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Thu test - inflammation Flashcards

1
Q

What suffix does a word end if it indicates Inflammation? Abnormal or diseased condition?

A

Inflammation -itis
Abnormal or diseased condition - -osis

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2
Q

What is pyroptosis?

A

lytic programmed cell death
associated inherently with inflammation

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3
Q

differences of hyperplasia, hypertrophy, metaplasia and dysplasia?

A

Hyperplasia: cells multiplying - greater growth
hyperplasia enlargement (of an organ, etc)
metaplasia - abnormal replacement of one cell type to another
dysplasia - abnormal growth thats not following normal rules

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4
Q

4 basic types of tissues?

A

CT, Epithelial, Muscle, Nerve

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5
Q

What’s the first response of the body to an injury?

A

Inflammation

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6
Q

What does the acute phase of inflammation constitutes in?

A

redness, swelling, heat, pain and altered function. It is self perpetuating

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6
Q

What’s a biological marker of inflammation?

A

CRP - C-reactive Protein. Elevated CRP is a risk factor for several chronic inflammatory diseases.

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7
Q

What makes the inflammation go down from the acute phase?

A

Emergence of Active Specialized Proresolving mediators (SPM) - non-immunosuppressive process

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8
Q

Chronic Inflammatory Diseases 2 signs?

A

Inflammatory Cell Infiltrates
Vascular & Tissue Damage

irreversible vascular & tissue damage

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9
Q

Acute inflammation 2 phases?

A

Acute inflammation is an immunovascular
response to an inflammatory stimulus

vascular phase (movement of plasma fluid, containing important proteins such as fibrin and immunoglobulins (antibodies), into the inflamed tissue) that occurs first, followed by a
cellular phase involving immune cells (more
specifically myeloid granulocytes in the acute
setting).

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10
Q

Which cells are mostly present in Chronic inflammation?

A

mononuclear cells - lymphocytes

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11
Q

particular characteristic of Chronic inflammation?

A

simultaneous destruction and partial healing of the tissue from the inflammatory process

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12
Q

What do inflammasomes do? What are they activated by?

A

Inflammasomes are implicated in the inflammation responses in connective tissues diseases (autoinflammation)

Activated by PAMPs and DAMPs

Inflammasomes → Caspase 1 → inflammatory cytokines (IL-1B and IL-18)

result in productions of CRP

can lead to pyroptosis and autophagy

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13
Q

Chronic inflammation causes more of what molecules to be secreted?

A

more PGE, IL-1B, TNF-a, and other proinflammatory molecules

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14
Q

What can be a good marker of systemic inflammatory burden?

A

CRPs

IL-18

IL-1B

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15
Q

What are the two mediators of acute inflammation which prevent it from becoming a chronic inflammatory disease?

A

Specialized Proresolving mediators (SPM)

appear at the height of inflammation and stop and clean it up

LIPOXINS are derived from Arachidonic acid

RESOLVINS (EPA, DHA) are derived from omega-3 fatty acid

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16
Q

Why diseases of aging have a common link with chronic inflammation?

A

They all are connected to inflammatory cell infiltration and the ongoing inflammatory response in the tissues resulting in vascular and tissue damage.

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17
Q

what are the treatments of inflammatory conditions?

A

COX Inhibitors (ibuprofen, flurbiprofen, Celecoxibs)

TNFa Antagonists (etaneracept, inflixamab)

Steroids (cortisone, prednisone, methyl prednisolone)

Statins (atorvastatin, fluvastatin, pravastatin)

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18
Q

The innate inflammatory process resolves and heals. However, if you lack ______ and _______, then the inflammatory process continues with vasculitis and the adaptive immune response with lymphocytic infiltration, immune complexes, and tissue damage or destruction

A

lipoxins

resolvins

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19
Q

Common connective tissue disease categories and examples?

