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BDS3 Human Systems > Rheumatoid Arthritis > Flashcards

Rheumatoid Arthritis Flashcards

1
Q

What are the 2 different factors of rheumatoid arthritis?

A
  • Sero-positive RA (rheumatoid factor present)
  • sero-negative RA (rheumatoid factor NOT present)
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2
Q

Basic definition of RA?

A

initially a disease of the synovium with gradual inflammatory joint destruction

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3
Q

What is the most common serious joint disease? and what is the most common joint disease in general

A

RA is the most common serious

osteoarthritis is the most common

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4
Q

Who does RA affect mostly and what is the peak age range

A

women

6:1 pre menopause

3:1 post menopause

peaks in 3rd-5th decades ( 20-50 years)

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5
Q

What is the prevalence of RA?

A

1%

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6
Q

Is RA a slow or fast onset? and how does it usually spread

A

slow

starts at hands and feet-> proximal spread

potentially all synovial structures

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7
Q

How can RA be described with regards to its total spead and distribution?

A

symmetrical polyarthritis

(affects joints on both sides of the body equally)

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8
Q

What are the typical symptoms of RA?

A

fatigue
morning stiffness
joint stiffness
joint pain
minor joint swelling
fever
numbness and tingling
decrease in range of motion

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9
Q

What are the systemic symptoms of RA?

A

fever
weight loss
anaemia

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10
Q

What are the 3 early signs of RA?

A
  • symmetrical synovitis of:

MCP joints
PIP joints
wrist joints

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11
Q

What are late signs of RA?

A
  • deviation of fingers at MCP joints
  • hyperextension of PIP joints (swan neck deformity)
  • “Z” deformity of thumb
    hyperflexion of MCP
    hyperextension of IP joint
  • subluxation of the wrist
  • loss of abduction and external rotation of shoulders
  • flexion of elbows and knees
  • deformity of the feet and ankles
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12
Q

What is systemic vasculitis?

A

Inflammation of Blood Vessels

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13
Q

What are the extra - articular features of RA?

A

caused by systemic vasculitis
psoriasis
scleritis and episcleritis
dry eyes, Sjögren’s syndrome
subcutaneous nodules
amyloidosis
pulmonary inflammation
neurological issues

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14
Q

What are the key investigations for patients with suspected RA?

A
  • radiographs:
    look for erosions, loss of joint space and deformity

joint destruction and secondary osteoarthritis

  • blood tests:

normochomic, normocytic anaemia

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15
Q

What is the main treatments for RA?

A
  • hollistic management
  • improve quality of life
  • combinations of physiotherapy, occupational therapy, drug therapy and surgery
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16
Q

How would physiotherapy be carried out for pt with RA?

A
  • keep pt active for as long as possible
  • active and passive exercises:

to maintain muscle activity

to improve joint stability

to maintain joint position

17
Q

How can occupational therapy treat pt with RA?

A
  • maximising the residual function
  • providing aids to independent living
  • assessment and alteration of home
18
Q

What drug therapies can be used to treat pt with RA?

A

-analgesics
(paracetamol, cocodamol
-NSAIDs
(Often combined with anti-PUD agents)
- Disease Modifying Drugs
(hydroxychloroquine, methotrexate,
Less commonly now: sulphasalzine, penacillamine, gold)
- Steroids
( intra-articular )

19
Q

Give example of disease modifying drugs used to treat RA?

A

hydroxychloroquine

methotrexate

20
Q

Give examples of immune modulators used for RA patients?

A

-biologics (TNF inhibitors such as infliximab, adalimumab)

21
Q

example of oral steroids for RA?

A

prednisolone

22
Q

How can surgery be carried out to treat RA?

A
  • excision of inflamed tissue
  • joint replacement
  • joint fusion
  • osteotomy

(pts often have poor medical condition for surgery)

23
Q

What is the prognosis for RA?

A
  • 10% spontaneously remit
  • fluctuating course
  • RF and late onset = worse prognosis
  • 10% severely disabled
24
Q

name some complications of RA with regards to poor prognosis?

A
  • infection
  • PUD
  • DRUGS
25
Q

What are the dental aspects of RA?

A
  • disability leads to reduced dexterity and access to care
  • Sjogren’s syndrome (dry mouth)
  • Joint replacements ( don’t usually require AB prophylaxis)
  • Chronic anaemia affects GA
26
Q

What are the oral manifestations of using NSAIDS?

A

bleeding

27
Q

What are the oral manifestations of using Sulphasalazine?

A

Bleeding

oral lichenoid reactions

28
Q

What are the oral manifestations of using Hydroxychloroquine?

A

oral pigmentation

oral lichenoid reactions

29
Q

What are the oral manifestations of using Methotrexate?

A

oral ulceration

30
Q

What are the oral manifestations of using steroids and azathioprine?

A

infection risk

31
Q

What is atlanto-occipital instability?

A

-supporting ligaments are weakened
- structure can slip more easily
-sudden trauma may can rupture which would allow the dens to impinge on spinal cord causing severe damage

32
Q

what is atlando-occipital instability?

A

-supporting ligaments are weakened
-structure can slip more easily
-sudden trauma may can rupture which would allow the dens to impinge on spinal cord causing severe damage

33
Q

What is seronegative spondyloarthritides

A

-arthritis of IBD

  • can lead to ankylosing spondylitis
  • reiter’s disease
34
Q

What causes SA?

A

association with HLA-B27

  • infection
35
Q

Describe the manifestation of SA?

A
  • symmetrical peripheral arthritis
  • ocular and mucocutaneous manifestations
36
Q

What are the symptoms of ankylosing spondylitis?

A
  • disabling progressive lack of axial movement
  • symetrical involvement of other joints - hips
  • low back pain
  • limited back and neck movement (turning spine restricted)
  • limited chest expansion - breathing compromised
  • cervical spine tipped forward (kyphosis) - restricted movement
37
Q

Treatment for ankylosing spondylitis?

A

generally same as RA

  • analgesia and NSAIDS
  • physio
  • OT
  • DMDs
  • immune modulators
  • surgery for joint replacement
38
Q

Dental effect of Ankylosing spondylitis

A

GA hazardous
- limited mouth opening
- limited neck flexion

TMJ involved: rare except in psoriatic arthritis

BDS3 Human Systems (6 decks)

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