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Rheumatologic diseases
- 2. Rheumatoid is much more than arthritis and encompasses a large group of disorders of the rheumatic diseases that affect bones, joints, and muscles. structures that are commonly involved in rheumatoid diseases include the joint, the joint cavity, synovial fluid, and periarticular structures.
- 3. Arthritis a term that means inflammation of the joints. Arthritic disease encompasses a group of disorders of the rheumatic diseases that affect bones, joints, and muscles. to denote aches, pains, and stiffness in the joints and muscles.
- 4. Rheumatoid Arthritis (RA) an autoimmune disease of unknown origin that is characterized by symmetric inflammation of joints, especially of the hands, feet, and knees. Occurs when your immune system attacks the synovium the lining of the membranes that surround your joints. Disease onset usually occurs between ages 35 and 50 years and is more prevalent in women than men by a 3:1 ratio.
- 5. Signs and Symptoms of RA gradual and subtle the disorder is commonly preceded by a prodromal phase of general fatigue and weakness with joint and muscle aches. symptoms come and go over varying periods painful joint swelling, especially of the hands and feet. occurs in several joints and progresses to other joints in a symmetric fashion.
- 6. Signs and Symptoms of RA pain in the affected joints aggravated by movement generalized joint stiffness after inactivity morning stiffness that lasts longer than 1 hour. Joints most commonly affected: - fingers, wrists, feet, ankles, knees, elbows
- 7. Diagnosis for RA Criteria for the Diagnosis of Rheumatoid Arthritis Morning stiffness Arthritis of three or more joint areas Arthritis of hand joints Symmetric arthritis Rheumatoid nodules Serum rheumatoid factor Radiographic changes *At least four must be present for a diagnosis of rheumatic arthritis.
- 8. Dental Management for RA Considerations in Patients with Rheumatoid Disorders Patient Evaluation/Risk Assessment Evaluate and determine whether rheumatoid or joint disorder exists. Obtain medical consultation if disease is poorly controlled or undiagnosed, or if the diagnosis is uncertain.
- 9. Potential Issues/Factors of Concern Analgesics If patient is taking aspirin or another NSAID or acetaminophen, be aware of dosing and the possibility that pain may be refractory to some analgesics. Antibiotics Provide antibiotic prophylaxis Anesthesia No issues. Anxiety No issues. Allergy Allergic reactions or lichenoid reactions are possible in patients taking many medications.
- 10. Potential Issues/Factors of Concern Bleeding Excessive bleeding may occur if major surgery performed on patients who take aspirin or other NSAIDs. Blood pressure No issues. Chair Position Ensure comfortable chair position. Consider shorter appointments and use supports as needed (e.g., pillows, towels).
- 11. Potential Issues/Factors of Concern Drugs Obtain blood cell count with differential if surgery is planned for patients taking gold salts, penicillamine, antimalarials, or immunosuppressives. If patient is taking corticosteroidssecondary adrenal suppression is possible Equipment No issues Emergencies If surgery is performed, supplemental techniques may be necessary to control bleeding. Follow-up Routine follow-up evaluation is appropriate