Diseases Of Human System

Question 1

What is arthritis?

Answer 1

Inflammation of the joints

Question 2

What is arthrosis?

Answer 2

Non-inflammatory joint disease

Question 3

What is arthralgia?

Answer 3

Joint pain

Question 4

What is the link between bone and calcium?

Answer 4

Bone forms a store for calcium - some exchangeable
The exchangeable calcium moves from bone into ECF and calcium is absorbed from the gut into the ECF
Calcium is lost through the gut and urine
Calcium lvl has to stay at particular level for nerve and muscle function
The use of parathyroid hormone helps promote the correct location of calcium

Question 5

What is the purpose of parathyroid hormone?

Answer 5

Maintains serum calcium levels - PTH raised if calcium levels fall
It increases calcium release from bone
It reduces renal calcium excretion

Question 6

What is hypoparathyroidism + consequences?

Answer 6

Low levels of PTH

Leads to low serum calcium as calcium is not promoted to be released from bone

Question 7

What is hyperparathyroidism + consequences?

Answer 7

Can be primary or secondary

Primary - usually caused due to gland dysfunction (i.e. Tumour) and results in high serum calcium as inappropriate activation of osteoclasts in bone

Secondary - caused by low serum calcium, appropriate activation of osteoclasts in bone

Both result in increased bone reabsoprtion
Appear as radiolucencies and reabsorption

Question 8

What in the skin produces vitamin D when exposed to sunlight?

Answer 8

Cholecalciferol

This is then sent to the blood to be processed by the kidneys and liver into 1,25-dihydroxycolecalciferol

Question 9

What is dihydroxycolecalciferol and how does it relate to bone health?

Answer 9

It is the active version of cholecalciferol after processing in the liver/kidneys and this helps calcium absorption in the gut

Question 10

What are the sources of vitamin D?

Answer 10

Sunlight
Milk
Orange Juice
Fish (salmon)
Supplements

Question 11

What are the problems with vitamin D?

Answer 11

Low sunlight exposure

Poor GI absorption - poor nutrition, small intestinal disease (malabsorption)

Drug Interactions - Some anti-epileptic drugs (carbamazepine, phenytoin)

Question 12

What is osteomalacia?

Answer 12

A poorly mineralised osteoid matrix and poorly mineralised cartilage growth plate
Matrix is formed fine however, not calcified properly (normal amount of osteoid but inadequate mineralisation) - makes bone soft

Question 13

What is osteoporosis?

Answer 13

A reduced quantity of normally mineralised bone

Loss of mineral and matrix - reduced bone mass
Mineral and matrix are in the correct form however, there is less of it therefore, correct bone mass is not achieved

Question 14

If osteomalacia occurs bone formation, what is the common term used to name the pathology?

Answer 14

Rickets

After bone formation completion it is termed osteomalacia

Both related to calcium deficiency - serum calcium is preserved at the expense of bone calcium

Question 15

What are the effects of osteomalacia?

Answer 15

Bone effects - “bow legs” in kids with rickets, vertebral compression in adults, bones ‘ache’ to touch

Hypocalcaemia effects - muscle weakness, carpal muscle spasm, facial twitching

Alkaline phosphatase is a measure of bone turnover and is v high when there is a problem w calcium levels

Question 16

What is the management of osteomalacia?

Answer 16

Correct the cause - malnutrition (control GI disease), sunlight exposure (30m x5 weekly), Dietary vitamin D

Question 17

What are risk factors of osteoporosis?

Answer 17

AGE
Female
Endocrine - oestrogen/testosterone deficiency, Cushings syndrome (increase corticosteroids in the blood)

Patient factors - inactivity, smoking, alcohol use, poor dietary calcium

Genetic - family history, race (caucasian/asian women), early menopause

Drug use - Steroids, Anti-epileptics

Question 18

What are the consequences of osteoporosis?

Answer 18

Increased bone fracture risk - long bones (femur), vertebrae (height loss, nerve root compression - back pain)

Hip fracture

Question 19

How do you prevent osteoporosis?

Answer 19

Build maximal peak bone mass - exercise, high dietary calcium intake

Reduce rate of bone mass loss - Continue exercise and calcium intake, Reduce hormone related effects (oestrogen HRT, most effective if early menopause)

Reduce drug related effects

Consider “Osteoporosis prevention” drugs - Bisphosphonates

Question 20

What are a few common bisphosphonates?

Answer 20

Nitrogenous - Alendronate, Risedronate and Zoledronate (1x a year)

These work on osteoclasts poisoning them thus preserving bone mass

Question 21

What are SYMPTOMS of joint disease?

Answer 21

Pain
Immobility stiffness
Loss of function

Question 22

What are SIGNS of joint disease?

Answer 22

Swelling - osteophytes (bony lumps) form at the end of joints

Deformity - bones will meet differently than normal changing external appearance

Redness - indicates infection

Crepitus - Noise made by bone ends moving, associated with loss of normal cartilaginous covering of bone end

Loss of function

Question 23

What are the investigations for osteromalacia?

Answer 23

Serum calcium - Decreased
Serum phosphate - decreased
Alkaline phosphatase - v high
Plasma creatinine - high if renal cause
Plasma PTH - High if secondary hyperparathyroidism

Question 24

What are the investigations for osteoporosis?

