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

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

1
Q

Septic arthritis is related to what 5 major things?

A 
RA (Rheumatoid arthritis)
DM (Diabetes)
Prosthesis
MEN (more common)
Elderly (>80yo)
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2
Q

Septic arthritis DIAGNOSIS

Which constitutional sx is usually present?

A
  • Joint Aspiration

- Fever (30 – 60%)

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3
Q

3 Septic arthritis Joint Aspiration results

A
  • Purulent synovial fluid
  • Elevated leukocyte count (>100,000 WBC/mm3)
  • Gram stain and/or culture positive
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4
Q

Septic arthritis effects usually how many joints?

A

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

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5
Q

Septic arthritis effects usually which joints?

A
  • Large joints are affected more commonly than small joints

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

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6
Q

Septic arthritis treatment

A

Antibiotic Therapy (1 – 6 weeks)

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7
Q

Septic arthritis Naturopathic tx

A

“CAGE”

  • Vitamin C: 1000mg TID
  • Vitamin A: 150,000 – 250,000 IU/day for 1 wk then taper
  • Glutamine: 5g TID – QID
  • EFAs:
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8
Q

GOUT is related to what 5 major things?

A 
MEN 
PURINE loading 
INSULIN RESISTANCE  
ALCOHOL
FRUCTOSE
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9
Q

GOUT is related to what 6 major diseases?

A 
Hypertension, 
coronary artery disease, 
diabetes, 
obesity 
alcoholism
Psoriasis
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10
Q

GOUT preferred method of diagnosis

A

Joint aspiration

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11
Q

GOUT Joints most affected

A

first metatarsal phalangeal (MTP) joint.

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12
Q

What has a huge impact on GOUT treatment outcome?

A

Diet and lifestyle

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13
Q

Underexcretion from what 5 areas cause etiology of GOUT?

A 
renal insufficiency, 
systemic illnesses, 
dehydration, 
drug reactions, 
toxins
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14
Q

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

A

Hyperuricemia

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15
Q

In GOUT, what 2 areas does Urate excretion occur?

A

gut and the kidneys

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16
Q

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

A
  • Increasing dietary purines
  • Increasing metabolic production
  • Decreasing renal excretion
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17
Q

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
A
  1. True
  2. False
  3. True
18
Q

List 3 Medications that are risk factor for GOUT

A

Salicylates,
Diuretics,
HTN meds

19
Q

Clinical Feature of Asymptomatic hyperuricemia

A

Not a disease in the absence of Sx

20
Q

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

A
  • 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
21
Q

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

A
  • No pain-free periods
  • Tophaceous deposits (usually painless)
  • Marked limitations in joint movement
22
Q

Definitive Dx for GOUT?

A

•The presence of urate crystals in synovial fluid

Urate crystals identified in tophi

23
Q

List 5 GOUT Treatments for an Acute Attack:

A
  • 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
24
Q

List 3 Preventative Therapies for GOUT

A
  • 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
25
Q

Dietary Modifications for GOUT

A 
•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
26
Q

4 Supplementation and Herbs for GOUT

A
  • Fish Oils: 3000mg EPA + DHA/day
  • Folic Acid: 10 – 40mg/day2
  • Quercitin: 200 – 400mg TID between meals3
  • High Anthocyanidin/Proanthocyanidin’s:
27
Q

High doses of what vitamin may increase uric acid levels?

A

Vitamin C

28
Q

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

A
  • Genetic mutation
  • Hyperparathyroidism
  • Over 55 yo
  • Strong overlap with osteoarthritis (OA)
29
Q

What 3 syndromes fall into CPPD?

A

Pseudogout,
chrondrocalcinosis,
pyrophosphate arthropathy.

30
Q

5 “Psedogout” major disease associated as Risk factors:

A
  • Hemochromatosis (MCP joints)-“IRON EXCESS”
  • Hyperparathyroidism,
  • Hypomagnesemia,
  • Hypophosphatasia
  • Presence of osteoarthritis (knee)
31
Q

2 Clinical features of Asymptomatic CPPD

A
  • Most common presentation

* Crystal deposition present on x-ray, but no symptoms.

32
Q

5 Clinical features Acute CPP crystal arthritis (Pseudogout)

A
  • Large joints: knee most common
  • Generally, only one joint
  • Excruciating pain, sudden onset, erythema, warmth and swelling
  • Fever and chills may be present
  • neutrophils
33
Q

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

A
  • MCP, wrists, elbows (joints spared by OA)
  • Generally multiple joints involved
  • Non-erosive, inflammatory arthritis with CPPD crystals
34
Q

2 Diagnostic Testing of Psedogout CPPD:

A
  • Joint aspiration!

* Acute CPPD will have turbid synovial fluid with neutrophils

35
Q

Name 6 Acute conventional tx of Psedogout CPPD:

A
  • 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
36
Q

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

A

•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:
37
Q

5 Naturopathic tx for Psedogout CPPD: :

A
  • Anti-inflammatory diet
  • Fish Oils: 3000mg EPA + DHA/day
  • Harpagophytum procumbens/Devil’s claw
  • Boswellia serrata:
  • High Anthocyanidin/Proanthocyanidin’s:
38
Q

Osteoarthritis is related to what 3 major things?

A

FEMALE,
CYTOKINE,
LOW LEUKOCYTES,

39
Q

Osteoarthritis; Improves & decreases in fxn, how?

A

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

40
Q

Pain, Osteoarthritis and exercise..

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

Rheumatolgy (14 decks)

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