Quiz 2 quick study (Septic arthritis, Gout, CCDD, OA)

Question 1

Septic arthritis is related to what 5 major things?

Answer 1

RA (Rheumatoid arthritis)
DM (Diabetes)
Prosthesis
MEN (more common)
Elderly (>80yo)

Question 2

Septic arthritis DIAGNOSIS

Which constitutional sx is usually present?

Answer 2

• Joint Aspiration

- Fever (30 – 60%)

Question 3

3 Septic arthritis Joint Aspiration results

Answer 3

• Purulent synovial fluid
• Elevated leukocyte count (>100,000 WBC/mm3)
• Gram stain and/or culture positive

Question 4

Septic arthritis effects usually how many joints?

Answer 4

Affects one joint (<20% of cases have more than one joint involved)

Question 5

Septic arthritis effects usually which joints?

Answer 5

• Large joints are affected more commonly than small joints

* Knee (50%) > Hip > shoulder > elbow

Question 6

Septic arthritis treatment

Answer 6

Antibiotic Therapy (1 – 6 weeks)

Question 7

Septic arthritis Naturopathic tx

Answer 7

“CAGE”

• Vitamin C: 1000mg TID
• Vitamin A: 150,000 – 250,000 IU/day for 1 wk then taper
• Glutamine: 5g TID – QID
• EFAs:

Question 8

GOUT is related to what 5 major things?

Answer 8

MEN 
PURINE loading 
INSULIN RESISTANCE  
ALCOHOL
FRUCTOSE

Question 9

GOUT is related to what 6 major diseases?

Answer 9

Hypertension, 
coronary artery disease, 
diabetes, 
obesity 
alcoholism
Psoriasis

Question 10

GOUT preferred method of diagnosis

Answer 10

Joint aspiration

Question 11

GOUT Joints most affected

Answer 11

first metatarsal phalangeal (MTP) joint.

Question 12

What has a huge impact on GOUT treatment outcome?

Answer 12

Diet and lifestyle

Question 13

Underexcretion from what 5 areas cause etiology of GOUT?

Answer 13

renal insufficiency, 
systemic illnesses, 
dehydration, 
drug reactions, 
toxins

Question 14

In GOUT, what drives the precipitation of crystals which triggers an inflammatory response?

Answer 14

Hyperuricemia

Question 15

In GOUT, what 2 areas does Urate excretion occur?

Answer 15

gut and the kidneys

Question 16

In GOUT, what 3 mechanisms in Diet increase serum urate levels?

Answer 16

• Increasing dietary purines
• Increasing metabolic production
• Decreasing renal excretion

Question 17

GOUT T/F:

1. Protein consumption DOES NOT increase the risk of hyperuricemia.
2. All purine rich foods increase serum urate
3. Non-purine foods that increase urate: fructose and alcohol

Answer 17

1. True
2. False
3. True

Question 18

List 3 Medications that are risk factor for GOUT

Answer 18

Salicylates,
Diuretics,
HTN meds

Question 19

Clinical Feature of Asymptomatic hyperuricemia

Answer 19

Not a disease in the absence of Sx

Question 20

List the 3 Clinical Feature of Acute (recurrent) gouty arthritis:

Answer 20

• Single joint involved (first MTP joint, midfoot, ankles, knees)
• Explosive pain, usually starting in the evening or early morning
• Within hours (24), joint is hot, dusky red, swollen and tender

Question 21

List the 3 Clinical Feature of Chronic gouty arthritis (tophaceous).

Answer 21

• No pain-free periods
• Tophaceous deposits (usually painless)
• Marked limitations in joint movement

Question 22

Definitive Dx for GOUT?

