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Arthritis Flashcards

(45 cards)

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1
Q

what is bone made of

A

a calcified extracellular matrix (ECM)
made of inorganic ions

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2
Q

what are osteoblasts

A

make bone by secreting collagen and calcium salts

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3
Q

what is an osteocyte

A

derived from osteoblasts and sits in a small chamber called a lacuna
it maintains the bone

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4
Q

what are osteoprogenitor cells

A

stem cells in the bone that make new osteoblasts as osteoblasts cant divide into new ones

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5
Q

what are osteoclasts

A

bone resorption
they come from white blood cells
osteoclasts cause proteolytic enzymes and hydrochloric acid to resorb bone

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6
Q

what is bone homeostasis

A

this means that there is no net gain or loss of bone

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7
Q

what are the different types of bone that are laid down

A
  1. first woven bone/immature bone
  2. secondary bone is split into:
    -cortical/lamellar- dense, compact
    -cancellous- spongy- this is below the roots of teeth
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8
Q

how does vitamin D relate to bone formation

A

vitamin D increases calcium and phosphate
vitamin D comes from sunlight or diet e.g. fish
vit D increases the uptake of calcium in the small intestine

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9
Q

what are rickets

A

curved legs from vit D deficiency

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10
Q

what does the parathyroid gland do

A

secretes the parathyroid hormone(PTH) which increases calcium and phosphate in the blood by promoting the kidneys to make vit D and reabsorb calcium into the blood

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11
Q

what are the 2 types of thyroid gland malfunctions

A
  1. primary hyperparathyroidism
  2. secondary hyperparathyroidism
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12
Q

what is primary hyperparathyroidism

A

increased parathyroid hormone levels
often due to an adenoma (benign tumouor)

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13
Q

what does secondary hyperthyroidism do

A

-it causes calcium salts in CKD chronic kidney disease
- it compensates for this the parathyroid gland secretes more parathyroid hormone
- it increases bone resorption
- it leads to renal osteodystrophy (when the kidneys cant maintain calcium and phosphate levels )

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14
Q

how does hyperparathyroidism affect the jaws

A

very rare but can present as central giant cell granuloma
if a pt has this alongside hyperthyroidism it is termed- brown tumour of hyperparathyroidism

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15
Q

what are the stages of bone fractures

A
  1. the early infalmmatory stage
  2. the repair stage
  3. the remodelling stage
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16
Q

what does the early inflammatory phase of bone fractures consist of

A
  1. bleeding occurs at the fracture site and forms a hematoma (blood clot)
    - inflammatory cells and fibroblasts infiltrate the site - TNF (tumour necrosis factor) alpha, IL1,6,10,12, TGF (transforming growth factor)
    - blood vessels go into the hematoma and granulation tissue forms
    -
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17
Q

what does the repair stage of bone fractures consist of

A

-the granulation tissue formed in the inflammatory stage turns to callus
- primary callus turns to secondary callus by endochondral ossification
- osteoids are secreted into the area forming new bone
cartilage calcified due to BMPs, TGF-betas, IGFs, osteocalcin, collagen I, V and XI
- collagen forms in the area forming new bone

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18
Q

what does the remodelling stage of bone fractures consist of

A

redistribute compact and oven bone
orgnised osteoblastic and osteoclastic activity coordinates remodelling

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19
Q

what factors impact bone fracture healing

Study These Flashcards
A

blood supply to the fracture
infections
if the fracture is closed or compound (pierces the skin)
the amount of bone or soft tissue loss
diabetes, radiotherapy, long term corticosteroids use (a steroid anti inflammatory e.g.eczema cream)
use of NSAIDS (IBUPROFEN, aspirin a non steroid anti inflammatory)
smoking
nutritional status
risk of future falls

20
Q

name the bone diseases we need to know about
name the arthritides we need to know about

Study These Flashcards
A

bone diseases-
osteogenesis imperfecta
osteopetrosis
osteopenia and osteoporosis
pagets disease

arthritides-
osteoarthritis
rheumatoid arthritits
ankylosing spondilitis

21
Q

what is osteogenesis imperfecta

Study These Flashcards
A
  • inherited condition where defects of collagen stop normal biomineralisaiton of the bone
  • caused by a type 1 collagen mutation
  • partial or complete absence of collagen
  • :. brittle bones
  • grey/blue discolouration of sclera
    oral features:
    skeletal class 3 pattern
    open bite
    impacted molars
    thin grey brown enamel
    delayed or premature eruption
    dentine can look opalescent - dentinogenesis imperfecta
22
Q

what is osteoPETrosis

Study These Flashcards
A

a genetic condition where osteoclasts dont resorb bone
bone becomes harder and more marble like :. less flexible when stressed
- bone becomes more dense and opaque on radiographs
- more inorganic component of bone :. bone marrows hematopoietic ability (making blood vessels decrease)
delayed tooth eruption can lead to nerve entrapment :. low blood supply

