Gout and Osteoporosis Flashcards
What are symptoms of Joint disease?
- Pain
- Immobility stiffness
- Loss of function
What are signs of joint disease?
- Swelling (can be fluctuant, bony or synovial)
- Deformity
- Redness
- Crepitus (Popping, clicking or crackling sound)
- Loss of function
What investigations should you do for patient complaining of joint disease?
Radiography (Plain/ MRI/ Arthrography)
Blood
- C-reactive protein (CRP)
- Rheumatoid factors (RF)
- Extractable Nuclear Antigens (ENA’s)
- Anti DS-DNA, Anti-Nuclear Antibody (ANA)
Arthroscopy and biopsy
What is Crystal Arthropathies?
- Group of joint disorders caused by deposits of crystals in joints and soft tissues around them
- Most common types are gout and calcium Pyrophosphate deposition (CPPD)
- Over time can lead to joint damage and kidney disease
What is an acute monoarthropathies?
- Acute arthritis of a single joint
- Can be initial stage of polyarthritis
Common causes
- Infection (septic arthritis)
- Crystal arthropathy (gout)
What is gout?
- Uric acid crystal deposition in joints
- Cause significant pain from reactive inflammation
- As a result of hyperuricaemia (high uric acid levels)
What can cause hyperuricaemia?
- Drug induced e.g. thiazide diuretics
- Genetic predisposition
- Can follow from nucleic acid breakdown as uric acid is product of this - chemotherapy cancer treatment causes nucleic acid breakdown so increase uric acid levels)
- Tumour related (in particular myeloma)
- Obesity and alcohol can enhance all of the above
- Less common in women until menopause then it equalises with men incidence
What are the Gout symptoms?
- Acute inflammation of single joint
- Most commonly great toe
- Usually a precipitating event occurs like trauma/ surgery/ illness/ diet/ alcohol excess
- Rapid onset within hours and v painful
- NSAIDS used to treat gout but still takes some time to settle
Dental aspects of Gout?
- Avoid aspirin as interferes with uric acid removal
- Anyone with history of gout don’t take aspirin
- Drug treatments taken to lower uric acid levels (e.g. allopurinol) can also give oral ulceration
What is osteoarthritis?
- Most common form of arthritis
- Degenerative joint disease
- Predominantly affects weight bearing joints/ joint damage (hips and knees)
- Used to be considered wear and tear disease BUT it is not
- It is a cartilage repair dysfunction, cartilaginous end above joints become thinner and thinner leading to signs and symptoms
What are the symptoms of Osteoarthritis?
- Pain that improves with rest and worsens with activity
- Brief morning stiffness
- Slowly progressive over years
What are the signs of Osteoarthritis?
Radiographically
- Loss of joint space and subchondral sclerosis (thickening of bone)
- Osteophyte lipping at joint edge (bony projection growing at edge)
Many patients may have asymptomatic changes and only show radiographic change therefore must determine if osteoarthritis is cause of this change
- Joint swelling and deformity (not common findings)
What is the treatment for Osteoarthritis?
- No preventative measures can be taken to alter disease progression
Pain can be improved by
- Increasing muscle strength around joint
- Weight loss
- Walking aids
- NSAIDs
- Prosthetic replacement is for pain not for function
What are the dental aspects of Osteoarthritis?
- TMJ is a joint and can be affect but symptoms are rare
- Difficulty assessing care
Chronic NSAID use - Oral ulceration possible
- Bleeding tendency due to antiplatelet
Joint replacements are beneficial to patient but causes concern in case antibiotic prophylaxis is needed - usually it is not but just an awareness
