Diseases of Human Systems - CTD: Rheumatoid arthritis

Question 1

What are the two types of rheumatoid arthritis?

Answer 1

Seropositive - RH factor present

Seronegative - RH factor absent

Question 2

What is rheumatoid arthritis?

Answer 2

Symmetrical polyarthritis of synovial joints
(synovial = connective tissue membrane in joint capsules)

with inflammatory joint destruction.

multisystem disease

Question 3

What are the early symptoms of seropositive rheumatoid arthritis?

Answer 3

Symmetrical synovitis of the joints in the hands and feet

Morning stiffness

swelling of joints

Fever

Decreased range of motion

numbness and tingling

Question 4

What are the late symptoms of seropositive rheumatoid arthritis? (7)

Answer 4

Swan neck deformities of the fingers at the PIP joints from Loss of directional integrity of bone

Z boutonniere deformity of the thumb

Ulnar deviation of the fingers at the metacarpophalangeal joints

others:
Loss of;
subluxation of wrist 
external rotation of shoulders 
flexion of elbows and knees 
deformity of feet and ankles

Question 5

What investigations would indicate seropositive rheumatoid arthritis?

Answer 5

Radiographs

Blood tests - normochomic normocytic anaemia

Question 6

What do we look for on a radiograph when diagnosing seropositive rheumatoid arthritis? (3)

Answer 6

Erosions & joint destruction

Loss of joint space

secondary osteoarthritis

Question 7

How do we treat seropositive rheumatoid arthritis? (4)

Answer 7

treat by improving quality of life only;

Physiotherapy
- Used to delay onset of debilitating disease

Occupational therapy

• Improve residual function
• Aid independent living

Drugs - analgesics, NSAIDS in combination with anti-PUDs, disease modifying drugs and steroids

Surgery - removing inflamed joint tissue, joint replacement

Question 8

What are the dental implications of seropositive RA? (8)

Answer 8

Disability:
Reduced manual dexterity - cannot grip toothbrush
Poor mobility and access

Dry mouth from sjogrens

Drug Effects:
Increased bleeding from NSAIDS
Increased infection from steroids
ulcers

Atlanto-occipital instability

GA hazard from the chronic anaemia

Question 9

List the types of seronegative spondyloarthritidies? (3)

Answer 9

Ankylosing spondylitis - Arthritis of the spinal joint
- can lead to fusion of the facets between the vertebrate.

Reiters syndrome - ocular and mucocutaneous manifestations

Arthritis of IBD

Question 10

What gene is associated with all of the spondyloarthritidies?

Answer 10

HLA-B27

Question 11

What effects can be seen from seronegative RA - ankylosing spondylitis? (4)

Answer 11

loss of axial movement;
Lower back pain

Limited movement of back and neck

Limited chest expansion

kyphosis of the cervical spine

Question 12

what gender is more prone to seronegative RA?

Answer 12

males

Question 13

how do we treat seronegative ankylosing spondylitis? (4)

Answer 13

same as seropositive

Physiotherapy
- Used to delay onset of debilitating disease

Occupational therapy

• Improve residual function
• Aid independent living

Drugs - analgesics, NSAIDS in combination with anti-PUDs, disease modifying drugs and steroids

Surgery - removing inflamed joint tissue, joint replacement

Question 14

what are the dental implications of seronegative ankylosing spondylitis? (4)

Answer 14

Problems with lying back and flat in chair since spine fused = difficult access

Poor mouth opening

(Rarely) TMJ involvement

GA hazards from the limited mouth opening and neck flexion