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Nutrition IV > 3: Rheumatic conditions > Flashcards

3: Rheumatic conditions Flashcards

1
Q

Th17

A

located in skin and mucosa
produce inflammatory cytokines against pathogens
dysregulation assoc with Auto Immune

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2
Q

Aryl HydroC activation

A

stimulates CYP450 stimulate Th17 or Treg

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3
Q

NF Kappa B

A

TF chronically active in inflammatory dz

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4
Q

Inhibitors of Th17

A

Vit D, Retinoic acid

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5
Q

Up-regulators of Th17

A

salt! TNFa

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6
Q

etiology of RA

A

begins in the lungs (pollutants activate aryl hydrocarbons!)

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7
Q

RA review

A

inflammatory, polyarthropathy
cutaneous nodules
vasculitis
cardiopulmonary complications

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8
Q

RA immunipathopys

A

AutoAbs to citrullinated peptides (anti CCP)
Th1, Th9, Th17
Treg suppression
leukocytes and fibroblast-like-synoviocytes
formation of pannus tissue
ROS mediated bone dstrxn

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9
Q

RA Risk Factors

A 
cigarette smoking: AhR ligands-PAH upregulates inflammatory cytokines
Family Hx
Female
Stress
Coffee >4cups ?
Obesity ?
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10
Q

RA Prevention

A

Dietary antioxidants
Antiox supplements (Vit C, Zinc)
Vit D

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11
Q

RA potential for malnutrition

A

hands greatly affected, greatly limits food choices

malabsorption dt inflammation, villous atrophy

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12
Q

RA Nutritional Tx

A 
Elimination Diet: NO corn, wheat, pork, oranges, milk, oats, rye, egg, beef, coffee, nightshades (?)
Veg Diet (low in aracadonic acid)
Mediterranean Diet (low in aracadonic acid)
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13
Q

RA Nutritional Tx: Fasting

A

reduces sx during the fast: ALL food has some degree of antigenicity
periodic (multiple consecutive days)
intermittent (alternate days 1-2/week)
fasting followed by veg diet

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14
Q

RA Supplements: Vit A

A

promotes Treg and suppresses Th17

monitor for toxicity (dry skin, anorexia, fatigue, HA, osteopenia, psych, arthralgia, bone pain)

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15
Q

Maillard Reaction

A

Protein + sugar + heat (>285° F)

Produces aromatic/flavorful compounds–Some of which are pro-inflammatory, immune-sensitizing, and/or carcinogenic

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16
Q

RA Supplements: Vit D

A

\prevents progression, reduces dendritic cells and immunoglobulins, reduces Th17 differentiation, IL 17 and IL 22; prevention of bone loss in steroid use

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17
Q

RA Supplements: EGCG and ALA

A

decrease IL1B, IL6, IL8, TNFa

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18
Q

RA Supplements: omega 3 and olive oil FAs

A

decreased tender jt count and AM stiffness
reduce MMP3, inflammatory cytokines
EVOO: monounsat fat, good for CV health

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19
Q

RA Supplements: gamma linolenic (borage, EPO)

A

PGE 1 synthesis facilitated anti-inflammatory

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20
Q

RA Supplements: virgin coconut

A

reduces inflammatory cytokines, CRP, WBCs

21
Q

RA Supplements: Se and Vit E

A

? maybe helpful

22
Q

RA Supplements: Zn

A

cofactor for SOD
deficiency common in RA
? maybe helpful

23
Q

RA Supplements: Misc

A

Mn: cofactor for SOD,

Cu: cofactor for SOD, bracelets may help

Vit C: increases SOD activity, reduces histamine

24
Q

RA Supplements: B vitamins

A

Pantothenic acid and pyridoxine, both found to be low in RA pts

25
Q

RA Supplements: Garlic

A

reduces IL6, IL8, TNFa

26
Q

Juvenile RA Tx Modifications

A

modify dose based on age/weight

increase protein, consider Zn supplementation

27
Q

Psoratic Arthritis: Nutritional Tx

A 
Elimination Diet (esp gluten, dairy, beef)
higher prevalence of celiac dz in pts with PsA
28
Q

Psoriatic Arthritis

A 
Enthesitis
Dactylitis
Anterior uveitis/iritis
Exacerbation of skin/nail psoriasis lesions
Th17 over-population
IL-23, IL-22, IL-17, IL-6 predominat
29
Q