A

Arthritis- Osteoarthritis, rheumatoid, Gout, juvenile idiopathic arthritis also call juvenile rheumatoid A, Spondyloarthropathies including Reactive Arthritis, Infective Arthritis,

Arthritis plus (only listed ones he covers)

Systemic Connective tissue diseases(with blood vessel inflammation too)- Lupus, Sjogrens

First degree Vasculitis- Large vessel-Temporal, Takayasu, Medium vessel-Kawasaki, small vessels-ANCA

Others- Myofascial pain

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20
Q

What is Rheumatoid Arthritis? Who gets it and prevalence?

A

Systemic, chronic inflammatory autoimmune disease that attacks multiple tissues (joints mostly)

Female:Male :: 5:1
Prevalence of 1%

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21
Q

Where does Rheumatoid A starts and what joints? What triggers it and what marker is present in 80% of the cases?

A
  • Bilateral start in just a few joints but progresses.
  • Wrists, hand, elbows, shoulders, knees and ankles.
  • Unknown trigger, genetic predilection
  • Rheumatoid Factor is a marker in 80% of cases
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22
Q

Describe the joint in rheumatoid arthritis? Other symptoms?

A
  • Synovitis (inflammation of joint)- Chronic inflammation in the synovial fluid leads to synovial hyperplasia and pannus/overgrowth formation.
  • Subcutaneous rheumatoid nodules/Granulomas
  • Pleural/pericardial effusions
  • Vasculitis
  • Swan Neck, Boutonniere deformities
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23
Q

What is Osteoarthrosis (Osteoarthritis)? Prevalence? Associations?

A

´aka Degenerative Joint Disease´WEAR and TEAR´Ignore the “itis” in the name (it is an “..osis”)

Cartilage in the joint gets damaged, bones rub together, bony growths/spurs happen, cartilage fragments in joint fluid

  • Most common disabling joint disease- no sex preference
  • Most over 65
  • Idiopathic etiology, but associated with Obesity and Trauma
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24
Q

Differences between Osteoarthosis and Rheumatoid Arthritis?

A

Osteoarthosis - bone ends rub together

  • Wear and Tear
  • Pain worse at night
  • Morning stiffness gone with moving
  • Large weight bearing joints (and hands)
  • Unilateral
  • Heberden and Bouchard’s nodes

Rheumatoid Arthritis - swollen inflamed synovial fluid

  • Inflammatory
  • Morning Pain and Stiffness often > 1 hr
  • Swan neck and boutonniere deformity of hands
  • Bilateral
  • Pannus formation
  • Rheumatoid nodules
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25
Q

Causes of acute, chronic and viral infectious arthritis?

A

Acute: Staphylococcus aureus, HIB, Gonococcus

Chronic: Lyme disease, Tuberculosis

Viral: Parvo, Hepatitis B & C, Epstein Barr,

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26
Q

Symptoms of infectious arthritis? and Common signature of a deer tick bite?

A

Patient symptoms of fatigue, joint pain, & rashes, associated with inflammation and vasculitis.

Bulls eye rash, deer ticks mostly east coast and midwest but some in the west.

27
Q

Reactive arthritis associations or causes?

A

Associated with GI/GU pathogens (post infection)

Associated with immune response to enteric or genitourinary organisms (Shigella, Salmonella, Yersinia, Chlamydia)

HLA – B27 (blood test – associated with disease onset)

Associated with STD (Reiter’s syndrome)- of the skin!!!

Drug reactions (Steven-Johnson’s syndrome)

(Immune complexes noted in small vessels)

28
Q

Reactive arthritis symptoms?

A

Can’t see, pee or climb a tree!

Conjunctivitis (discharge, erythema, burning, photophobia)

Urethritis (dysuria, urgency, frequency, discharge)

Arthritis (knees, ankles, feet)

29
Q

What is gout?

A

Inflammatory disease from higher levels of uric acid in body which deposit in joints (tophus). The crystals can activate inflammasomes and elicit macrophage rich inflam response.

Can affect kidneys both stones and nephropathy.

Either make too much or don’t excrete enough, assoc. with alcohol and rich foods.

30
Q

Describe the gout crystals?

A

´Negatively birefringent (2 dif color)

needle shaped crystals of´Uric acid

31
Q

What is Lupus erythematosus or Systemic Lupus Erythematosus (SLE)?

