Week 8 - Musculoskeletal Disease Flashcards
general signs and symptoms of joint disease?
- inflammation: hot, red, swollen, painful
- destruction: immobility, deformity, instability
osteoarthritis: what joints affected? associated with?
- hands
- weight bearing joints (hips, knees, ankles)
- genetic
- obesity
- previously damaged joints or bones
osteoarthritis - pathophysiology?
- inflammation in the joint,
- body tries to remodel bone back to original state, but does more damage than benefit
- joint space reduced
osteoarthritis - symptoms?
- pain: worse on movement, relieved by rest
- immobility: worse in morning
- swelling
- deformity
osteoarthritis - how is it diagnosed?
what are the physical landmarks of osteoarthritis?
- clinical: history & examination
- radiology: plain x-rays
- heberden’s and bouchard’s nodes
what is the difference between heberden and bouchard nodes?
- heberden nodes located on distal interphalangeal joints
- bouchard’s nodes are located at distal interphalangeal nodes
osteoarthritis - management?
surgical management?
- lose weight
- physiotherapy
- analgesia
- steroid injection: temporary relief only
- joint replacement. but difficult to repair if goes wrong. dont do on young pts.
osteoarthritis - dental considerations?
- reduced dexterity
- reduced mobility
- associated medication?
- recognition
rheumatoid arthritis - pathophysiology?
- autoimmune disease of unknown aetiology
- joint destruction, due to synovial inflammation
- multi-system disease
rheumatoid arthritis - signs and symptoms?
presentation in acute and in established RA?
on joints: hands and feet initially, later cervical spine, knees, ankles, elbows, shoulders
presentation:
- acute - hot, swollen, tender
- established: deformity, restriction, sub-luxation (veers off to one side)
rheumatoid arthritis - physical deformities in those affected?
- ulnar deviation
- rheumatoid nodule
- Z thumb
- Boutonniere deformity
- swan neck deformity
rheumatoid arthritis - signs and symptoms?
- nervous system: peripheral neuropathy, cervical cord compression - paralysis
- lungs: pulmonary fibrosis
- heart disease
- kidney failure
- eyes: inflammation
- sjogren’s syndrome: dry mouth & eyes
- systemic inflammation: malaise, anaemia
rheumatoid arthritis - methods of diagnosis?
- clinical exam
- blood tests
- radiology
rheumatoid arthritis - medical management?
- analgesia
- disease modifying anti-rheumatic drugs
- corticosteroids: systemic & local (for joint infection)
examples of disease modifying anti-rheumatic drugs?
- sulphasalazine
- penicillamine
- methotrexate
- gold (?)
- hydrochloroquine
- azathioprine
biologicals: adalimumab, infliximab
rheumatoid arthritis - what do the following help with?
- surgery?
- physiotherapy?
- occupational therapy?
- joint replacements
- optimise joint function
- optimise functional abilities
rheumatoid arthritis - dental considerations for making diagnosis?
- TMJ disease?
- sjogren’s syndrome?
- hands?
rheumatoid arthritis - dental considerations for those with established disease?
- reduced manual dexterity
- managing the patient’s sjogren’s syndrome
- c-spine vulenrability: lying back?
- drug side effects
systemic sclerosis/scleroderma - pathophysiology? describe the condition
- autoimmune disease: mainly affecting the skin.
- thickening and bound to underlying structures
- multi-organ disease
systemic sclerosis/scleroderma - physical signs and symptoms?
characteristic appearance?
- sclerodactyly
- telangiectasia
- calcinosis
- beaked nose, fixed expression, radial furrowing of lips, limitation of mouth movements
systemic sclerosis/scleroderma - diagnosis?
- clinical
- blood test: specific auto-antibodies
- management: symptomatic
systemic sclerosis/scleroderma - dental considerations about diagnosis and management?
diagnosis: dentist may suspect from oral findings
mouth care:
- limitation of opening
- atrophic mucosa
- loss of dexterity for OH
- side effects of medication
systemic lupus erythematous -
pathophysiology?
antibodies against?
widespread deposition of?
- autoimmune + multi-system disease
- aetiology unknown
- antibodies against cell nuclear components
- widespread vascular complex deposition
systemic lupus erythematous - signs and symptoms?
- skin: photosensitivity, butterfly rash
- joints: small joint arthritis
- raynaud’s syndrome
what is raynaud’s syndrome?
temporary spasm of blood vessels, blocking the flow of blood
- affected experience pain, numbness, pins and needles
SLE - signs and symptoms?
