the disease relate to dentistry

A

reduced dexterity

access to care

30
Q

What are the drug effects that are relevant to dentistry

A 
bleeding
infection risk
oral lichenoid reactions
oral ulceration
oral pigmentation
31
Q

What is seronegative spondyloarthritides

A

ankylosing spondylitis (spinal joint arthritis)
renters disease
arthritis of IBD

32
Q

What is the features of SAs

A

association with HLA-B27
infection likely as a precipitant
often asymmetrical peripheral arthritis
ocular and mucocutaneous manifestations

33
Q

What are differences between ankylosing spondylitis and RA

A

AS more common in men

more common in young

34
Q

What is the ankylosing spondylitis effect

A

disabling progressive lack of axial movement

symmetrical other joint involvement e.g hips

35
Q

What are the result of ankylosing spondylitis

A

low back pain
limited back and neck movement - turning spine restricted
limited check expansion - breathing compromised
cervical spine tipped forward (kyphosis) - movements restricted

36
Q

What is the treatment for ankylosing spondylitis

A

generally same as RA

analgesia (NSAIDS)
physiotherapy
occupational therapy
DMDs 
immune modulators
surgery where appropriate
37
Q

What are dental aspects for AS

A

GA hazard

TMJ involvement possible but rare except in psoriatic arthritis

38
Q

What is GA hazardous for AS

A

limited mouth opening

limited neck flexion

BDS3 BAMS Diseases of Human Systems (11 decks)

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