Answer 22

•The presence of urate crystals in synovial fluid

Urate crystals identified in tophi

Question 23

List 5 GOUT Treatments for an Acute Attack:

Answer 23

• Treatment should begin AS SOON as the attack begins if possible (or at least within several hours).
• Treatment can stop within 2-3 days of complete cessation of symptoms.
• Joint should be rested and elevated; ice packs may help to reduce pain and swelling.
• NSAIDs – for mild to moderate pain prn
  * Naproxen 500mg BID
• Colchicine – for mild/moderate pain when NSAIDs are contraindicated
  * Most effective if administered within 12 – 24 hours of Sx onset

Question 24

List 3 Preventative Therapies for GOUT

Answer 24

• Allopurinol: (Max dose 800mg-titrate up)
• Urate lowering therapies will only help lower acute attacks if taken for > 1 year.
• Serum urate should be measured every 3 months during the first year, then annually

Question 25

Dietary Modifications for GOUT

Answer 25

``` •Eliminate alcohol consumption •Reduce purine intake **(Meats: organ meats, seafood, red meats, poultry **(Yeast: brewer’s and baker’s) •Reduce body weight •Reduce refined carbohydrates •Low fat intake •Increase fluid intake ```

Question 26

4 Supplementation and Herbs for GOUT

Answer 26

* Fish Oils: 3000mg EPA + DHA/day * Folic Acid: 10 – 40mg/day2 * Quercitin: 200 – 400mg TID between meals3 * High Anthocyanidin/Proanthocyanidin’s:

Question 27

High doses of what vitamin may increase uric acid levels?

Answer 27

Vitamin C

Question 28

What are 4 Calcium Pyrophosphate Dihydrate Deposition (CPPD): “Psedogout” characteristics?

Answer 28

* Genetic mutation * Hyperparathyroidism * Over 55 yo * Strong overlap with osteoarthritis (OA)

Question 29

What 3 syndromes fall into CPPD?

Answer 29

Pseudogout, chrondrocalcinosis, pyrophosphate arthropathy.

Question 30

5 “Psedogout” major disease associated as Risk factors:

Answer 30

* Hemochromatosis (MCP joints)-“IRON EXCESS” * Hyperparathyroidism, * Hypomagnesemia, * Hypophosphatasia * Presence of osteoarthritis (knee)

Question 31

2 Clinical features of Asymptomatic CPPD

Answer 31

* Most common presentation | * Crystal deposition present on x-ray, but no symptoms.

Question 32

5 Clinical features Acute CPP crystal arthritis (Pseudogout)

Answer 32

* Large joints: knee most common * Generally, only one joint * Excruciating pain, sudden onset, erythema, warmth and swelling * Fever and chills may be present * neutrophils

Question 33

3 Clinical features Chronic CPP crystal inflammatory arthritis (Pseudo-RA)

Answer 33

* MCP, wrists, elbows (joints spared by OA) * Generally multiple joints involved * Non-erosive, inflammatory arthritis with CPPD crystals

Question 34

2 Diagnostic Testing of Psedogout CPPD:

Answer 34

* Joint aspiration! | * Acute CPPD will have turbid synovial fluid with neutrophils

Question 35

Name 6 Acute conventional tx of Psedogout CPPD:

Answer 35

* Removal of crystals through joint aspiration * Intra-articular corticosteroids * Ice or cool pack application (acute flares) * NSAIDs – acute flares for continued pain * Colchicine – acute flares for continued pain * Most effective when given within the first 24 hours of acute flare

Question 36

Name 1st and 2nd line medications for prevention of Psedogout CPPD:

Answer 36

•First line treatment: •low-dose colchicine: OR oral NSAIDs daily (the latter is not being used as much due to CV risk) * Second line treatment: * Methotrexate: * Hydroxychloroquine:

Question 37

5 Naturopathic tx for Psedogout CPPD: :

Answer 37

* Anti-inflammatory diet * Fish Oils: 3000mg EPA + DHA/day * Harpagophytum procumbens/Devil’s claw * Boswellia serrata: * High Anthocyanidin/Proanthocyanidin’s:

Question 38

Osteoarthritis is related to what 3 major things?

Answer 38

FEMALE, CYTOKINE, LOW LEUKOCYTES,

Question 39

Osteoarthritis; Improves & decreases in fxn, how?

Answer 39

*Use of joint improves function; Abuse of joint reduces function.

Question 40

Pain, Osteoarthritis and exercise..

Answer 40

* Consistent exercise is as effective for pain and function as NSAIDs * Range of motion and strengthening exercises – symptom relief