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Kumar Valori > Reumatologie - Artrite microcristaline > Flashcards

Reumatologie - Artrite microcristaline Flashcards

1
Q

Artrite microcristaline - Guta + hiperuricemie - prevalenta Marea Britanie

A

2,5%

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2
Q

Artrite microcristaline - Guta + hiperuricemie - prevalenta SUA

A

3,9%

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3
Q

Artrite microcristaline - Guta + hiperuricemie - grupuri etnice cu frecventa mai mare a hiperuricemiei

A

populatia Maori

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4
Q

Artrite microcristaline - Guta + hiperuricemie - raportul sexelor

A

M:F = 5:1

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5
Q

Artrite microcristaline - Guta + hiperuricemie - procent idiopatice

A

85-90%

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6
Q

Artrite microcristaline - Guta + hiperuricemie - prag AUS in definitia hiperuricemiei patologice

A

408 micromol/l (6,86 mg%)

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7
Q

Artrite microcristaline - Guta + hiperuricemie - prag AUS pentru formarea cristalelor de urat monosodic in articulatiile periferice la 35 de grade Celsius

A

360 micromol/l (6,05 mg%)

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8
Q

Artrite microcristaline - Guta + hiperuricemie - prag AUS pentru formarea cristalelor de urat monosodic in articulatiile periferice la 30 de grade Celsius

A

300 micromol/l (5,04 mg%)

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9
Q

Artrite microcristaline - Guta + hiperuricemie - in ce procent este realizata eliminarea uratului de catre rinichi, respectiv intestin

A

rinichi - 66%
intestin - 33%

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10
Q

Artrite microcristaline - Guta + hiperuricemie - parcursul renal al uratului - procent filtrare, reabsorbtie, secretie, rezultat net excretie

A

filtrare - 100%
reabsorbtie - 98% -> restant 2%
secretie activa - 50%
reabsorbtie pre-secretorie (?) - 40-45%
rezultat net excretie in circumstante normale - aprox. 5-10% din cantitatea filtrata glomerular

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11
Q

Artrite microcristaline - Guta + hiperuricemie - excretie renala - molecule de reabsorbtie schimbatoare de anioni-urat

A

URAT1/SLC22A12
OAT4/SLC22A11
OAT10/SLC22A3

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12
Q

Artrite microcristaline - Guta + hiperuricemie - excretie renala - transportorul de reabsorbtie al uratului

A

GLUT9/SLC2A9

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13
Q

Artrite microcristaline - Guta + hiperuricemie - excretie renala - transportoare de anioni secretori

A

OAT1, OAT2, OAT3

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14
Q

Artrite microcristaline - Guta + hiperuricemie - excretie renala - proteine transportoare de fosfat de sodiu

A

NPT1/SLC17A1
NPT4/SLC17A3

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15
Q

Artrite microcristaline - Guta + hiperuricemie - excretie renala - pompa secretorie cu motor ATP

A

MRP4/SLC17A3

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16
Q

Artrite microcristaline - Guta + hiperuricemie - excretie intestinala - transportor secretor prezent smenificativ in intestine

A

ABCG2

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17
Q

Artrite microcristaline - Guta + hiperuricemie - GWAS - loci predominanti care codifica transportatori de urat

A

in primul rand:
- GLUT9/SLC2A9
- ABCG2
apoi gene care codifica:
- URAT1/SLC22A12
- OAT4/SLC22A11
- NPT1/SLC17A1
- NPT4/SLC17A3

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18
Q

Artrite microcristaline - Guta + hiperuricemie - cauze hiperuricemie - afectare excretie acid uric

A

HTA
BRC - guta clinic manifesta rar
hiperparatiroidism primar
hipotiroidism
crestere productie acid lactic - consum alcool, infometare, excercitii fizice
terapie medicamentoasa - diuretice tiazidice, aspirina in doze mici
saturnism
deficit glucozo-6-fosfataza - interfera cu excretia renala

19
Q

Artrite microcristaline - Guta + hiperuricemie - cauze hiperuricemie - crestere productie acid uric - crestere sinteza purine de novo

A

sindrom Lesch-Nyhan - deficit de HGPRT - X-linkat
deficit Glc-6-fosfataza - boala de depozitare glicogen tip 1
hiperactivitate fosforibozil-pirofosfat sintaza

20
Q

Artrite microcristaline - Guta + hiperuricemie - cauze hiperuricemie - metabolism crescut purine

A

boli mieloproliferative - ex: policitemia vera
boli limfoproliferative - ex: leucemie
alte boli - ex: carcinoame, psoriazis sever

21
Q

Artrite microcristaline - Guta + hiperuricemie - ce inflamazom este activat?

