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slide design for a friend who presented information about rheumatological diseases. used an egyptian pyramid theme

slide design for a friend who presented information about rheumatological diseases. used an egyptian pyramid theme

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  • Celebrex failed to establish superiority to traditional NSAIDs in reducing GIT side effects Cardiovascular effects include heart attach, thromboemboli and strokes Systemic vs Injectable glucocorticoids Systemic causes adrenal suppression, impaired wound healing, and infections and it causes steroid diabetes (hyperglycemia)
  • The disease affects the hand joints which in turn impairs the manual dexterity, and reduces the patients ability for oral hygiene, which may lead to caries and perio disease There is a systemic link between periodontal disease and arthritis since both of them are inflammatory diseases and associated with increase of inflammatory markers such as CRP The disease affects the hand joints which in turn impairs the manual dexterity, and reduces the patients ability for oral hygiene, which may lead to caries and perio disease There is a systemic link between periodontal disease and arthritis since both of them are inflammatory diseases and associated with increase of inflammatory markers such as CRP Varying degrees of pain and discomfort: sitting or semisupine position with frequent position changes. Short appointments. C1-C2 instability may lead to spinal nerve compression. Physical support such as pillow or rolled towel.
  • Aspirin and Ibuprofen block cox irreversibly for 10 days. Other NSAIDS for 2-3 days. If bleeding time is less than 20 minutes, you can do minor surgeries. More than 20 minutes, consult the physician. Bone marrow suppression: CBC with differential WBCs and bleeding time. Abnormal results must be discussed with the physician.
  • Also known as degenerative arthritis 17 millions have painful degenerative arthritis. It’s the lading cause of disabiltiy in the US. Heberden’s nodes are bone outgrowths in the distal interphalanges. Actually most of autoimmune diseases are more common in females except for type I DM which is equal. Etiology: normal wear and tear. Genetics, trauma and obesity. The cartilage becomes thicker as a repair method. May last for year. Ultimately the joint thins out.bone becomes polished and sclerotic and resemble ivory. The most two common complications are pain and disability. Heberden’s nodes may occasionally be painful. There is narrowing of the joint space TMJ changes with age anyway, but it could be affected with OA causing unilateral pain. Crepitus can also happen.
  • Treatment is mainly analgesic. Acetaminophen is the drug of choice since there is no remarkable inflammation but this may change depending of the patients liver condition. Also they might not be effective sometimes so we can switch to NSAIDs or Acetaminophen. Opioids for acute flares and used for a short period.
  • 1ry generalized OA is a type that can involve a group of joints.
  • This is basically an autoimmunity against lacrimal and salivary glands which causes a chronic inflammation. Our body is not very smart in terms of how it responds to chronic inflammation. The salivary glands end up healing with fibrosis. And on biopsy we see CD4 lymphocytes. The same thing happens with HIV as well, but we see CD8 lymphocytes instead. Xerostomia causes cervical and incisal caries as well.