- nervous system: fits, paralysis, neuropathy, psychosis
- heart: valve disease, endocarditis
- lungs: effusions
- kidney failure
systemic lupus erythematous - diagnosis?
- clinical exam
- test for specific auto-antibodies
systemic lupus erythematous - management?
- pharmacological same as rheumatoid arthritis
- psychological, for practical support
systemic lupus erythematous - dental considerations? (diagnosis & established)
- recognition of orofacial features (butterfly rash) -> diagnosis
diagnosed disease:
- drug side effects
- reduced anxiety
- secondary sjogren’s syndrome
gout - what is it? caused by? more common in?
- accumulation of urate crystals in joints (overnourished + change in metabolism + high protein diet)
- common in older men
gout - acute presentation? precipitated by?
- extremely painful joints
- starvation, alcohol excess, certain foods, operations, drugs
gout - chronic presentation?
tophi deposition (crystalline uric acid at joints)
psoriatic arthritis: psoriasis associated with? can rarely affect where?
- destructive arthritis associated with psoriasis
- can rarely affect TMJs
name 4 bone disorders?
- hyperparathyroidism
- paget’s disease
- osteomalacia
- osteoporosis
hyperparathyroidism: pathophysiology?
- excess thyroid hormone
- usually adenoma in parathyroid gland
hyperparathyroidism - hypercalcaemia associated with what symptoms?
- malaise and depression
- constipation
- abdominal pains
- bone pain
- kidney stones
hyperparathyroidism: untreated hypercalcaemia leads to?
cardiac disrhythmia and death
hyperparathyroidism: diagnosis?
- blood tests
- xrays: look for sub-periosteal erosions
hyperparathyroidism: management?
- parathyroidectomy
- drugs
hyperparathyroidism: dental considerations?
- consider the effect of bone resorption: giant cell lesions, loss of lamina dura around roots
- may have had treatment with bisphosphonates
paget’s disease: pathophysiology?
- abnormal bone remodelling: abundant bone formation.
bone formed is structurally abnormal and prone to fracture
paget’s disease: signs and symptoms?
- most is asymptomatic
- bone deformities
- enlargement of skull
- nerve compression (due to the narrowing of foramina in skull). leading to deafness & spinal cord compression
- fractures
paget’s disease: diagnosis?
- clinical exam: presence of gross deformities, can’t bear weight
- xray characteristics: cotton wool deposits on mandible? hypercementosis, possible ankylosis of teeth
paget’s disease: dental considerations - initial and established diagnosis?
initial:
- recognition of radiological features & dental changes
established diagnosis:
- care with surgery to bone, risk of infection and fracture
- awareness of osteosarcoma risk
- may be treated with bisphosphonates
osteomalacia - deficiency in? due to? what is it called in children?
vitamin D deficiency
- due to lack of sunlight
- poor intake (lack oily fish, eggs, red meat, fortified cereal/margarine)
- malabsorption in intestine
- rickets -> typical deformity
osteomalacia - epidemiology in UK:
- what increases risk?
- who is it also likely to affect?
- darker skin increases risk
- frail/elderly/institutionalized patients
- increased demand (babies, children, pregnancy, breastfeeding)
osteomalacia - symptoms?
- diffuse bony pains
- proximal muscle weakness
osteomalacia - diagnosis and treatment?
diagnosis:
- history
- investigations: x-rays, blood tests. looser’s zone fracture: pseudofracture, area of radiolucency
treatment: replacement, change in diet: Healthy Start
osteoporosis - pathophysiology?
- loss of bone mass
- increased fracture risk
osteoporosis: characteristics in:
- vertebrae?
- hip?
- wrist/neck or humerus?
- pain, loss of height, kyphosis
- disabling, high mortality, moribidity
- less disabling, but marker of underlying osteoporosis
osteoporosis: risk factors?
- white, female, smoking, alcohol
- lack of exercise
- steroids
- thin
- short menstrual history: less abundance of protective hormones
- malabsorption
- hyperthyroidism
- hypogonadism
osteoporosis: diagnosis?
DEXA (dual energy x-ray absorptiometry)
osteoporosis : treatment?
- calcium & vitamin D
- treat risk factors
osteoporosis: dental considerations?
- bisphosphonates: risk of MRONJ
