Gout, CPPD, Fibromyalgia, & Raynaud Flashcards Preview

Clin Med IV - Ortho > Gout, CPPD, Fibromyalgia, & Raynaud > Flashcards

Flashcards in Gout, CPPD, Fibromyalgia, & Raynaud Deck (35):
1

Pathogenesis of gout

Deposition of uric acid crystals in joints, tissues, fluids within body/joint

2

How is uric acid produced in gout?

Byproduct of purine metabolism (dietary and metabolic)

3

How do you treat hyperuricemia?

You don't. Not unless it's symptomatic b/c doesn't always lead to gout

Hyperuricemia ≠ gout

4

Gout is commonly see in what other comorbidities (4)

- Obesity
- HTN
- Diabetes
- Hyperlipidemia

5

Non-modifiable risk factors of gout

- Male
- African American or Pacific Islander
- Advanced age (esp. postmenopausal)

6

Modifiable risk factors of gout

- High purine food ingestion
- Obesity
- HTN
- Medications (e.g. HCTZ)
- Toxic exposure to lead

7

90% of gout is due to _______

Underexcretion

8

Gout is due to either _______ or _______ of uric acid

Underexcretion or overproduction

9

Clinical presentation of gout

- Podagra (MTP of big toe)
- Commonly affects feet, ankle, knees
- Joint swelling
- Extremely tender, erythematous → may awaken pt from sleep

10

Manifestations of chronic gout

- Tophi
- Drainage
- CT destruction, gross deformities
- Infection
- Bone destruction/erosions
- Functional loss

11

Dx gout

Arthrocentesis → intracellular uric acid crystals w/ negative birefringence

Note - elevated serum uric acid can be misleading (not diagnostic)

12

24-hr urine in gout pt

- Underexcretors will have normal 24-hr urine
- Overproducers will have elevated level

13

Early vs. late radiograph findings in gout

- Early → soft tissue swelling, can exclude CPPD or septic changes
- Late → bony erosions w/ sclerotic margins, calcifications

14

4 categories of gout treatment

- Anti-inflammatory for acute attack (initiate within 24 hrs)
- Anti-hyperuricemic for prevention and reversal of consequences
- Chronic tophaceous gout

15

Treatment for acute gout flare

- Dietary restrictions
- Initiate therapy within 24 hrs → NSAIDs (e.g. indomethacin), colchicine, corticosteroid, anakinra
- Increase fluid intake, elevate affected extremity
- Treat co-morbidities
- Re-evaluate in 2-4 wks then start chronic tx after rechecking uric acid level

16

What food should gout pts avoid?

Meat
Beans
Peas
Shellfish
Sardines
Spinach
Alcohol (esp. beer)
High fat milk

17

Gout pts should keep uric acid levels at ______

<5

18

What drugs should gout pts avoid?

HCTZ
Low-dose ASA

19

Indications for chronic gout tx

- Multiple or painful attacks of gouty arthritis or radiographic signs
- Tophi or deposits in subchondral bone
- Renal insufficiency
- Nephrolithiasis even after tx
- Urinary uric acid level ≥ 6.5mmol

20

Pathogenesis of chondrocalcinosis

Ca++ pyrophosphate dihydrate deposition in kidneys & joints

i.e. psuedogout

21

Risk factors for chondrocalcinosis (3)

- Aging (>60)
- Genetics
- Orthopaedic trauma

22

Disorders that increase risk of chondrocalcinosis

Hyperparathyroidism
Hemochromatosis
Hypothyroidism
Amyloidosis
Hypomagnesemia
Hypophosphatemia

23

Clinical presentation of chondrocalcinosis

**Valgus deformity of knees
- Erythematous, warm, tender, swollen joint
- Fever possible
- Often co-exist w/ OA
- Can have ligamentum flavum involvement → sx's mimic meningitis

24

Dx CPPD

- CPPD crystal deposition
- Positive birefringence**
- Rhomboid shape
- Elevated ESR/CRP
- Radiographic findings of calcified joint cartilage with Ca++ deposits in joint spaces***

25

If these 4 radiograph views are negative, CPPD is unlikely

AP knee
AP pelvis
PA hands
PA wrist

26

Tx CPPD

- Acute → NSAIDs, short-term colchicine, short-term steroids, drain fluid, ice, rest

- Chronic (>3 attacks/yr) → 1st line colchicine, 2nd line NSAIDs

27

Fibromyalgia commonly affects what pts?

Women age 20-50

28

There is an increased incidence of these conditions in fibromyalgia pts (7)

- Depression
- Anxiety
- H/A
- IBS
- Chronic fatigue syndrome
- SLE
- RA

29

The fibromyalgia cascade

Psychological trauma/stressors → Psychological distress → Sensitization of pain system → Clinical features of fibromyalgia → Clinical features of other syndromes

30

Clinical presentation of fibromyalgia

- Widespread pain w/ multiple tender points → fluctuates in A.M. and before bed
- Allodynia (pain to stimulus that doesn't normally provoke pain)
- Stiffness, sensation of swelling, fatigue, cognitive disturbances, paresthesia
- No swelling or erythema

31

Dx fibromyalgia

- Generalized body pain for at least 3 months
- At least 11/18 specific tender points

32

Non-pharmacologic tx for fibromyalgia

- CBT
- Exercise
- Weight reduction w/ nutrition counseling
- Acupuncture
- Massage
- Chiropractic tx
- US and interferential current tx

33

Pharmacologic tx for fibromyalgia

NO NARCOTICS OR STEROIDS!
1st line - Tylenol and/or Tramadol
2nd line - TCAs (amitriptyline, nortriptyline)
3rd line - SNRIs, SSRIs, cyclobenzaprine, antiepileptic (pregabalin, gabapentin)

34

Secondary Raynaud phenomenon is commonly associated w/ what illnesses?

- Connective tissue disease
- Scleroderma pts, esp. CREST

35

Tx Raynaud phenomenon

Pharmacologic → DHP CCBs (amlodipine, nifedipine)

Non-pharm. → reassurance, mittens, caution with cold objects, avoid smoking, avoid BBs