Connective tissue diseases

Question 1

connective tissue diseases - general management

Answer 1

dependent on disease activity
- immune suppression
analgesic NSAIDs for joint/muscle symptoms
immune modulating treatment
- hydroxychloroquine
- methotrexate
- azathioprine
- mycophenolate
- biologic medication - cytokine inhibitors and lymphocyte depleting drugs
systemic steroids - prednisolone

Question 2

Antibodies in autoimmune diseases

Answer 2

Anti-nuclear antibody (ANA)
Anti-double0strand DNA (dsDNA)
Anti-Ro antibody (Ro)
Anti-La antibody (La)
Anti-Centrmere antibody
Anti-Scl-70 antibody
Anti-neutrophil cytoplasmic antibody (ANCA)

Question 3

Circulating immune complexes in Systemic Lupus Erythematosis

Answer 3

• ANA, ds,DNA and Ro

Question 4

Systemic Lupus Erythematosis features

Answer 4

12-64/100,000 population
twins 20-50% concordance
females of child bearing age
photosensitivity common
- butterfly zygomatic rash

Question 5

Systemic lupus Erythematosis - dental aspects

Answer 5

chronic anaemia
- oral ulceration
- GA risk
bleeding tendency
- thrombocytopenia
renal disease
- impaired drug metabolism
drug reactions -photosensitivity
steroid and immunosuppressive therapy
- possible increased malignancy risk
- lichenoid oral reactions
- oral pigmentation from hydroxyclorquine use

Question 6

Sjogren’s syndrome features

Answer 6

inflammatory disease
- associated with circulating antibodies
- ANA, Ro and La
mainly associated with dry eyes and dry mouth
multi-system in some
- major salivary gland involvement

Question 7

types of Sjorgren’s syndrome

Answer 7

Sicca syndrome
- dry eyes or dry mouth

primary Sjorgens
- not associated with any other disease

secondary Sjorgens
- associated with another connective tissue disease - e.g. rheumatoid arthritis, SLE

Question 8

sjogrens syndrome oral and dental implications

Answer 8

oral infection
caries risk
functional loss
denture retention
swelling of salivary glands - sialois

Question 9

Systemic sclerosis features

Answer 9

excessive collagen deposition
connective tissue fibrosis
loss of elastic tissue
predominantly effects women
gradual onset
slow progression - no treatment to prevent

Question 10

Systemic sclerosis dental aspects

Answer 10

involvement of personal tissues
- limited mouth opening
- progressively poor oral access
- limited tongue movement
plan treatment 10 years ahead
dysphagia
reflux oesophagitis
- dental erosion
cardiac and renal vasculitic disease
- watch drug metabolism
widening of pdl space
- no dental mobility

Question 11

Vasculitis features

Answer 11

inflammation of blood vessels
infarction of tissue
- may present as ulcers (tissue necrosis)
- may present as oral inflammatory masses
vessel wall thickens with inflammation
- narrowing of lumen
- reduced blood flow