This document discusses rheumatologic diseases, which encompass disorders that affect bones, joints, and muscles. Rheumatoid arthritis is an autoimmune disease characterized by symmetric joint inflammation, especially in the hands, feet, and knees. It occurs when the immune system attacks the synovium lining joints. Signs include gradual joint pain, swelling, stiffness, and involvement of multiple joints. A diagnosis requires meeting several criteria related to symptoms and joint involvement. When treating rheumatoid arthritis patients dentally, their medications and joint issues should be considered to safely provide care and prevent complications.

1. Rheumatologic disease
or rheumatoid

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 corticosteroids—secondary
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