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Medical Nutrition Therapy > Rheumatic Disorders > Flashcards

Rheumatic Disorders Flashcards

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USMLE® Step 1 flashcards
1
Q

rheumatic diseases are _____ diseases of the ________ tissue

A

chronic
connective

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2
Q

rheumatic diseases are characterized by ________, pain, and degeneration

A

inflammation

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3
Q

tissues that are affected by rheumatic diseases

A

joints
ligaments
tendons
cartilage
synovial membranes
skin

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4
Q

Two categories of rheumatic diseases

A

Systemic, autoimmune rheumatic disease

Non-systemic osteoarthritis

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5
Q

Systemic, autoimmune rheumatic disease examples

A

Rheumatoid arthritis, scleroderma, lupus, gout, fibromyalgia

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6
Q

Non-systemic osteoarthritis examples

A

Osteoarthritis, bursitis, tendonitis

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7
Q

Inflammation is a normal process:

Occurs to ___________ damaged tissues by _______________

Inflammation usually subsides after the tissue is healed/free of infection

A

protect & repair
moving blood & WBC to the site of injury

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8
Q

Inflammatory diseases is when

A

Inflammation continues out of control and causes more damage rather than repair

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9
Q

The inflammatory response is initiated by tissue injury

Release of _____, _____, _____, _____

initiates the ______________

A

histamine, prostaglandins, plasma proteases, cytokines

Arachidonic acid cascade

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10
Q

The Arachidonic Acid cascade releases ________, ________, and ________

A

Prostaglandin E2
Thromboxane A2
Leukotriene B4

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11
Q

what does Prostaglandin E2 do ?

A

pain, vasodilation

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12
Q

what does Thromboxane A2 do?

A

platelet aggregation, vasoconstriction

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13
Q

what does Leukotriene B4 do ?

A

attract WBC, inflammation

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14
Q

Most prevalent form of osteoarthritis

A

Osteoarthritis (OA)

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15
Q

Osteoarthritis is also called ___________________

A

Degenerative joint disease (DJD)

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16
Q

Osteoarthritis is characterized by loss of ___________, __________, and ____________

OA _____(is/is not) an autoimmune disease

A

loss of articular cartilage
vascular congestion
osteoblastic activity (abnormal bone growth)

Not

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17
Q

osteoarthritis results in _____ inflammation and destruction that is caused by joint overuse.
The OA is usually _____ in the body

can occur in ______, ______, _____, _____, and _____

A

cartilage
localized

knees
hips
ankles
spine
interphalangeal joints

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18
Q

clinical manifestations of OA include pain that worsens when ___________
also ______ after periods of _______

A

weight bearing and activity

stiffness after periods of inactivity

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19
Q

risk factors for OA

A

Obesity
Repetitive-use injury
Aging
Female gender
Caucasian
Greater bone density
Genetic factors

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20
Q

pharmacologic therapy for OA

A

NSAIDS
Corticosteroids (stronger than NSAIDS & more side effects)

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21
Q

NSAIDS side effects

A

decrease secretion in stomach = ulcers and bleeding
nausea

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22
Q

examples of NSAIDS

A

ibuprofen
naprozen

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23
Q

side effects of corticosteroids

A

calcium deficiency
raise blood sugar
hyperlipidemia
edema
hunger

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24
Q

Treatment for osteoarthritis

A

Physical therapy

Massage therapy

Exercise=>non-loading aerobic; range of motion; strengthening exercises

Surgical treatment=> total joint arthroplasty

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25
Q

MNT for osteoarthritis

A

weight loss to achieve desirable body weight

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26
Q

MNT for OA

A

Weight loss to achieve desirable body wt
Well-balanced diet
DRI for calcium & vitamin D
? Use of antioxidant supplements

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27
Q

Possible use of “____________” for MNT for OA

A

anti-inflammatory diet

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28
Q

Anti Inflammatory Diet
- Aims for variety, with a whole foods, plant-based diet with minimal _________ foods
- Increased fruits & veg
- High in ________ and ______ FA; lower in ______ fatty acids
- Low in SFA
- Low in______________ and added _________

A

processed
MUFA & omega-3
omega-6
refined CHO & added sugars

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29
Q

Complementary & Integrative Therapies for OA

A

Glucosamine & chondroitin sulfate

30
Q

Glucosamine & chondroitin sulfate is involved in ________ production
Sold as ______________

Unclear whether ____________ helps with OA pain
____________ may improve OA pain slightly in the short term
No serious side effects

A

cartilage
dietary supplements

glucosamine
Chondroitin sulfate

31
Q

Chronic, autoimmune, systemic disease characterized by inflammatory changes in joints & related structures resulting in crippling deformities

A

Rheumatoid Arthritis (RA)

32
Q

Rheumatoid Arthritis (RA) is Marked by periods of ______ and _______
More common in ______
Peak onset: age _______ yrs