A
  • a chronic, inflammatory, variable autoimmune disease of connective tissue that occurs chiefly in women (females in a more mature population. More frequent in Blacks, Hispanics, and Asians)
  • Small vessel disease with immune complexes adding to the inflammation. So, wherever you have small vessels, you may have problem

Discoid lupus = usually affects skin only

32
Q

Symptoms of Lupus?

A
  • typically characterized by fever, skin rash, fatigue, and joint pain and often by disorders of the blood, kidneys, heart, lungs, and brain (such as hemolytic anemia, nephritis, pleurisy, pericarditis, cognitive dysfunction, or meningitis)
  • ´Lupus can appear as different types of conditions. Usually seen as a white enathem in the buccal mucosa (which should be pink). More on a different card)
  • ´A butterfly rash can often be seen over the nose and malar regions. This rash is photosensitive. Alopecia can occur with the rash.´
  • Lesions may not be painful, but a bother for the patient.
  • May have multiple organ involvement rather than just the skin/mucosa. Almost always seen with arthritis and joint pain and fatigue. Serious kidney damage with renal failure can occur.
33
Q

Lupus patient recommendations? Possible “need” before dental treatment?

A
  • Avoid exposure to the sun and use sunscreen regularly.
  • Need to maintain medication usage and have frequent checkups with physician and appropriate specialists.
  • Possible heart valve abnormalities that may require antibiotic premedication prior to dental treatment.
34
Q

More about the oral manifestations of Lupus?

A
  • Red scaly lesions seen on the lower vermilion border (chelitis).
  • Buccal mucosa with red and white areas that may scar and fibrose. ´
  • Periodontal disease along with
  • dry mouth,
  • dysgeusia (altered taste),
  • and secondary yeast infections can occur.
35
Q

What is Sjogren’s Syndrome? Main Symptoms? Common? Co-occurring?

A

´Sjögren’s syndrome is a connective tissue disease (autoimmune disease) of the salivary glands. The immune system cells destroy the exocrine glands of the mouth and the eyes. ´

  • Xerostomia and Sicca (keratoconjunctivitis sicca) are the result. These glands are often swollen and become prominent to inspection.
  • It is the second most common connective tissue disorder (after rheumatoid arthritis) in the USA. ´Usually, this disease is seen in people over 40 (52yo ave.) and women are much more likely to develop it.´
  • ´Sjögren’s is a chronic condition that is termed primary if it is not associated with other autoimmune diseases. (Sicca disease)´´
  • It is called secondary Sjögren’s if there is a co-morbid disease such as rheumatoid arthritis, lupus, or scleroderma.
  • Often another connective tissue disease is present (e.g. rheumatoid arthritis).´
  • Chronic Sjögren’s may result in pneumonia, bronchitis, kidney dysfunction, and hepatitis or cirrhosis of the liver.
  • Patients with Sjögren’s have a 10% chance of developing cancer of the lymph nodes.
  • They may also have peripheral neuropathy of the hands and feet
36
Q

More detailed Sjogrens Symptoms?

A
  • ´The hallmark symptom of Sjögren’s is dryness in the mouth and eyes.
  • Other tissues can also be dry (vagina and bronchioles).
  • And kidneys, skin, lungs, liver, pancreas, and nervous system are sometimes affected.´
  • ´Joint pain, swelling, and stiffness, Swollen salivary glands (esp. parotids),Skin rashes, Vaginal dryness, Persistent dry cough, Prolonged fatigue
  • Orally, the dryness results in root caries, difficulty in speaking and swallowing, yeast infections, and burning tongue. ´
  • Remember, also, that xerostomia can result from many medications used in today’s medical world.
37
Q

Sjogrens diagnosis and treatment?

A

Diagnosis- Done by identifying a combination of symptoms and diseases. Laboratory blood tests for SS-A or SS-B type antibodies, rheumatoid factor (RF), or antinuclear antibodies (ANA).

Histology shows a lymphocytic infiltrate in the salivary and lacrimal glands. This biopsy is often done using minor salivary glands from the lower labial mucosa.

