Metabolic endocrine and heme, crystaline Flashcards
a. Crystal-associated diseases: monosodium urate monohydrate (gout), calcium pyrophosphate dihydrate deposition disease, basic calcium phosphate (hydroxyapatite), calcium oxalate b. Endocrine-associated diseases: rheumatic syndromes associated with diabetes mellitus, acromegaly, hyperparathyroidism, hypoparathyroidism, hyperthyroidism, hypothyroidism, Cushing’s disease c. Hematologic-associated diseases: rheumatic syndromes associated with hemophilia, hemoglobinopathies, angioimmunoblastic lym
What endocrine diseases may cause acute arthritis?
Endocrine diseases rarely present with acute arthritis but may include: acromegaly, hypothyroidism, addison’s disease.
What hematologic diseases cause arthritis?
Likely causes include: Intraarticular hemorrhage, hemophilia, acute leukemia, lymphoma.
how does diabetes cause muscle disease
Diabetic muscle infarction usually causes severe pain and some swelling in the thigh or calf unrelated embolism. Most have type I diabetes with retinopathy, nephropathy, and neuropathy. Sepsis needs exclusion. Antiplatelet agents shorten recovery whereas surgery markedly increases recovery time.
Diabetic amyotrophy is less well-defined and is related to lumbosacral plexopathy from microvascular disease.
What is Hashimoto’s encephalopathy?
Hashimoto’s encephalopathy and acute disseminated encephalomyelitis ( ADEM) are suspected consequences of autoimmune activity based on perivascular lymphocytic brain infiltration, elevated CSF protein, myoclonus or tremor, seizures, lymphocytic pleocytosis, and nonspecific T2 signal abnormalities in the subcortical white matter.
Improvement has occurred during treatment with corticosteroids and thyroid hormone replacemant.
What symptoms and signs results from metabolic changes of myxedema?
Metabolic dysfunction in myxedema causes fatigue and weakness, cold intolerance, dyspnea on exertion, weight gain, cognitive dysfunction, constipation, slow movement and slow speech, delayed relaxation of tendon reflexes, bradycardia, and carotenemia.
What signs and symptoms result from interstitial matrix accumulation in myxedema?
Myxedema is associated with accumulation of matrix substances resulting in dry skin, hoarseness, non pitting edema, course skin, puffy face and loss of eyebrows, periorbital edema, and tongue enlargement.
What is thyroid acropathy and pretrial myxedema?
Thyroid acropathy refers to a process of periostitis and clubbing that occurs in patients with Graves’ disease almost always associated with dermopathy and exophthalmos.
Pre-tibial myxedema is associated with antibodies to thyroid receptor, seen in Graves disease, hashimoto’s disease, and stasis dermatitis. Improvement has been reported during treatment with topical steroids with occlusion, intralesional steroids, rituximab, and IVIG.
What medical conditions are associated with celiac disease?
Other conditions associated with celiac disease include type I diabetes (3 – 16%), Hashimoto’s thyroiditis (5%), autoimmune liver disease, Down’ s syndrome (5%), IgA nephropathy, Turner’s syndrome (3%),
How does factor 12 work and what happens if deficient ?
Factor 12 is composed of a heavy chain 80,000 kDa with fibronectin and epidermal growth factor domains connected by disulfide bonds to a light chain that contains protease domain. Factor 12 is activated by biphosphonates released from activated platelets.
Factor 12 activates plasminogen so that deficiency may increase venous thromboses, but mostly there are no adverse effects from factor 12 deficiency.
How are cryoglobulinemias classified?
Type I cryoglobulinemia has a monoclonal immunoglobulin component usually IgG or IgM less commonly IgA or free light chains and accounts for 5 to 25% of cases. The hematological diagnosis is usually Waldenstrom’s macroglobulinemia or multiple myeloma.
Type II cryoglobulinemia is usually made up of a polyclonal IgG and monoclonal or oligoclonal IgM rheumatoid factor, and accounts for 40 to 60% of cryoglobulinemias. These are usually due to viral infections especially hepatitis C and HIV.
Type III cryoglobulinemia consists of polyclonal immunoglobulins and accounts to 40 to 50% of all cryoglobulinemias. These are usually secondary to connective tissue diseases.
What mixture of fats, carbohydrates, proteins are optimal in treating obesity?
A moderately high fat diet is helpful in managing hunger that develops with dieting. A Mediterranean diet with high intake of olive oil is probably optimal. There are 880 cal in 3.5 ounces of olive oil or 100 g. 4 ounces or 1/2 cup is therefore about 1000 cal.
What treatments are commonly used for acute gouty arthritis?
NSAID, PO glucocorticoids, cochicine, and intraarticular glucocorticoids In various combinations are commonly used. Comorbid conditions affect the choice as many patients have associated cardiovascular disease or gastric irritation that contraindicates NSAID use. 5 mg of prednisone twice daily is usually adequate however much higher doses are commonly used. Colchicine doses used in the past were commonly excessive and 0.6 mg twice daily initially is adequate. Education about gout causes including hyperuricemia, obesity, hypertension, and diuretic use may also need attention.
What conditions develop cancer pyrophosphate deposition disease?
Most subjects have associated osteoarthritis however hyperparathyroidism, hemochromatosis, hypomagnesemia, hypothyroidism, denervation, and gout may be predisposing factors.
What ion transport system correlates with uric acid transport?
Sodium and urate have similar transport systems in a kidney, high sodium retention occurs with hyperuricemia, and low sodium retention with hypouricemia.
What disease does a mutation in Uromodulin (Tamm Horsfal protein) cause?
Uromodulin (Tamm Horsfal protein) is encoded by the HUMOD gene and produces a GPI-anchored glycoprotein produced by the ascending limb of the loop of Henle. Mutations produce chronic interstitial nephritis in children resulting in low urate excretion, hyperuricemia, and gout. Excessive mutated protein builds up in the endoplasmic reticulum resulting in various phenotypes medullary cystic kidney disease-2 (MCKD2) and familial juvenile hyperuricemia nephropathy.
