N.Z. Yarema, ass.prof.

1. Diseases of diffuse connective tissue decomposition. Modern concept about etiology, clinical pattern, diagnostics, principles of treatment. Signs of diffuse connective tissue decomposition in oral cavity. The role of a dentist in early diagnotics N.Z. Yarema, ass.prof.

2. Lupus erythematosus /LE/ • LE is the system disease of connecting tissue, which develops on the basis of the genetically conditioned imperfection of immunoregulatory processes of, which results in formation of great number of antibodies to the own cages and their components and to the origin of immunocomplex inflammation with the damage of many organs and systems.

3. Diagnostic criteria of LE • 1. Erythema is a “butterfly” • 2. Diskoid LE • 3. Photosensibilisation • 4. Ulcers of cavity of mouth • 5. Arthritis • 6. Serositis • Pleuritis, pericarditis • 7. Nephritis (proteinuriya, cylindruria) • 8. Changes of the nervous system (neuropathy,psycosis) • 9. Haematological changes(anaemia, leucopenia, trombocytopenia, lymphopenia) • 10. Immunological changes(anti-DNC,anti-SM,antiphospholipid antibodies) • 11. Antinuclear antibodies

4. СЧВ

6. Diagnosis • The diagnosis of LE is set at presence of 4 and anymore from 11 criteria • ( recommendations of ACR, 1997 )

8. skin “butterfly”

14. Systemic sclerosis / SSD/ • SSD is a system disease of connective tissue , for which making progress fibrosis and defeat of vessels is characteristic on the type of obliterate microangiopathy, which results in development of general syndrome of Reynoud, indurative changes of skin, defeats of the muscles and bones system, and internal organs( lungs, heart, kidneys, digestive tract)

15. Diagnostic criteria of SSDACR, 1980 • A.Main / large/ criteria • Proxymal sclerosis: symmetric bulge, drew on that induration of skin of fingers ( the defeats of extremities, face, neck, trunk are possible)

16. Criteria of diagnostics of SSD • B. Small criteria: • Sclerodactylia • · Osteolisis of finger-tips is as a result of ischemia • · Fibrosis of basale parts of lungs • At presence of one large or two small criteria set a diagnosis

19. CREST - syndrome • C- is a calcinosis of the skin • R- is a syndrome of Reynoud • E- is a esophagitis • S- is a sclerodactylia • T- is a teleangioectasia

24. Dermatomyositis/Polymyositis//DM/ • Polymyositis is a system inflammatory disease with the overwhelming defeat of skeletal musculature, smooth musculature and skin • Diagnostic criteria: • 1. Weakness in the muscles of hands, feet, trunk • 2. Increase of creatinphosphocinase or aldolase • 3. Spontaneous muscle pains • 4. Changes are on an electromyogrames • 5. A positive test on antibodies to RNA • 6. Undestructive arthritises and arthralgii • 7. Signs of systemic inflammation • 8. Results of the biopsy • Presence 4 of more than 4 criteria show diagnosis DM

25. Diagnostic criteria of DM • 1. Heliotrope pouring(purple red eritema of overhead eyelid)out • 2. Sign of Gottrona(atrophy eritema surface of joints of fingers) • 3. Eritema of skin surface of joints of hands and feet

28. Polyarteritis nodosa /PN/ • PN- necrotic inflammation of middle and shallow arteries without glomerulonephritis or vasculitis arterioles, capillaries and venules.

29. Diagnostic criteria of PN • 1. Loss of mass of body of 4kg and anymore • 2. Livedo reticularis • 3. Pain or a sensitiveness is enhanceable in testicles • 4. Diffuse myalgia, sensitiveness of muscles shins • 5. Mono- or polyneuropathy • 6. Diastolic pressure more than 90 mm Hg

30. Diagnostic criteria of PN /continuation/ • 7. Increase of level of urea or kreatinine • 8. Virus of hepatitis B • 9. Arteriographic change • 10. Changes are at a biopsy At presence of 3 or more criteria can be put diagnosis of PN