A

flare-up & remission
women
20-45

33
Q

Pathophysiology of RA

Unknown etiology
Inflammation starts in the_________ and progresses to ___________
Small joints of extremities are the most affected=> __________________
_________ is a risk factor

A

synovial membrane
joint cartilage
interphalangeal joints of the hands & feet
Smoking

34
Q

Manifestations of RA

Pain, stiffness, & swelling of joints
Decline in function/ability to perform _______________

______ syndrome=> __________=> ____________________

_________________ syndrome => _________________

Anorexia due to=> pain, fatigue, depression, FMI, & cytokines

A

activities of daily living (ADLs)

Sjögren’s
xerostomia
dental decay, dysgeusia, dysphagia

Temporomandibular joint syndrome (TMJ)
pain and chewing issues

35
Q

Rheumatoid Cachexia Characterized by loss of _______ and elevated ______

Excessive __________ due to_________ and by __________

Causes muscle weakness, loss of function, and may hasten morbidity & mortality

A

muscle mass
REE

muscle catabolism
cytokines
disuse atrophy

36
Q

Goal of Pharmacologic Therapy for RA

A

control pain & inflammation

37
Q

Different types of medications for RA and examples

A

NSAIDS & salicylates
- aspirin

Methotrexate: FDI=> inhibits conversion of folate to active form

Corticosteroids

Azathioprine (Imuran): FDI=> can cause N/V, loss of appetite, steatorrhea

TNF-α inhibitors: adalimumab (Humira) => increases infection risk

38
Q

Nutritional Assessment for RA

Current disease _____
Past ______ & ______ history
Food-medication interactions
Laboratory values
Weight ______ & anthropometrics
Nutrition-Focused Physical Examination

A

status
medical & surgical
history

39
Q

Diet history for nutrition assessment for RA should include…
- Appetite
- Assessment of usual _____
- Ability to prepare food &_______
- Chewing & ________ ability
- _____ status
- Modified diets
- Supplement use; alternative therapies

A

intake
feed self
swallowing
GI

40
Q

Energy needs for RA

_______ REE due to inflammatory process
TEE is often________ in individuals due to decreased physical activity
Need to assess individually

A

Elevated
lower

41
Q

Protein for RA

Elevated whole-body protein catabolism
For individuals who are poorly nourished or having a flare-up=> _______ g/kg

A

1.2-1.5

42
Q

Individuals with RA are at increased risk for _____
Change the type of fat in the diet=> “_______________ diet”)

______ animal fat, SFA, & trans-fats
_______ omega-3 fatty acids=> reduce inflammatory activity

A

CVD
anti-inflammatory

Decrease
Increase

43
Q

Antioxidants->________

May need _______ & ___________ supplementation

Those on methotrexate=> _____________ supplementation daily

A

vit E

calcium & vit D

1 mg folic acid

44
Q

MNT for Rheumatoid Arthritis

  • Healthy diet with a variety of foods
  • Consider use of the “____________ diet”
  • TMJ: ___________ diet
  • Self-feeding: Adaptive feeding devices—referral to __________
A

anti-inflammatory
easy-to-chew
an occupational therapist

45
Q

Complementary & Integrative Therapies for RA
__________________

Can be converted in the body to _______________
May relieve______ and joint ________
side effects?

A

Gamma-linolenic acid (GLA)

anti-inflammatory prostaglandins
pain and joint stiffness
no serious side effects

46
Q

Note for RA GLA as alternative or integrative therapy

some ____________ preparations contain ____________ that can cause________disease

Only preparations that are labeled as “_______” should be used

A

borage seed oil
pyrrolizidine alkaloids (PAs)
liver

PA-free

47
Q

Gout is a disorder of ___________ metabolism
Resulting in accumulation of high levels of ______ in the blood=> ________________ are formed and become deposited__________________

These deposits destroy_________
Affects ____ gender more
Peak incidence is in the ______

A

purine
uric acid
monosodium urates
in and around small joints

joint tissue
male
50s

48
Q

Common sites of Gout? ____________

Characterized by a sudden & _____ onset of _______ pain generally beginning in the_______ and continues__________

__________ & __________ may occur

A

large toe, elbow, wrist & finger joints, and helix of the ear

acute
localized
large toe
up the leg

Uric acid nephrolithiasis & renal disease

49
Q

Risk Factors for Gout

Hereditary
_____ gender
Age
Obesity
Excessive alcohol use
Diseases: ____________________
Use of ______________________________

A

Male

HTN, DM, hyperlipidemia, renal insufficiency

thiazide diuretics (e.g., hydrochlorothiazide)

