Rheumatology - Rheumatoid Arthritis

Question 1

What is rheumatoid arthritis initially

Answer 1

a disease of the joint synovium with gradual inflammatory joint destruction

Question 2

What are the different patterns of joint involvement

Answer 2

sero-positive RA (rheumatoid factor present)

seronegative RA (rheumatoid factor NOT present)

Question 3

What are the symptoms of RA

Answer 3

slow onset - initially hands and feed, proximal spread and can potentially effect all synovial structures

symmetrical poly arthritis

occasionally has an onset with systemic symptoms such as fever, weight loss, anaemia etc

Question 4

What are the early signs fo RA

Answer 4

symmetrical synovitis of MCP joints
symmetrical synovitis of PIP joints
symmetrical synovitis of wrist joints

Question 5

What are late signs of RA

Answer 5

ulnar deviation of fingers at MCP joints
hyperextension of PIP joints
'swan-neck' deformity
Z deformity of thumb 
subluxation of the wrist
loss of abduction and external rotation of shoulders 
flexion of elbow and knees
deformity of the feet and ankles

Question 6

What is ‘z’ deformity of the thump

Answer 6

hyper flexion of MCP and hyperextension of IP joint

Question 7

What are the extra-articular features of RA due to

Answer 7

due to systemic vasculitis (inflammation of blood vessels)

present in 75% of patient

Question 8

What is the name of psoriasis seen in some patients with RA

Answer 8

give much more aggressive forms of RA and in younger patients psoriatic arthritis

Question 9

What is the eye involvement seen with RA

Answer 9

scleritis and episcleritis

dry eyes, sjrogens syndrome can be associated with RA

Question 10

What is the subcutaneous nodules involvement with RA

Answer 10

can see changes in the skin with pressure points

Question 11

What are the extra auricular features seen in RA

Answer 11

psoriasis
eye involvement
subcutaneous nodules
amyloidosis 
pulmonary inflammation
neurological

Question 12

What are the investigations for RA

Answer 12

radiographs

blood

Question 13

What are we looking for int radiographs for RA

Answer 13

erosions, loss of joint space, deformity

joint destruction and secondary osteoarthritis

Question 14

What are we looking for in the blood

Answer 14

normochomic

normocytic anaemia

Question 15

What is tx of RA

Answer 15

aim to improve QoL

combination of 
physiotherapy
occupational therapy
drug therapy
surgery

Question 16

What is the aim of physiotherapy for RA

Answer 16

keep px active for as long as possible

active and passive exercises

Question 17

What are the reasons for the active and passive exercises

Answer 17

to maintain muscle activity
to improve joint stability
to maintain joint position

Question 18

What is the function of occupational therapy

Answer 18

maximizing the residual function
providing aids to independent living
assessment and alteration of home

Question 19

What are the 4 groups of drug therapy used for RA

Answer 19

analgesics
NSAIDs
disease modifying drugs
steroids

Question 20

What are the analgesics given for RA

Answer 20

paracetamol, cocodamol

Question 21

What are the NSAIDs given for RA often combined with

Answer 21

anti PUD agents

Question 22

What are the disease modifying drugs that are used for RA

Answer 22

hydroxychloroquine

methotrexate

Question 23

What is the drug therapy given for moderate and severe cases

Answer 23

immune modulators

steroids

Question 24

What are the steroids used for most cases in drug therapy for RA

Answer 24

intra articular - injected into joint space

Question 25

What immune modulators are used for severe RA

Answer 25

azathioprine mycophenolate biologics

Question 26

What are the steroids used for drug therapy

Answer 26

oral prednisolone

Question 27

What are the surgeries done for RA

Answer 27

excision of inflamed tissue joint replacement joint fusion osteotomy

Question 28

What are the dental aspects of RA

Answer 28

``` disability from disease sjogrens syndrome joint replacements drug effects chronic anaemia - ga ```

Question 29

How does disability of the disease relate to dentistry

Answer 29

reduced dexterity | access to care

Question 30

What are the drug effects that are relevant to dentistry

Answer 30

``` bleeding infection risk oral lichenoid reactions oral ulceration oral pigmentation ```

Question 31

What is seronegative spondyloarthritides

Answer 31

ankylosing spondylitis (spinal joint arthritis) renters disease arthritis of IBD

Question 32

What is the features of SAs

Answer 32

association with HLA-B27 infection likely as a precipitant often asymmetrical peripheral arthritis ocular and mucocutaneous manifestations

Question 33

What are differences between ankylosing spondylitis and RA

Answer 33

AS more common in men | more common in young

Question 34

What is the ankylosing spondylitis effect

Answer 34

disabling progressive lack of axial movement | symmetrical other joint involvement e.g hips

Question 35

What are the result of ankylosing spondylitis

Answer 35

low back pain limited back and neck movement - turning spine restricted limited check expansion - breathing compromised cervical spine tipped forward (kyphosis) - movements restricted

Question 36

What is the treatment for ankylosing spondylitis

Answer 36

generally same as RA ``` analgesia (NSAIDS) physiotherapy occupational therapy DMDs immune modulators surgery where appropriate ```

Question 37

What are dental aspects for AS

Answer 37

GA hazard | TMJ involvement possible but rare except in psoriatic arthritis

Question 38

What is GA hazardous for AS

Answer 38

limited mouth opening | limited neck flexion