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Management of Patients with Chronic Diseases

Course Number: 567


The inflammation or swelling of one or more joints. The term encompasses more than 100 diseases and conditions that affect the joints, tissues surrounding the joints, and other connective tissues.31 Some of the most common types of arthritis include osteoarthritis, rheumatoid arthritis, fibromyalgia, gout, and juvenile idiopathic arthritis. Some forms of arthritis, such as rheumatoid arthritis and juvenile idiopathic arthritis, have inflammation present that affects the entire body including the skin, muscles, gastrointestinal tract, lungs, heart, and eyes.31,32 Clinical signs and symptoms of arthritis are summarized in Figure 4. These symptoms will vary depending on the type of arthritis present.

Figure 4. Clinical Signs and Symptoms of Arthritis.31,32

  • Pain and stiffness in and around one or more joints is the most common symptom
  • Decreased range of motion
  • Swelling and erythema
  • Unsteadiness
  • Deformity
  • Weight loss
  • Fever
  • Fatigue
  • Weakness
  • Depression/anxiety
  • Sleep problems
  • Headaches
  • Memory and concentration problems
  • Tingling/numbness
  • Pain in the face/jaw, including temporomandibular joint dysfunction
  • Digestive problems

Epidemiology and Etiology

Arthritis is one of the most common chronic diseases in the United States.31 The Centers for Disease Control reports 58.5 million adults and 300,000 children have been diagnosed with this disease.31,33 The etiology of arthritis varies depending on the type of arthritis present. Common risk factors for arthritis include joint injury and overuse, occupations involving repetitive movements, infection of joints, obesity, autoimmune disorders, and genetic factors.31 Osteoarthritis is a type of arthritis caused by the joint cartilage between bones breaking down.45,46 Common risks factors for rheumatoid arthritis (an autoimmune disorder) are inherited genotypes, smoking and early life exposure to secondhand smoke.45,46 Fibromyalgia can be triggered by stressful events.45,46 Gout is a type of arthritis resulting from too much uric acid in the blood.45,46 Juvenile idiopathic arthritis appears to be genetic.32 Chronic heart failure, hypertension, insulin resistance, metabolic syndrome or diabetes increases the risks for developing gout.45,46 Figure 5 provides additional statistics about this disease.

Figure 5. Arthritis Statistics and Risk Factors.31,32

  • Arthritis is the leading cause of disability in the United States
  • Risk for developing arthritis increases with age
  • Most types of arthritis are more common in women
  • Gout is more common in men
  • Some Asian populations have a lower risk of osteoarthritis
  • Women who have given birth have a lower risk of developing rheumatoid arthritis

Patient Management and Oral Health Considerations for Arthritis

Patients diagnosed with arthritis routinely experience problems in the oral cavity such as periodontitis, temporal joint dysfunction (TMD), oral ulcers, xerostomia, and Sjogren’s syndrome.31,32,34 There are a number of factors that contribute to this. Arthritis medications frequently suppress the immune system which inhibits the mouth’s ability to fight harmful bacteria.31 Methotrexate is known to induce oral ulcers.34 And, stiff, painful hands can make oral self-care difficult.35 Dental providers should keep these items in mind when developing treatment plans for patients diagnosed with arthritis.

Dental providers must also be aware of the considerable amount of evidence that a relationship exists between rheumatoid arthritis and periodontal disease. Historically dental providers assumed that rheumatoid arthritis led to periodontal disease because of the strong epidemiological serological and clinical associations.36 However, we now know the relationship is much more complicated. Joint tissue and oral tissue have similar inflammatory processes.36 In fact, periodontal problems can precede the diagnosis of rheumatoid arthritis. Research has revealed multiple intersecting pathobiologic pathways.34,36 Nonsurgical treatment for periodontal disease has been shown to improve rheumatoid arthritis symptoms.34,35,37