Quiz 2 quick study (Septic arthritis, Gout, CCDD, OA) Flashcards
Septic arthritis is related to what 5 major things?
RA (Rheumatoid arthritis) DM (Diabetes) Prosthesis MEN (more common) Elderly (>80yo)
Septic arthritis DIAGNOSIS
Which constitutional sx is usually present?
- Joint Aspiration
- Fever (30 – 60%)
3 Septic arthritis Joint Aspiration results
- Purulent synovial fluid
- Elevated leukocyte count (>100,000 WBC/mm3)
- Gram stain and/or culture positive
Septic arthritis effects usually how many joints?
Affects one joint (<20% of cases have more than one joint involved)
Septic arthritis effects usually which joints?
- Large joints are affected more commonly than small joints
* Knee (50%) > Hip > shoulder > elbow
Septic arthritis treatment
Antibiotic Therapy (1 – 6 weeks)
Septic arthritis Naturopathic tx
“CAGE”
- Vitamin C: 1000mg TID
- Vitamin A: 150,000 – 250,000 IU/day for 1 wk then taper
- Glutamine: 5g TID – QID
- EFAs:
GOUT is related to what 5 major things?
MEN PURINE loading INSULIN RESISTANCE ALCOHOL FRUCTOSE
GOUT is related to what 6 major diseases?
Hypertension, coronary artery disease, diabetes, obesity alcoholism Psoriasis
GOUT preferred method of diagnosis
Joint aspiration
GOUT Joints most affected
first metatarsal phalangeal (MTP) joint.
What has a huge impact on GOUT treatment outcome?
Diet and lifestyle
Underexcretion from what 5 areas cause etiology of GOUT?
renal insufficiency, systemic illnesses, dehydration, drug reactions, toxins
In GOUT, what drives the precipitation of crystals which triggers an inflammatory response?
Hyperuricemia
In GOUT, what 2 areas does Urate excretion occur?
gut and the kidneys
In GOUT, what 3 mechanisms in Diet increase serum urate levels?
- Increasing dietary purines
- Increasing metabolic production
- Decreasing renal excretion
GOUT T/F:
- Protein consumption DOES NOT increase the risk of hyperuricemia.
- All purine rich foods increase serum urate
- Non-purine foods that increase urate: fructose and alcohol
- True
- False
- True
List 3 Medications that are risk factor for GOUT
Salicylates,
Diuretics,
HTN meds
Clinical Feature of Asymptomatic hyperuricemia
Not a disease in the absence of Sx
List the 3 Clinical Feature of Acute (recurrent) gouty arthritis:
- 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
List the 3 Clinical Feature of Chronic gouty arthritis (tophaceous).
- No pain-free periods
- Tophaceous deposits (usually painless)
- Marked limitations in joint movement
Definitive Dx for GOUT?
•The presence of urate crystals in synovial fluid
Urate crystals identified in tophi
List 5 GOUT Treatments for an Acute Attack:
- 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
List 3 Preventative Therapies for GOUT
- 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
Dietary Modifications for GOUT
•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 intake4 Supplementation and Herbs for GOUT
- Fish Oils: 3000mg EPA + DHA/day
- Folic Acid: 10 – 40mg/day2
- Quercitin: 200 – 400mg TID between meals3
- High Anthocyanidin/Proanthocyanidin’s:
High doses of what vitamin may increase uric acid levels?
Vitamin C
What are 4 Calcium Pyrophosphate Dihydrate Deposition (CPPD): “Psedogout” characteristics?
- Genetic mutation
- Hyperparathyroidism
- Over 55 yo
- Strong overlap with osteoarthritis (OA)
What 3 syndromes fall into CPPD?
Pseudogout,
chrondrocalcinosis,
pyrophosphate arthropathy.
5 “Psedogout” major disease associated as Risk factors:
- Hemochromatosis (MCP joints)-“IRON EXCESS”
- Hyperparathyroidism,
- Hypomagnesemia,
- Hypophosphatasia
- Presence of osteoarthritis (knee)
2 Clinical features of Asymptomatic CPPD
- Most common presentation
* Crystal deposition present on x-ray, but no symptoms.
5 Clinical features Acute CPP crystal arthritis (Pseudogout)
- Large joints: knee most common
- Generally, only one joint
- Excruciating pain, sudden onset, erythema, warmth and swelling
- Fever and chills may be present
- neutrophils
3 Clinical features Chronic CPP crystal inflammatory arthritis (Pseudo-RA)
- MCP, wrists, elbows (joints spared by OA)
- Generally multiple joints involved
- Non-erosive, inflammatory arthritis with CPPD crystals
2 Diagnostic Testing of Psedogout CPPD:
- Joint aspiration!
* Acute CPPD will have turbid synovial fluid with neutrophils
Name 6 Acute conventional tx of Psedogout CPPD:
- 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
Name 1st and 2nd line medications for prevention of Psedogout CPPD:
•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:
5 Naturopathic tx for Psedogout CPPD: :
- Anti-inflammatory diet
- Fish Oils: 3000mg EPA + DHA/day
- Harpagophytum procumbens/Devil’s claw
- Boswellia serrata:
- High Anthocyanidin/Proanthocyanidin’s:
Osteoarthritis is related to what 3 major things?
FEMALE,
CYTOKINE,
LOW LEUKOCYTES,
Osteoarthritis; Improves & decreases in fxn, how?
*Use of joint improves function; Abuse of joint reduces function.
Pain, Osteoarthritis and exercise..
- Consistent exercise is as effective for pain and function as NSAIDs
- Range of motion and strengthening exercises – symptom relief
