Flashcards in Musculoskeletal Deck (43)
what does osteoarthritis cause? what is it an association of?
hands and weight bearing joints - hip,knees,ankles
associated with genetics, obesity, previously damaged joints/bones
pathophysiology of osteoarthritis?
whole joint involved
cartilage damaged - disruption of regeneration and loss
bone beneath is exposed and erosion of bony surface
progressive inflammatory destruction
etiology of osteoarthritis?
risk increases with age
50% of over 60's xray evidence - only 25% symptomatic
2 x more likely in women
symptoms of osteoarthritis?
pain - worse on movement relieved by rest
immobility - worse in mornings
swelling and deformities
how is osteoarthritis diagnosed?
by clinical exam
bouchards nodes medial, heberdens distal
effusion = swelling b/c of inflammation
radiology and osteoarthritis? MRI? arthroscopy?
radiology useful in advanced conditions does not diagnose
MRI - early cartilage injury/bone changes
arthroscopy visualises joint, aspirates synovial fluid
management of osteoarthritis?
lose weight, physio, analgesia
steroid injections - temp relief
dental relevance of osteoarthritis?
reduced dexterity, reduced mobility, medications
what is rheumatoid arthritis?
an autoimmune disease of unknown aetiology
joint destruction due to synovial inflammation
multi system disease
etiology of rheumatoid?
1-3% of population
3x more in women
onset between 30-50
initially where does rheumatoid begin?
initially hands and feet, spreads to cervical spine, knees, ankles, elbows, shoulders
hot, swollen, tender joints worse in morning
deformity, restriction, sub laxation
clinical signs of rheumatoid?
swan neck deficiency
what other body systems can rheumatoid affect?
NS - peripheral neuropathy, cervical cord compression = paralysis
lungs - pulmonary fibrosis
systemic inflammation - malaise and anemia
how is rheumatoid diagnosed?
clinical exam and blood tests
radiology for destructive arthritis
management of rheumatoid?
analgesic - NSAIDs
disease modifying anti rheumatic drugs e.g sulphasalazine, penicillamine, methotrexate, hydrochloroquinone, gold, azathioprine
corticosteroids - orally/local injection
non pharmacological management of rheumatoid?
surgery - joint replacement, physio - optimise joint function, occ therapy - optimise functional abilities
dental relevance of rheumatoid?
TMJ disease, sjogrens, hands - used to diagnose
already diagnosed - reduced dexterity, manage sjogrens, caution if cervical spine diseased, drug side effetcs esp DMARD's
what is systemic sclerosis?
autoimmune disease. Skin thickens and binds to underlying structures. Multi organ disease
etiology of systemic sclerosis?
3-5x more common in women
presents in middle age
clinical signs of systemic sclerosis?
telangiectasia - ruptured capillaries
sclerodactyly - sclerosis of fingers
calcinosis - bony hard deposits
radial furrowing of lips
limitation of mouth movements
how to diagnose systemic sclerosis?
clinically/ blood tests for spec. autimmune abs
oral involvement and loss of dexterity
what is systemic lupus erythematous?
what is discoid lupus?
autoimmune, multi system, uknow aetiology
abs against nuclear cell components
widespread vascular immune complex deposition
confined to head/neck region
etiology of SLE?
0.1% population. young women 20-40
more common if origin african
skin - 75% photosensitivity, butterfly rash
joints - 90% - small joint arthritis
raynauds - 20%
N.S - 60% - fits, paralysis, neuropathy, psychosis
heart - valvular disease, aseptic endocarditis 25%
lungs - 50% effusions
kidney failure - 30%
how to diagnose SLE?
how to treat?
clinically - blood tests for spec. autoimmune abs
same meds as rheumatoid arthritis
drug side effects, reduced dexterity
what is gout?
accumulation of urate crystals in joints
more common in older men
precipitated by excess alcohol, starvation, certain foods, operations, drugs
acute - painful joints
chronic - tophi deposition
what is psoriatic arthritis?
destructive arthritis associated with psoriasis
what is hyperparathyroidism?
excess parathyroid hormone
usually an adenoma in gland
0.1% of population