Treatment- is symptomatic and supportive.

  • Topical steroid eye drops may be used.
  • Occlusion of the lacrimal ducts to prevent tears from be washed away can be done.
  • Special glasses that seal to the skin around the eye prevent the more loss of moisture.
  • Treatment for oral dryness involves use of salivary stimulants (sugarless lemon drops, etc.), artificial saliva, pilocarpine medication to stimulate the glands, and mucosal coating agents.
  • Topical fluoride in trays that cover the roots can be worn to help prevent the root caries.
  • Meticulous oral hygiene needs to be taught by dental provider and followed by the patient.
38
Q

Sjogrens summary slide. What? Symptoms? Cause? Diagnosis?

A
  • Sjögren’s syndrome is a long-term autoimmune disease that affects the body’s moisture-producing (lacrimal and salivary) glands, and often seriously affects other organ systems, such as the lungs, kidneys, and nervous system.
  • Primary symptoms are dryness in mouth and eyes, pain and fatigue. Other symptoms can include dry skin, vaginal dryness, a chronic cough, numbness in the arms and legs, muscle and joint pains, and thyroid problems. Those affected are also at an increased risk (15%) of lymphoma.
  • While the exact cause is unclear, it is believed to involve a combination of genetics and an environmental trigger such as exposure to a virus or bacterium. The on-going inflammation that results because of this initiation progressively damages the glands.
  • Diagnosis is by biopsy of moisture-producing glands and blood tests for specific antibodies. On biopsy, there are typically lymphocytes within the glands. We biopsy minor salivary glands in the lips.
39
Q

More about what Vasculitis and Lymphangitis are?

A
  • ´Vasculitis is a group of disorders that destroy blood vessels by inflammation. Both arteries and veins are affected.
  • Lymphangitis (inflammation of lymphatic vessels) is sometimes considered a type of vasculitis. ´
  • Vasculitis is primarily caused by leukocyte migration and resultant damage. Although both occur in vasculitis, inflammation of veins (phlebitis) or arteries (arteritis) on their own are separate entities.
  • Categorize them based on:´SIZE of vessel involved´and Immune-complex vs ANCA (anti-neutrophil cytoplasm antibody)
40
Q

2 Large vessel Vasculitis diseases?

A
  • Giant Cell Arteritis
  • Takayasu’s Arteritis
41
Q

What is Temporal arteritis (Giant Cell Arteritis)?

A
  • Temporal arteritis is specific form of Giant Cell Arteritis. GCA is a systemic vasculitis of medium and large arteries, most commonly the extracranial branches of the carotids. (TEMPORAL, ophthalmic, facial, lingual or occipital)
  • Temporal Arteritis is the most common form of GCA.
  • Elderly patients -Seen in women more than men, after age 50 (average age is 72 yrs).
  • Patients present to you with TMJ pain and complaints.
    Mononuclear cell infiltrate of T cells and macrophages which penetrate the walls of the arteries and cause a narrowing of the vascular lumen.
42
Q

Symptoms of Temporal Arteritis?

A

Occlusion of the artery causes-

  • Jaw pain and discomfort/muscle pain in the muscles of mastication
  • Headache/Cranial Pain
  • Scalp Tenderness
  • Visual Impairment/Blindness
  • Tenderness along artery
  • Excessive sweating, fever, malaise, anorexia,
  • Transient ischemic attacks (TIAs)(short term strokes),
  • and Stroke
43
Q

Treatment of Temporal Arteritis? Why is it important to treat?

A

Treatment consists of glucocorticoid therapy (prednisone 60mg per day). And adjunctive therapy with low dose aspirin (to reduce ischemic events).

Important to treat to prevent blindness

44
Q

What is Takayasu’s Arteritis?

A
  • A large artery disease
  • aka Pulseless Disease
  • YOUNG ASIAN WOMEN
  • Granulomas in aortic arch and branches (obliterates pulse)
  • Non-specific symptoms: fever, night sweats etc.
45
Q

2 medium size vessel diseases and the basics about them?