Answer 24

Radiography - Plain, MRI, Arthrography

Blood - C-reactive protein, Rheumatoid factors (RF), Extractable nuclear antigens (ENA’s), ANA

Arthroscopy and biopsy

Question 25

What is acute monoathropathies?

Answer 25

Acute arthritis of a single joint Common causes involve infection (septic arthritis), crystal arthropathy (gout) - uric acid crystals deposited in joint which cause irritation to the joint surface - this causes swelling and inflammation Can be an initial stage of polyarthritis

Question 26

What is gout?

Answer 26

Uric acid crystals deposition in joints Significant pain from reactive inflammation Hyperuricaemia - high uric acid levels

Question 27

What are the dental aspects of gout?

Answer 27

Avoid aspirin - interferes with uric acid removal Drug treatments may give oral ulceration (allopurinol)

Question 28

What are the causes of gout?

Answer 28

Drug induced - thiazide diuretics Genetic predisposition Nucleic acid breakdown - Chemotherapy cancer treatment Tumour related - Myeloma Obesity and alcohol endurance

Question 29

What are the symptoms associated with gout?

Answer 29

Acute inflammation of single joint Usually great toe Usually a precipitating event - trauma, surgery, illness, diet/alcohol excess Rapid onset - hours NSAIDs used to treat

Question 30

What is osteoarthritis?

Answer 30

Degenerative joint disease Weight bearing joints/joint damage - predominantly hips and knees Not wear and tear - cartilage repair dysfunction

Question 31

What are the symptoms of osteoarthritis?

Answer 31

PAIN - improves w rest, worse with activity Brief morning stiffness Slowly progressive over years

Question 32

What are the signs of osteoarthritis?

Answer 32

Radiographs - loss of joint space and subchondral sclerosis (thickening of bone under cartilagenous layer), Osteophyte lipping at joint edge, radiographs may show ASYMPTOMATIC changes Joint swelling and deformity

Question 33

What is the treatment for osteoarthritis?

Answer 33

Nothing alters disease progression Pain can be improved by - increasing muscle strength around the joint - weight loss - walking aids Role of NSAIDs Prosthetic replacement for PAIN not function

Question 34

What are the dental implications of osteoarthritis?

Answer 34

TMJ can be involved - symptoms rare Difficulty in accessing care Chronic NSAID use - oral ulceration possible, bleeding tendency - anti-platelet Joint replacements - AB prophylaxis? - usually not needed

Question 35

What is rheumatoid arthritis?

Answer 35

Initially a disease of the synovium with gradual inflammatory joint destruction Different patterns of joint involvement - Sero-positive RA (RF present) - Sero-negative RA (RF not present)

Question 36

What are the symptoms of RA?

Answer 36

Slow onset - initially hands/feet, proximal spread, potentially involving all synovial structures SYMMETRICAL polyarthritis Occ. onset with SYSTEMIC symptoms - Fever, weight loss, anaemia

Question 37

What are the early signs of RA?

Answer 37

Symmetrical synovitis of Metacarpal pharyngeal joints Symmetrical synovitis of PIP joints Symmetrical synovitis of wrist joints These cause joint stiffness, swelling and pain - eventually lead to destruction of the joint

Question 38

What are the late signs of RA?

Answer 38

Ulnar deviation of fingers at MCP joints Hyperextension of PIP joints - "swan-neck" deformity "Z" deformity of thumb - Hyperflexion of MCP - Hyperextension of IP joint

Question 39

What are the consequences of RA on patients hands?

Answer 39

Less possible for pts to grip and use their hand effectively which may affect OH

Question 40

What investigations would you carry out for rheumatoid arthritis?

Answer 40

Radiographs - To see erosions, loss of joint space, deformity, joint destruction and secondary osteoarthritis Blood - Normochromic, normocytic anaemia - due to failure of RBC stimulation

Question 41

What is the treatment of Rheumatoid Arthritis?

Answer 41

Aim is to improve the quality of life Combination of: - Physiotherapy - maintain patients function and actions for as long as possible - Occupational therapy - Maintain patients function and actions for as long as possible - Drug therapy - Slow down the disease and ease of pain - Surgery - can be helpful with joint stability that has been lost

Question 42

In terms of RA, what drug therapy is used?

Answer 42

for most cases: Analgesics - Paracetamol, Cocodamol NSAIDs Disease modifying drugs - Hydroxychloroquine, methotrexate (slow down immune process and damage to joints) For moderate/severe cases: Immune modulators - Azathioprine, Steroids - Oral Prednisolone

Question 43

What are the dental implications of RA?

Answer 43

Disability from the disease - reduced dexterity, access to care Sjogrens syndrome - Association of connective tissue disease - the dry eyes/mouth Joint replacement - Multiple - Large/small joints Drug effects - Bleeding (NSAIDs/Sulphasalazine) Infection risk (steroids, immune modulators), Oral lichenoid reactions (gold, sulphasalazine, hydroxycholoroquine) Oral Ulceration (methotrexate) Oral Pigmentation (hydroxychloroquine) Chronic anaemia - GA problems

Question 44

Where is a common area for ligaments to rupture with Rheumatoid Arthritis?

Answer 44

Damage to the ligaments in the neck particularly the ligaments connecting the skull base to the upper cercival vertebrae With RA it is easier for these ligaments to rupture and the bone of the dens impinging into the space of the spinal cord causing spinal damage