22
Q

Artrite microcristaline - Guta + hiperuricemie - ce caspaza recruteaza inflamazomul NLRP3?

23
Q

Artrite microcristaline - Guta + hiperuricemie - ce citokina mediaza afluxul de PMN?

24
Q

Artrite microcristaline - Guta + hiperuricemie - in cat timp apare al doilea atac de guta?

A

urmatorii 2 ani

25
Q

Artrite microcristaline - Guta + hiperuricemie - in ce procent de cazuri este afectata alta articulatie decat MTF1 in atacurile de guta?

26
Q

Artrite microcristaline - Guta + hiperuricemie - cat timp dureaza un atac netratat?

A

aprox. 7 zile

27
Q

Artrite microcristaline - Guta + hiperuricemie - ce valori are AUS de obicei la investigatii in cazul unui atac?

A

de obicei crescut - > 600 micromol/l (10,09 mg%) - rar la valori AUS in jum. inf. a intervalului normal sub punctul de saturatie 360 micromol/l (6,05 mg%)

28
Q

Artrite microcristaline - Guta + hiperuricemie - doze naproxen

A

750 mg imediat, apoi 500 mg la 8-12 h

29
Q

Artrite microcristaline - Guta + hiperuricemie - doze diclofenac

A

75-100 mg imediat, apoi 50 mg la 6-8 h

30
Q

Artrite microcristaline - Guta + hiperuricemie - dupa cat timp de la prima doza de AINS se incepe tratament cu dozele reduse si pentru cat timp?

A

dupa 24-48 h, timp de 1 saptamana

31
Q

Artrite microcristaline - Guta + hiperuricemie - care e doza de colchicina care e de obicei suficienta pentru terminarea atacului fara efecte adverse?

A

500 microg 2-3x/zi

32
Q

Artrite microcristaline - Guta + hiperuricemie - care sunt alimentele bogate in purine?

A

carne rosie, crustacee, organe, spanac

33
Q

Artrite microcristaline - Guta + hiperuricemie - cu ce procent pot reduce AUS modificarile dietetice?

34
Q

Artrite microcristaline - Guta + hiperuricemie - care este tinta tratamentului pentru AUS in cazul in care guta nu e severa?

A

< 360 micromol/l (6,05 mg%)

35
Q

Artrite microcristaline - Guta + hiperuricemie - care este tinta AUS in cazul in care guta este severa (atacuri frecvente, tofi)?

A

< 300 micromol/l (5,04 mg%)

36
Q

Artrite microcristaline - Guta + hiperuricemie - alopurinol - reactii adverse

A

frecvente:
- eruptii cutanate
- intoleranta GI
rare:
- reactie de hipersensibilitate
- supresie maduva osoasa

37
Q

Artrite microcristaline - Guta + hiperuricemie - alopurinol - doze in IR

38
Q

Artrite microcristaline - Guta + hiperuricemie - alopurinol - pe ce perioada de la atac nu trebuie administrat

A

prima luna

39
Q

Artrite microcristaline - Guta + hiperuricemie - alopurinol - cu cat timp inainte si cat timp dupa trebuie administrat pe fondul tratamentului cu AINS/colchicina

A

primele 2-4 saptamani inainte
4 saptamani dupa inceperea alopurinolului

40
Q

Artrite microcristaline - Guta + hiperuricemie - alopurinol - la cat timp se creste doza si pana cand?

A

la fiecare cateva saptamani pana cand AUS < 360 micromol/l (6,05 mg%)

41
Q

Artrite microcristaline - Guta + hiperuricemie - febuxostat - doze

A

80-120 mg/zi

42
Q

Artrite microcristaline - Guta + hiperuricemie - benzbromarona - asupra carui transportor actioneaza?

A

URAT1/SLC22A12

43
Q

Artrite microcristaline - Guta + hiperuricemie - lesinurad - ce transportor inhiba?

A

URAT1/SLC22A12

Kumar Valori (5 decks)

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