A
  • Polyarteritis nodosa

Immune complex disease (associated with Hepatitis B)´

Affects kidneys, coronary arteries, joints, GI system

  • Kawasaki Disease´Infants and Kids

Fever, mucositis, cervical lymphadenopathy

Can cause coronary artery vasculitis and coronary aneurysms.

Treat with IV-immune globulins and aspirin

46
Q

Polyarteritis nodosa What? Symptoms? Associated with? Who?

A
  • Nodular swellings in medium arteries (looks like beads on a string on in imaging w/ contrast) that cause a restriction in blood flow.
  • Palpable rash
  • Assoc with chronic HBV (immune complexes)
  • Males >females
47
Q

Kawasaki Symptoms?

A
  • Fever for 5 days,
  • rash and photosensitivity
  • conjunctivitis
  • lymphadenopathy- cervical
  • fissured lips/ mucositis,
  • strawberry tongue
  • periungual (fingernails and toes) desquamation
  • Swelling and erythema and palms and soles

Recognize and refer!

Treat within the first 10 days to prevent cardiac aneurysms

48
Q

Kawasaki Treatment?

A

Need to treat to prevent cardiac aneurysms within the first 10 days

  • IV immunoglobulins
  • Aspirin (low dose)
  • if not responding to above, then steroids
49
Q

Small vessel diseases he talks a little more about?

A

Anca diseases

50
Q

2 types of ANCA (Anti-neutrophil cytoplasm antibody)
diseases?

A
  • P-ANCA
    Peri-nuclear-ANCA
    Antigen is myeloperoxidase (neutrophil enzyme)
  • C-ANCA
    Cytoplasmic-ANCA
    Antigen is Proteinase 3 (neutrophil enzyme)

Do NOT form immune-complexes

51
Q

What is Granulomatosis with Polyangiitis (Wegener’s Granulomatosis)?

A
  • Necrotizing granulomatous vasculitis (small vessel)
  • Respiratory tract (sinuses and lungs) and Kidneys (& Oral tissues)
  • Associated with C-ANCA
  • Steroid treatment and possibly, cyclophosphamide

Remember the case presentation of soft gum tissue of the woman

52
Q

Common thread of connective tissue diseases and what do they progress to?

A
  • Inflammation that becomes chronic and then results in tissue changes, vasculitis, and lymphocytic infiltration.
  • They will progress to tissue or organ dysfunction.
  • Management of these diseases require modulation or reduction of the inflammatory components.
53
Q

TMJ structure? And function?

A

The TMJ consists of a condylar process that sits in the condylar fossa with the meniscus and capsule in between

Two joint functions – it rotates and it slides. It has four main muscles of mastication that move it in three different spatial directions, the lateral pterygoid attaches to both the condyle and the meniscus.

Lots of force that also pushes the condyle into or against the fossa (and the meniscus).
Patients complain of jaw dysfunction when these forces operate outside of this normal function.
Under normal function, the jaw opens and slides forward as the condyle rotates on the meniscus and the whole capsule (meniscus and condylar head) slides down the articular eminence.

This is a coordinated movement of the muscles of mastication and should allow the person to open fully without pain.

54
Q

TMJ dysfunction?

A

When these forces operate outside of this normal function.

  • Clicking sounds noted by the patient. This is usually a reciprocal click as the condyle moves forward and pushes on the posterior part of the meniscus and then clicks into place then opens fully. It also clicks when the patient closes (often at full interdigitation).
  • Arthritis is usually seen in a more mature population, but the TMJ can exhibit rapidly progressive juvenile arthrosis (Cheerleader’s disease).
  • The condyle will tend to flatten out and osteophytes will be seen extending from the anterior surface (which looks like a birds beak on X-ray).
55
Q

2 categories of TMJ problems?

A

´either intracapsular or extracapsular

56
Q

TMD versus MPD?

A
  • Temporomandibular dysfunction (TMD) is a general term that adequately describes either type of joint problem. (as opposed to TMJ which just refers to the joint)
  • Myofascial pain dysfunction (MPD) can describe the muscle pain and extracapsular problems with the TMJ (and of the H&N muscles).
57
Q

Other muscles that refer pain to the TMJ?