Ankylosing Spondylitis

A

begins at SI joints; Peripheral jt ~20% of patients
Extra-articular manifestations: Iritis, Cardiopulmonary complications, Renal disease,
~90% of AS patients are HLA-B27 positive

30
Q

AS: Nutritional Supplements

A

Allicin: Reduced IL-6, IL-8, TNF-α with Inhibition of HLA-B27 protein translation

31
Q

Polymyositis (PM) and Dermatomyositis (DM)

A

Inflammatory autoimmune conditions affecting skeletal muscle (PM and DM) and skin (DM)
Th1 and Th17 excess, elevated Th17:Treg, elevated IL17 and Il6

32
Q

PM and DM: Nutritional Tx

A

Elimination diet!! Esp gluten
Creatine monohydrate
vit E
vit D

33
Q

Scleroderma

A 
Skin and visceral fibrosing dz
CREST: 
Calcinosis cutis
Raynaud phenomenon
Esophageal dysmotility
Sclerodactyly
Telangiectasia
34
Q

Scleroderma Risk Factors

A 
Silica dust
Organic solvents
Paint thinner/remover
Heavy metals
Plastics manufacturing
Iatrogenic, eg antiretrovirals
Family Hx
35
Q

Scleroderma Nutritional Tx

A

caution with fiber
SAMe
ALA
Green tea/EGCG

36
Q

Sjogren syndrome

A 
AI against exocrine glands
Dry eyes (keratoconjunctivitis sicca)
Dry mouth (xerostomia)
37
Q

Sjogren: Nutritional Tx

A

Elimination diet– Gluten, Dairy

Common to have def dt hypochlorohydria: iron, B12, folate

38
Q

Systemic Lupus Erythematosus pathophys

A 
Auto Abs to: 
Nuclear antigens
Cell membrane antigens
Phospholipid-associated antigens
Blood cells
Endothelial cells
Nervous tissue
Plasma proteins
Matrix/ECM proteins

Reduced clearance of apoptotic cells
Induction of T follicular helper (Tfh) and Th17 cell differentiation
Elevated IL-17, IL-23
Generally elevated inflammatory cytokines

39
Q

SLE sxs

A 
Malar (“butterfly”) rash
Renal disease
Pulmonary disease
Arthritis
Cardiovascular disease (rapidly progressive atherosclerosis)
Photosensitivity
Weight loss
Neuropsychiatric involvement
40
Q

SLE Treatment

A

Xenobiotic avoidance/depuration (pollutants, drugs, environmental exposures)

41
Q

SLE Nutritional Tx

A 
elimination diet
flax seeds
omega 3 fatty acids
Brassicas 
vitamin A
vitamin D
42
Q

Gout Pathophys

A

Hyperuricemia usually present
Overproduction via xanthine oxidase/excess substrate (purines
Under excretion in urine

43
Q

Gout Nutritional Tx AVOID

A

Low purine diet (avoid alcohol, esp beer)
Limit animal proteins, yeast, beans
Avoid spirulina, chlorella, royal jelly, fructose, sugar

44
Q

Gout Nutritional Tx

A

Protective effect: dairy, coffee, cherry juice
Vit C: gradually increase dose d/t migration of uric acid
Folic acid
Weight Loss (gradual)
Do NOT need to limit protein
ANTI-Inflammatory Diet

45
Q

Osteoathritis Pathophys

A

Degenerative arthropathy: knee, hip, spine, hands
both wear and tear AND inflammatory process
chondrocyte senescence accelerated by cytokines, ROS, AGEs

46
Q

OA Risk Factors

A

Age > 55 yrs
Obesity
Diet high in refined foods

47
Q

OA Nutritional Tx

A

Weight loss: >5.1 % improves function and pain; (adipokines detection in synovial fluid!)
Elimination Diet: plus no nightshades (and citrus)

48
Q

OA Nutritional supplements

A

Glucosamine sulfate: must take high enough dose!! (1500mg)
Chondroitin sulfate: polysaccharide component of proteoglycans
Niacinamide: decreased dz progression, increase jt mobility, but increase in liver enzymes :{
MSM
SAMe
Vit C: reduces risk of cartilage loss, synergy with vit E
Vit D
Pantothenic Acid (getting this in multi is fine)
Vit K: only important if deficient
(Also Vit A, Fe, Vit E, B6, Zn, Cu, Boron)

Nutrition IV (10 decks)

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