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Clin Med IV - Ortho > Gout, CPPD, Fibromyalgia, & Raynaud > Flashcards

Gout, CPPD, Fibromyalgia, & Raynaud Flashcards

1
Q

Pathogenesis of gout

A

Deposition of uric acid crystals in joints, tissues, fluids within body/joint

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2
Q

How is uric acid produced in gout?

A

Byproduct of purine metabolism (dietary and metabolic)

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3
Q

How do you treat hyperuricemia?

A

You don’t. Not unless it’s symptomatic b/c doesn’t always lead to gout

Hyperuricemia ≠ gout

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4
Q

Gout is commonly see in what other comorbidities (4)

A
  • Obesity
  • HTN
  • Diabetes
  • Hyperlipidemia
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5
Q

Non-modifiable risk factors of gout

A
  • Male
  • African American or Pacific Islander
  • Advanced age (esp. postmenopausal)
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6
Q

Modifiable risk factors of gout

A
  • High purine food ingestion
  • Obesity
  • HTN
  • Medications (e.g. HCTZ)
  • Toxic exposure to lead
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7
Q

90% of gout is due to _______

A

Underexcretion

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8
Q

Gout is due to either _______ or _______ of uric acid

A

Underexcretion or overproduction

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9
Q

Clinical presentation of gout

A
  • Podagra (MTP of big toe)
  • Commonly affects feet, ankle, knees
  • Joint swelling
  • Extremely tender, erythematous → may awaken pt from sleep
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10
Q

Manifestations of chronic gout

A
  • Tophi
  • Drainage
  • CT destruction, gross deformities
  • Infection
  • Bone destruction/erosions
  • Functional loss
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11
Q

Dx gout

A

Arthrocentesis → intracellular uric acid crystals w/ negative birefringence

Note - elevated serum uric acid can be misleading (not diagnostic)

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12
Q

24-hr urine in gout pt

A
  • Underexcretors will have normal 24-hr urine

- Overproducers will have elevated level

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13
Q

Early vs. late radiograph findings in gout

A
  • Early → soft tissue swelling, can exclude CPPD or septic changes
  • Late → bony erosions w/ sclerotic margins, calcifications
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14
Q

4 categories of gout treatment

A
  • Anti-inflammatory for acute attack (initiate within 24 hrs)
  • Anti-hyperuricemic for prevention and reversal of consequences
  • Chronic tophaceous gout
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15
Q

Treatment for acute gout flare

A
  • Dietary restrictions
  • Initiate therapy within 24 hrs → NSAIDs (e.g. indomethacin), colchicine, corticosteroid, anakinra
  • Increase fluid intake, elevate affected extremity
  • Treat co-morbidities
  • Re-evaluate in 2-4 wks then start chronic tx after rechecking uric acid level
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16
Q

What food should gout pts avoid?

A 
Meat
Beans
Peas
Shellfish
Sardines
Spinach
Alcohol (esp. beer)
High fat milk
17
Q

Gout pts should keep uric acid levels at ______

A

<5

18
Q

What drugs should gout pts avoid?

A

HCTZ

Low-dose ASA

19
Q

Indications for chronic gout tx

A
  • Multiple or painful attacks of gouty arthritis or radiographic signs
  • Tophi or deposits in subchondral bone
  • Renal insufficiency
  • Nephrolithiasis even after tx
  • Urinary uric acid level ≥ 6.5mmol
20
Q

Pathogenesis of chondrocalcinosis

A

Ca++ pyrophosphate dihydrate deposition in kidneys & joints

i.e. psuedogout

21
Q

Risk factors for chondrocalcinosis (3)

A
  • Aging (>60)
  • Genetics
  • Orthopaedic trauma
22
Q

Disorders that increase risk of chondrocalcinosis

A 
Hyperparathyroidism
Hemochromatosis
Hypothyroidism
Amyloidosis
Hypomagnesemia
Hypophosphatemia
23
Q

Clinical presentation of chondrocalcinosis

A
  • *Valgus deformity of knees
  • Erythematous, warm, tender, swollen joint
  • Fever possible
  • Often co-exist w/ OA
  • Can have ligamentum flavum involvement → sx’s mimic meningitis
24
Q

Dx CPPD

A
  • CPPD crystal deposition
  • Positive birefringence**
  • Rhomboid shape
  • Elevated ESR/CRP
  • Radiographic findings of calcified joint cartilage with Ca++ deposits in joint spaces***
25
Q

If these 4 radiograph views are negative, CPPD is unlikely

A

AP knee
AP pelvis
PA hands
PA wrist

26
Q

Tx CPPD

A
  • Acute → NSAIDs, short-term colchicine, short-term steroids, drain fluid, ice, rest
  • Chronic (>3 attacks/yr) → 1st line colchicine, 2nd line NSAIDs
27
Q

Fibromyalgia commonly affects what pts?

A

Women age 20-50

28
Q

There is an increased incidence of these conditions in fibromyalgia pts (7)

A
  • Depression
  • Anxiety
  • H/A
  • IBS
  • Chronic fatigue syndrome
  • SLE
  • RA
29
Q

The fibromyalgia cascade

A

Psychological trauma/stressors → Psychological distress → Sensitization of pain system → Clinical features of fibromyalgia → Clinical features of other syndromes

30
Q

Clinical presentation of fibromyalgia

A
  • Widespread pain w/ multiple tender points → fluctuates in A.M. and before bed
  • Allodynia (pain to stimulus that doesn’t normally provoke pain)
  • Stiffness, sensation of swelling, fatigue, cognitive disturbances, paresthesia
  • No swelling or erythema
31
Q

Dx fibromyalgia

A
  • Generalized body pain for at least 3 months

- At least 11/18 specific tender points

32
Q

Non-pharmacologic tx for fibromyalgia

A
  • CBT
  • Exercise
  • Weight reduction w/ nutrition counseling
  • Acupuncture
  • Massage
  • Chiropractic tx
  • US and interferential current tx
33
Q

Pharmacologic tx for fibromyalgia

A

NO NARCOTICS OR STEROIDS!
1st line - Tylenol and/or Tramadol
2nd line - TCAs (amitriptyline, nortriptyline)
3rd line - SNRIs, SSRIs, cyclobenzaprine, antiepileptic (pregabalin, gabapentin)

34
Q

Secondary Raynaud phenomenon is commonly associated w/ what illnesses?

A
  • Connective tissue disease

- Scleroderma pts, esp. CREST

35
Q

Tx Raynaud phenomenon

A

Pharmacologic → DHP CCBs (amlodipine, nifedipine)

Non-pharm. → reassurance, mittens, caution with cold objects, avoid smoking, avoid BBs

Clin Med IV - Ortho (7 decks)

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