Diseases of Human Systems - connective tissue disease (lupus)

Question 1

What are the two subgroups of systemic connective tissue disease?

Answer 1

Multisystem vasculitic inflammatory disease

Vascular vasculitic disease

Question 2

Name the types of multi system vasculitic vascular disease.

Answer 2

Systemic lupus erythrematosis

Systemic sclerosis

Sjogrens syndorme

Undifferentiated connective tissue disease

Question 3

Name the types of vascular vasculitic disease.

Answer 3

Giant vessel disease - giant cell temporal arthritis

Medium vessel disease - kawasaki disease

Small vessel disease - weighers granulomatosis

Question 4

How do we manage connective tissue diseases? (5)

Answer 4

Immunosuppressants

Biological medications - cytokine inhibitors and lymphocyte depleting drugs

Analgesics - NSAIDS

Systemic steroids - prednisolone (short time use only)

Immune modulating treatments - hydroxychloroquine

Question 5

Name the types of systemic lupus erythrematosis (subtype of multi system vasculitic inflammatory disease)

Answer 5

Discoid lupus

Antiphospholipid antibody syndrome

Question 6

Who is most at risk of discoid lupus?

Answer 6

Females of child bearing age

Question 7

What autoantibodies are likely to be present in an individual with SLE? (3)

Answer 7

AntiANA
Anti-double stand DNA
Anti-ro

Question 8

What are the signs and symptoms of discoid lupus?

Answer 8

Photosensitive butterfly rash

Raynauds

Arthritis

Renal disease

CVD

lung diseases

Question 9

What are the dental implications of discoid lupus? (5)

Answer 9

High risk when carrying out GA due to the anaemia

Bleeding tendency due to thrombocytopenia

Impaired drug metabolism from the renal disease

Lichenoid reactions

Oral pigmentation

Question 10

How can you determine is a patient has antiphospholipid antibody syndrome (subgroup of lupus erythematosis) ?

Answer 10

There is the presence of the lupus anticoagulant marker in the blood

Question 11

What are the type types of antiphospholipid antibody syndrome? (2)

Answer 11

Primary - no associated inflammatory diseases

Secondary - associated with other inflammatory conditions e.g. rheumatoid arthritis, sjogrens

Question 12

What are the signs and symptoms of patients with APS?

Answer 12

Recurrent thrombosis - venous, arterial, DVT with pulmonary embolism

Question 13

What autoantibodies are present in a patient with sjogrens syndrome (subtype of multi system vasculitic inflammatory disease)?

Answer 13

Anti-ANA
Anti-la
Anti-ro

Question 14

What are the 3 main types of sjogrens and what are they characterised by?

Answer 14

Sicca - dry eyes and mouth only

Primary - features of the disease mainly affect the eyes and mouth

Secondary - associated with another connective tissue disease e.g. SLE

Question 15

What is the guaranteed method of diagnosing patient’s with sjogrens?

Answer 15

Histopathological sample from the labial salivary gland

Question 16

What are the dental implications of sjogrens?

Answer 16

Oral infections

Caries

Functional loss i.e. swallowing

Problems with denture retention

Sialosis

Salivary lymphoma

Question 17

What is systemic sclerosis (subtype of multi system vasculitic inflammatory disease)?

Answer 17

Where elastic tissue is replaced by connective fibrous tissue both internally and externally

Question 18

How can we tell if the systemic sclerosis is localised or generalised?

Answer 18

Local = anticentromere antibodies are present

Generalised = anti scl-70 antibodies are present

Question 19

Who is most at risk of systemic sclerosis?

Answer 19

Females

Question 20

What are the associated complications of symptoms of systemic sclerosis? (3)

Answer 20

Raynauds

Renal failure

Malabsorption via the GIT (slow progression)

Question 21

What are the dental implications of systemic sclerosis? (6)

Answer 21

Limited mouth opening and tongue movement

Patient can also have sjogrens

Dysphagia due to loss of elasticity of the oesophagus

Reflux oesophagitis

Poor drug metabolism

Widening of PDL space

(We must plan treatment for 10 years ahead)

Question 22

Describe what occurs in vasculitic diseases

Answer 22

There is inflammation of the blood vessels which leads to narrowing and infarction of the tissues.

Question 23

In giant cell arthritis (large vessel vasculitic disease) what vessels are involved?

Answer 23

The temporal artery

The external carotid artery and its branches

Question 24

In giant cell arthritis (large vessel vasculitic disease) what will the patient present with?

Answer 24

facial pain

headache

chewing claudication from involvement of the carotid branches

Blindness from occlusion of the central renal artery

Question 25

How do we treat In giant cell arthritis?

Answer 25

Immunosuppressants e.g. prednisolone

Question 26

who is affected by poly myalgia rheumatica (large vessel vasculitic disease)?

Answer 26

Those in their 60/70s

Question 27

What are the sigs and symptoms of poly myalgia rheumatica? (5)

Answer 27

Pain and stiffness of muscles around the shoulder and hip

Restricted range of movement

malaise

weight loss

Fatigue

Question 28

What is the key indicator of polymyalgia rheumatica?

Answer 28

Rapid response to steroids

Question 29

Who is affected by Kawasaki disease (medium vessel vasculitic disease)?

Answer 29

Children

Question 30

How would a child with kawasaki disease present with? (4)

Answer 30

strawberry tongue - crusty and cracked

peeling rash on the hands and feet

fever and lymphadenopathy

Coronary vessel aneurysms

Question 31

What is wegner’s granulomatosis (small vessel vasculitic disease)?

Answer 31

An inflammatory disease that affects small blood vessels and can lead to the destruction of the hard and soft tissues of the face and oral cavity

Question 32

What does wegner’s granulomatosis affect?

Answer 32

Starts in the upper respiratory tract and makes its way down the digestive tract to the lungs, heart and kidney.

The skin is also affected.