Gout and Osteoarthritis

Question 1

What are 3 symptoms of joint disease

Answer 1

pain
immobility stiffness
loss of function

Question 2

What are some signs of joint disease?

Answer 2

• swelling (fluctuant, bony and synovial)
• deformity
• redness
• crepitus
• LOSS of function

Question 3

Name 3 radiographic investigations for joint disease?

Answer 3

• plain
• MRI
• Arthrography

Question 4

Name 4 blood tests used to investigate joint disease?

Answer 4

• c-reactive protein (CRP)
• Rheumatoid factors (RF)
• Extractable Nuclear Antigens (ENA’s)
• Anti DS-DNA, anti- nuclear antibody (ANA)

Question 5

Name 4 types of investigations used to investigate joint disease?

Answer 5

• radiography
• blood
• arthroscopy
• biopsy

Question 6

What is anthrography?

Answer 6

radiography where dye is injected into joints

Question 7

What is acute monoarthropathies? and what are the common causes?

Answer 7

• acute arthritis of a single joint
• infection- septic arthritis
• crystal arthropathy (GOUT)
• can be initial stale of polyarthritis

Question 8

What is gout?

Answer 8

• uric acid crystal deposition in joints
• significant pain from reactive inflammation

Question 9

What are the causes of hyperuricaemia?

Answer 9

• high uric acid levels
• drug induced (thiazide diuretics)
• genetic predisposition
• nucleic acid breakdown (chemotherapy cancer treatment)
• tumour related myeloma

obesity and alcohol enhance

Question 10

What are the symptoms of gout?

Answer 10

• acute inflammation of SINGLE joint
• usually great toe
• usually a precipitating event (trauma, surgery, illness, diet/alcohol excess)
• rapid onset - hours

Question 11

How do you treat gout?

Answer 11

NSAIDS

Question 12

What are the dental aspects of gout>

Answer 12

• avoid aspirin - it interferes with uric acid removal
• drug treatments may give oral ulceration (allopurinol)

allopurinol lowers high uric acid levels in the blood

Question 13

What is osteoarthritis?

Answer 13

• degenerative joint disease
• affects weight bearing joints/joint damage (hips and knees)
  -cartilage repair dysfunction (NOT wear and tear)

Question 14

What are the stats for osteoarthritis in the population?

Answer 14

• symptomatic in 10% population
• 60% show degenerative changes on XR

Question 15

What are the symptoms of osteoarthritis?

Answer 15

PAIN (improves with rest and worsens with activity)

brief morning stiffness

slowly progressive over years

Question 16

What are the signs of osteoarthritis?

Answer 16

• radiographs

loss of joint space and subchondral sclerosis

osteophyte lipping at joint edge

joint swelling and deformity (usually seen in hand)

Question 17

What is the treatment of osteoarthritis?

Answer 17

• nothing alters disease progression
• pain improved by:

increasing muscle strength around the joint

weight loss

walking aids

• role of NSAIDS
• prosthetic replacement for pain

Question 18

Describe osteophyte lipping?

Answer 18

Bony projections at the joint edge, seen on a radiograph

Question 19

Describe subchondral sclerosis?

Answer 19

Thickening of bone under cartilage layer, seen on a radiograph

Question 20

How does osteoarthritis affect dentistry?

Answer 20

• TMJ can be involved but the symptoms are rare
• difficulty in accessing care
• chronic NSAID use (oral ulceration and bleeding tendency - anti-platelet)
• joint replacement may require AB prophylaxis (usually not needed)