A
  • Neck muscles (esp. the trapezius) can refer pain into the area of the joint and the masticatory muscles.
  • This referred pain is often caused by postural habits and positioning. (e.g. head forward posture).
  • So, when treating the jaw (and jaw joint), one needs to manage the muscles of the head and neck (fibromyalgia – to be discussed soon).
58
Q

What is Crepitus?

A
  • Crepitus is the crunchy grinding sound you hear or feel as the joint moves. It is caused by roughness to the surface of the meniscus (think of wrinkles) or erosion of the articular surface of the condyle or the eminence.
  • Crepitus is usually associated with osteoarthritis.
    It can be rated as light, moderate, or severe. Pain is not always correlated with the amount of crepitus detected.
  • Severe crepitus can limit joint function (when painful).

Crepitus is different than clicking which is the movement of the condyle and the meniscus. You can have both crepitus and clicking sounds in the joint during function.

59
Q

Other conditions that affect the jaw?

A
  • The TMJ is subject to arthritic conditions, i.e. osteoarthritis, rheumatoid arthritis, infective arthritis, psoriatic and gouty arthritis.
  • The muscles of mastication are subject to autoimmune conditions also (fibromyalgia, scleroderma) and to muscle contraction problems (fatigue and oxygen deprivation).
60
Q

Treatment of TMJ disorders?

A
  • Arthritis in the jaw joints is usually treated with NSAID’s and other arthritis medicines.
  • Dental treatment for arthritis of the jaw joint is the same as for DJD (osteoarthritis) in other parts of the body. These are:
  • Conservative treatments to reduce the muscle load on the joints and to maintain range of motion. (flat plane splints, physical therapy, massage, muscle relaxants, behavioral counseling, etc.)
61
Q

What is Fibromyalgia?

A

Fibromyalgia is a widespread chronic diffuse (muscle) pain accompanied by fatigue, sleep disturbance, and neuropathies.

  • FM is the most common cause of chronic pain in the USA, up to 4% of the population (primarily women).
  • Up to 25% of FM patients have co-morbid diseases (Lupus, Sjögren’s, rheumatoid arthritis, etc.)
62
Q

What is myofascial pain syndrome?

A
  • Myofascial pain syndrome (associated with TMJ) is more regional (about the head and neck and face) but can be considered as part of the fibromyalgia spectrum.
  • Also described as dull, aching pain which is worse with jaw function.
  • MFP can vary in intensity and location depending on which muscles are involved. (muscles of neck or muscles of mastication).

Fibromyalgia is usually a stable and consistent pain seen in the lower body (back, hips, etc.)

63
Q

Treatment of myofascial pain dysfunction?

A

Treatment for MFP is similar to that for fibromyalgia

  • Anxiolytic drugs (benzodiazepines, tricyclic antidepressants)
  • Anticonvulsant drugs (gabapentin, topiramate)
  • Selective Serotonin Reuptake Inhibitors (SSRI’s) (e.g. fluoxetine)
  • NSAID’s and muscle relaxants
  • Physical therapy, massage, flat plane splints
64
Q

His theory on what disease results from?

A

´As you have seen, our oral structures and tissues are subject to many conditions that can cause difficulty in function. You remember the fifth sign of inflammation - Loss of Function.

´Disease results when the ability of the tissues to adapt are exceeded by trauma, misuse or overuse, and changes due to inflammation. Dentists are the one health professional that works to prevent these diseases and knows how to manage them as they arise in your patient population.

65
Q

What is most oral cavity pain from? And how should we treat it?

A

Most pain associated with the oral cavity (TMJ pain, dental pain, gum pain, etc.) is from an inflammatory cause.

  • Simple, conservative and symptomatic treatments (muscle therapies, flat plane splints, etc.) will alleviate the pain of TMJ and headache pains.
  • Most oral pains can or should be treated with symptomatic treatments and NSAIDs, as needed.
  • Opioid medications should be avoided for treating common oral pain.

I&D (19 decks)

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