50
Q

Medical management of Gout

A

Allopurinol
Probenecid
Colchicine
NSAIDS

51
Q

Allopurinol function

A

inhibits uric acid production

52
Q

Probenecid function

A

increases excretion of uric acid via the kidneys

53
Q

Colchicine is used to ______________

A

treat joint pain in acute flares

54
Q

MNT for Gout

Purines are found in a many ___________

Drugs have become the primary treatment and have replaced the “rigid” ________ diet because most ________ is produced endogenously

Avoid foods high in _______

A

high protein foods

low purine
uric acid

purines

55
Q

MNT for Gout

Well-balanced diet with limited intake of ____________
Increase consumption of fluids to at least_____ cups/d=>aids in the _______

Attacks can be precipitated by=> ________________
Limit/avoid alcohol (especially _______)=> increases _______ production
During an acute flare=>avoid ___________

A

animal foods
8
excretion of uric acid

excessive eating, drinking alcohol, exercise
beer
uric acid
meat & alcohol

56
Q

Some foods high in purines

A

Anchovies
bouillon
broth
organ meats
wild game
goose
gravy
scallops
sardines
mussels
herring
mackerel
roe
meat extracts
yeast taken as a supplement

57
Q

MNT for Gout

______ restriction to promote gradual weight loss if overweight

Limit consumption of ______ which increases serum uric acid levels

A

Calorie

fructose

58
Q

Systemic Lupus Erythematosus (SLE) is …

A

Chronic inflammatory, connective tissue disorder
Autoimmune disorder

59
Q

Systemic Lupus Erythematosus (SLE) is characterized by periods of relapses and remissions

The cause is multifactorial involving multiple ____________ and __________ factors

Prevalence is greatest in ____________
More common in ___________

A

genes and environmental

women of child-bearing age
African Americans

60
Q

Symptoms of SLE

A

Painful, swollen joints
Extreme fatigue
Muscle pain
Sun sensitivity
Skin rashes on the face
Mouth ulcers

61
Q

syndrome that can occur with SLE ?

what organs are affected by SLE ?

A

Sjögren’s syndrome
Raynaud’s syndrome

Can affect organs:
1. Kidneys=>excessive protein excretion & renal failure
2. Pleurisy, pericarditis, primary pulmonary HTN

62
Q

medical management of SLE

A

Corticosteroids
NSAIDS
Disease-modifying antirheumatic drugs (DMARDs)

63
Q

Disease-modifying antirheumatic drugs (DMARDs) example

A

azathioprine (Imuran)

64
Q

MNT for SLE
Protein considerations:

If on corticosteroids=> provide _______

If develops chronic kidney disease (CKD):
If not on dialysis yet, restrict protein to _______
If on dialysis, provide ________ protein

A

1 g/kg

0.55-0.6 g/kg
1.0-1.2 g/kg

65
Q

MNT for SLE

Sodium & fluid=> may need to be___________
At risk for _________ deficiency
Calories as needed to attain/maintain desirable body weight

A

restricted if renal disease
vitamin D

66
Q

Scleroderma is _____________________ characterized by _____________

Etiology: _________ with a ________ component
More common in ________

Subtypes:
____________
____________

cure ?

A

Chronic, systemic, sclerosis of the skin & visceral organs
deposition of fibrous connective tissue

autoimmune
genetic
women

Localized - skin
Systemic – skin and organs

no cure

67
Q

Manifestations of Scleroderma

Widespread sclerosis of the skin & visceral organs with multisystem involvement
_______ stiffness/pain
________ syndrome
_______ syndrome
_____________
_______ dysfunction
Pulmonary _______

A

Joint
Sjögren’s
Raynaud’s
Hypertension
Renal
fibrosis

68
Q

GI manifestations of Scleroderma

A

GERD
N/V/C/D
dysphagia
malabsorption
loss of peristalsis
small bowel bacteria growth
weight loss
malnutrition

69
Q

MNT for Scleroderma
- No specific diet
- Individualize based on manifestations:

_______________ for dysphagia
______ for xerostomia
_______for GERD
Use of _______, _______ supplements

A

Modify diet texture
MNT
MNT
high-calorie, high-protein

70
Q

MNT for Scleroderma

If fat malabsorption: _______________

_________ nutrition if needed
If malabsorption= ___________

End-Stage=> may need ___________ nutrition due to _________

A

40 g low fat diet

Enteral
semi-elemental formula

parenteral
GIT failure

71
Q

Complementary & Alternative Therapies in Rheumatic Disorders are
commonly used among patients with rheumatological diseases because:
______________ and ____________

Many therapies are _______; some may be __________; lack of ________

A

No cure for diseases
Chronic pain

unproven
harmful
regulation

72
Q

Unproven Therapies in Rheumatic Disorders

A

Comfrey=> contains pyrrolizidine alkaloids that are toxic to the liver

Alfalfa=> not recommended for auto-immune disorders

Medical Nutrition Therapy (12 decks)

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