23
Q

what is osteopenia and osteoporisis

Study These Flashcards
A

osteopenia = bone has thinned
the degree of bone thinness using a DEXA scanner
osteopenia= -1 to -2.5
osteoporosis- lower than -2.5
can happen due to a bit D deficiency in youngsters
it Is normal to some degree in adults due to lack of bone protecting oestrogen after menopause and androgen in males

osteoporosis:
affects mainly vertebra, femur and wrists
can happen to people with COPD from coughing
kyphosis can occur - spine bends forward

24
Q

what factors increase bone loss

Study These Flashcards
A

lifestyle- high caffeine, salt, low BMI (anorexia) , alcohol, smoking, immobility

genetic factors- females, family history of osteoporosis

endocrine- early menopause
hormonal changes
amenorrheoea- lack of periods

diseases-
cushings
hyperthyroidism
hyperparathyroidism

drugs -
Glucocorticoids (aka corticosteroids) Thyroxine
Heparin
Diuretics e.g. furosemide
Cytotoxic drugs

25
what race are less likely to have bone loss
afro- caribbeans
26
what drugs prevent bone loss
bisphophonates HRT (hormone replacement therapy)
27
how would you manage osteoporosis
pt lifestyle advise - vit D, low alc/smoking etc, low salt and caffeine pain relief- AVOID NSAIDS, take para or physio physio to stay mobile physical aids- walking sticks meds to prevent further bone loss- vit D bisphosphonates SERMS (selective aoestrogen receptor modules hormone replacement therapy testosterone tx regular med reviews with the GP surgery to fix fractures
28
what is pagets disease
increased resorption from overactive osteoclasts cause a response where osteoblasts become more active and secrete larger and weaker bone can affect 1 bone or several common in pelvis and spine constant dull one pain be careful when giving lengthy dental appointments there can be cranial nerve deficits e.g. conductive deafness if the skulls foramina is in the path of this bone growth pagets can lead to enlarged maxillae or mandible hypercementosis- ossifying of the PDL
29
what are some tx of pagets disease
bisphosphonates analgesia physiotherapy surgery - if joint damage
30
what are the 3 types of arthritides
osteoarthritis rheumatoid arthritis ankylosing spondilitis
31
what is osteoarthritis
a wear and tear degeneration of the joints low level chronic inflammation of the joints effects the large weight bearing joints such as hips and knees but also some small like wrists
32
what are features of primary osteoarthritis
synovial softening, tearing of articular cartilage, development of subchondral bone cysts and development of bony spurs or “osteophytes” in the joint itself due to obesity or lack of physical exercise
33
what are features of secondary osteoarthritis
develops following trauma of some sort, pain and stiffness in bones, fracture of the TMJ can lead to OA in the long term
34
how can Osteoarthritis affect daily life
mobidity rate increases limitations in functioning impacts daily activity impacts quality of life
35
what symptoms does OA usually present with
stiffness after movement of a joint e.g. painful knees after gardening can be swelling of the joints but usually non inflammatory :. no redness or heat involved with long term disease, the swelling can become bony rather than soft tissue resulting in herberdens nodes in dip joints of hands
36
what is the managment of OA
pt management programmes weight loss for obese pts physio and walking aides topical NSAIDS Intra-articular corticosteroid injections for single, painful joints Intramuscular corticosteroid injections for more widespread arthritis surgery
37
what surgical managements can be used to treat OA
1.Arthrocentesis or arthroscopies (direct endoscopic visualisation of the joint space +/- washing out of the joint, removal of osteophytes etc) 2. Osteotomies (removal of bony deformities by surgical means) 3. Arthrodesis (surgical fusion of a painful or unstable joint) 4. Total joint replacements.
38
what is rheumatoid arthritis
this is more suddenly occuring joint problem than OA. occurs more in younger people (under 40) compared to progressively occurring in older people for OA. It is SYMMETRICAL. both right and left sides are affected this is a multi system disease :. doesn't only affect joints but also systemically e.g. neurological, renal,pulmonary (see other card)
39
what are clinical signs of rheumatoid arthritis
“calor, dolor, rubor, tumor, functio laesa”) i.e. acombinationofheat,pain,redness,swellingandlossoffunction early morning stiffness which takes hours to subside
40
what are the systemic effects of rheumatoid arthritis
opthalmological- keratoconjunctivitis sica (dry eyes), sclera etc hematological (sjogens) pulmonary gastrointestinal dermatalogical musculoskeletal
41
what is ankylosing spondilitis
another chronic inflammatory arhtirits specifically affecting neck and spine more prevalent in males genetic predisposition- HLA-B27, HLA-B60, HLA-DR1
42
how does ankylosing spondilitis present
this starts by sacroilitis -inflammation of the sacro iliac joints (where the pelvis meets the spine) this then progresses up the vertebraes until it reaches the neck this gives a slanting forward posture known as the question mark posture
43
how would we manage ankylosing spondilitis in dental setting
pillow, shorter pts, adjust chair for neck support
44
what is the difference between ankylosing spondilitis and OA and rheumatoid arthritis
mainly targets spine over distal or periphral joints (e.g. wrists)
45
what commonly presents with autoimmune diseases such as OA and RA
these can go on to develop other Autoimmune diseases as they target other tissues e.g. inflammatory bowel disease and crohns

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