Gout, LBP, & Ankylosing Spondylitis Flashcards
Gout is determined by? By which organ?
- How well breakdown & Excretion of PURINES.
- By Kidneys
Most common inflammatory joint disease in men over 40?
Gout
If no excretion, Purines break down resulting in? Which forms what? Causing?
- ^ Uric Acid levels
- Crystals
- Inflammation & Acute pain
Genetic disposition is a risk factor for Gout. Name 4 more.
- ^Alcohol
- Obesity
- Diuretics
- Lead Toxicity
X-Rays identify ____ but not ____.
Chronic Gout
Not acute attacks
Where does crystallised uric acid deposit?
Gouty Arthritis: crystals where?
Tophi: Crystals where?
- Any connective tissues (synovial fluid/membrane, cartilage)
- Synovial fluid
- Subcutaneous tissue
Gout: S/S: Which serum concentraion is elevated? Recurrent \_\_\_\_ arthritis. What deposits around joints? Renal?
- Urate: Hyperuricemia
- MONOARTICULAR
- TOPHI
- Renal Disease & Renal Stones ( for Breakdown + Excretion of Purines)
Gout appears in 3 clinical stages?
Asymptomatic Hyperuricemia
Acute Gouty Arthritis
Tophaceous Gout
ACUTE Gouty Arthritis: Urate levels? Symmetrical? Which joints? Aggrivated by? Triggers? (2)
- ^ Urate Hyperuricemia
- Monoarticular (BIG TOE, knee, ankle, elbow)
- TRAUMA
- Drugs & Alcohol
(CHRONIC) Tophaceous Gout:
When does it occur?
Most common area affected?
Also occurs where?
- 3-40yrs after initial (acute attack) gouty arthritis
- EAR
- fingers hands knees feet
ulnar surface forearm, tibial leg, achilles tendon, elbow
Gout is related to what factors? (4)
Diabetes
Obesity
Kidney complaints
Diuretics (for ^BP)
Gout:
Treatment?
Avoid?
- Anti-inflammatory drugs
- Avoid ^Purine foods: Red meat, liver, kidneys & shellfish;
Red wine, Alcohol
Preventative drug for Gout? Only taken when? NOT taken during?
- Allopurinol (Treats Hyperuricemia) alloPURINol
- Only: During Remission (period of subsiding symptoms)
- NOT: Acute attack
LBP:
Top 3 causes?
- Disc degeneration (Internal disruption OR Herniation)
- Spinal Arthritis: Osteoarthritis & SPONDYLITIS (inflammation of vertebrae)
- Back Injuries
What is Sciatica?
Caused by?
- Pain in Buttock & Legs along Sciatic Nerve
- HERNIATED (Disc protrusion) intervertebral disc in lumbar region –> COMPRESSION of Sciatic Nerve
(Large nerve from lower back –> lower limb legs)
Lumbar Spondylosis?
Discogenic pain?
- Degenerative changes in intervertebral disc
Occurs with ageing - Originating in or from intervertebral disc
Spinal stenosis?
Relation to Sciatica?
- Narrowing of spinal canal
- Common cause of Sciatica
Most common cause of Sciatica?
Peripheral Nerve root compression from intervertebral disc protrusion (hernia)
Sciatica: S/S: 50% of > 60y.o.
Pain radiates where?
Associated with?
- Along Sciatic nerve (YButtocks, posterior back of leg –> Beyond knee)
- Muscle spasms: Paravertebral (alongside spine) & Hamstring muslces
Spondylosis on X-Ray?
Osteophytes & Loss of Disc height
Internal Disc Disruption (IDD): Genetic & Asymptomatic
- Arises from ____ changes in the ____ & ____.
Chemical changes
Nucleus Pulposus
Annulus Fibrosus
What happens in IDD (Internal Disc Disruption)?
Nucleus Pulposus degenerates –> pressure on Annulus Fibrosus –> circumferential fissures –> pain
Disc tears & pulposus leaks into sensitive 1/3 of annulus causing sinuvertebral nerve inflammation/irritation thus pain.
Internal Disc Disruption: disc hernia & nerve compression? External structure?
No & no
Retains external structure but Painful internal damage.
Low back pain Treatment:
Acute? Chronic?
- Acute: Exercise; Analgesics & NSAIDs
- Chronic: Intensive STRUCTURED exercise; SURGERY (Disc hernia & nerve root compression)
