Dental Management Chapter 20 Rheumatologic Disorders

The lining membrane, known as the synovium, consists of a thin layer of ________ (type A cells) and ________ (type B cells) with a sublining of rich, vascular, loose connective tissue.

macrophages, fibroblasts

The hyaline cartilage has high water content and obtains its nutrition solely from the ______ fluid.

synovial

Rheumatoid Arthritis is more prevalent in what sex by a 3:1 ratio?

Women

Which one is symmetrical: RA or OA

Rheumatoid Arthritis

Clinical Signs of Rheumatoid Arthritis compared to Osteoarthritis

RA: Multiple joint involvement and inflammation involving systemic 

OA: Usually one or two joints and no inflammation 

In Rheumatoid Arthritis

ESR

C-reactive protein

Rheumatoid Factor

Type of anemia

Neutropenia

CCP

ESR: Increased ESR mean inflammation when clump together and fall faster

Elevated C reactive protein made by liver in response to tissue

RF is Autoantibody IgM against normal IgG

Microcytic

Neutropenia: Low neutrophil count

CCP: Autoantibody against protein with citrulline (arginine) highly specific to RA

What is Felty syndrome

Rheumatoid Arthritis with Splenomegaly

What type of pleural effusion is in RA: Trasundative or Exudative?

Exudative (cloudy yellow) inflammation

Transudative (clear) more common with heart failure

Morning Stiffness are common in 

Arthritis of 3 or more joint and symmetric

Rheumatoid Arthritis patients

What is methotrexate

DMARD used to treat Rheumatoid Arthritis

Inhibit folate metabolism and reduce cytokines to decrease inflammation

What is the most common sign of aspirin toxicity?

Tinnitus (rining in ear)

DIP vs PIP

DIP most common in osteoarthritis (most extreme finger knuckle)

PIP most common in RA (middle finger knuckle)

Patients recently received prosthetic joint (particularly in the _______) are at increased risk of having a thromboembolic event.

Knee

In general, patient do not need prophylactic antibiotics before dental treatment

Most joint infection is S. aureus which is not in oral cavity

The most significant complication of the oral and maxillofacial complex is _______ involvement, which affects up to 75% of patients with RA.

TMJ

What would you expect the ESR to be in osteoarthritis?

Normal because usually no inflammation

First line of drug for osteoarthritis?

Acetaminophen

What is crepitus?

Popping and clicking of joint when moving 

In osteoarthritis

2 types of lupus

Discoid: only skin

Generalized: multiple organ system

Lupus is most common in what sex?

Female especially childbearing age

What is the most reliable test for systemic lupus erythamatus?

ANA test

Primary Sjogren compared to Secondary Sjrogen

Primary: No connective tissue disorder

Secondary: connective tissue disorder

Sjögren syndrome is characterized by eye dryness, hyposalivation, and enlargement of the ______- glands.

parotid

What stimulates saliva production for sjogren syndrome and when does it not work?

Pilocarpine and Cevimeline (muscarinic agonist)

Does not work when pt lost most of salivary acinar tissue

Most autoimmune disease affect which sex?

Women more than men

Giant Cell Arteritis should be included in the differential diagnosis for orofacial pain in ______ adults

older

Lyme disease is a multisystem inflammatory disease caused by the tick-borne spirochete of the _______ species.

Borrelia burgdorferi is most common in US

Early stage vs Late stage Lyme Disease

Early stage: erythema migrans (bullseye rash)

Late stage: arthritis

What is the treatment for lyme disease

Doxycycline or amoxicillin

What is fibromyalgia?

Chronic Pain syndrome with no known cause (maybe central nervous)