rheumatological diseases Presentation Transcript

  • 1. Rheumatological diseases
    • Rheumatism
    • Rheumatoid
    • High morbidity
    • Dental implications
    • Over 40 million Americans
    • More than 60 types:
      • Rheumatoid Arthritis
      • Osteoarthritis
      • Sjogren’s Syndrome
    4/11/2011 Mohamed Abdelhakim, NYUCD 2013
  • 2. Rheumatoid Arthritis
    • Autoimmune disorder: Chronic systemic inflammation affecting joints
    • Etiology:
    • Unknown
    • Infections
    • Genetic
    • Prevalence: 1-2%
    • F:M: 3:1
    • Onset 35-50 yrs old
    • Pathophysiology:
    • Microvascular endothelial cell activation
    • Synovium
    • Pannus
    • Immunoglobulin G
    • Rheumatoid factor
    4/11/2011 Mohamed Abdelhakim, NYUCD 2013
  • 3. Clinical presentation
    • Gradual onset vs. sudden
    • Come and go
    • Progressive symmetrical inflammation of joints:
    • Multiple joints:
    • Ankle, fingers, knees, elbows, wrist, and interphalangeal joints
    • TMJ 75%
    • -pain
    • -stifness >1 hour
    • Extra-articular: Pericarditis Vasculitis Skin ulcers
    4/11/2011 Mohamed Abdelhakim, NYUCD 2013
  • 4. Cell-derived mediators: arachidonic acid metabolite inhibition Phosphatidylcholine Arachidonic acid Phosphatidyl inositol–P 2 Cycloxygenase pathway Lipoxygenase pathway
    • Prostaglandins
    • PGE 2
    • PGI 2
    • Thromboxanes
    • TxA 2
    HPETES Leukotriene A 4 HETES LTB 4 LTC 4 ↓ LTD 4 ↓ LTE 4 SRS-A P-lipase A 2 P-lipase C Aspirin, COX-2 inhibitors, NSAIDS corticosteroids Zileutin 4/11/2011 Mohamed Abdelhakim, NYUCD 2013
  • 5. Treatment
    • No cure Palliative
    • Group 1: treat symptoms Salicylates: Aspirin NSAIDs: Iboprufen (Advil, Motril) COX02 inhibitors: Refecoxib (Vioxx!!) Celecoxib (Celebrex)
    • Side effects: anti-platelets, GI problems, Asthma, Cardiovascular!!
    4/11/2011 Mohamed Abdelhakim, NYUCD 2013
  • 6. Treatment cont.
    • Group2: DMARDS
      • TNF-alpha inhibitor (intercept)
      • Glucocorticoids
      • Immunosuppressive drugs
      • Gold compounds and penicillamine
    • Side effects: wound healing, infections, and bleeding.
    • COMBINATION THERAPY
    4/11/2011 Mohamed Abdelhakim, NYUCD 2013
  • 7. Dental implications
    • Varying degrees of pain
    • Cervical spine instability
    • Drug related: bleeding, would healing, infection, bone marrow suppression
    • Caries and Periodontal disease?
    • TMJ 75%: Anterior open bite Obstructive sleep apnea
    • Joint prosthesis
    4/11/2011 Mohamed Abdelhakim, NYUCD 2013
  • 8. Dental management
    • Short appointments
    • Comfortable chair position sitting or semi-supine
    • Drug consideration: Bleeding time Bone marrow suppression
    • Oral health:
    • Oral hygiene aids (ex: electric toothbrush)
    • Ongoing preventive care
    • Occlusal appliace
    • Moist heat or ice to face/jaw
    • Soft diet
    • Antibiotics?!!!
    4/11/2011 Mohamed Abdelhakim, NYUCD 2013
  • 9. Osteoarthritis
    • Etiology!!
    • Most common >60 yrs: close to 100%
    • F:M 2:1
    • Minimum symptoms most of the time
    • Leading cause of disability in the US
    • Knees, feet, spine, hands, wrist (Scaphoid bone)
    • Heberden’s nodes
    • TMJ
    • Prognosis
    4/11/2011 Mohamed Abdelhakim, NYUCD 2013
  • 10. Management 4/11/2011 Mohamed Abdelhakim, NYUCD 2013
  • 11.
    • Rheumatic Arthritis
    • Multiple joints and symmetric
    • Significant joint inflammation
    • Stifness >1hr
    • Bouchard’s nodes
    • Systemic and extra-articular manifestations
    • Osteoarthritis (Degenerative Arthritis)
    • One or two joints or group of joints
    • Joint pain without inflammation
    • Stifness <15 minutes
    • Heberden’s nodes
    • No systemic involvement
    4/11/2011 Mohamed Abdelhakim, NYUCD 2013
  • 12. Sjogren syndrome
    • Autoimmune disease affecting salivary and lacrimal glands
    • Sicca syndrome: Xerostomia Xerophthalmia
    • Diffuse enlargment and fibrosis of major salivary glands
    4/11/2011 Mohamed Abdelhakim, NYUCD 2013