joint disorders secondary to other disease

what is gout?

metabolic condition associated with limited excretion of uric acid by the kidneys

what builds up due to gout?

urate salt builds up in the bloodstream → crystals accumulate and deposit in joints

gout causes recurrent attacks of what?

recurrent attacks of articular and periarticular inflammation, accumulation of tophi, and uric acid calculi

causes and contributing factors of gout

genetic defect causing overproduction of uric acid (hyperuricemia)

renal insufficiency

diet high in purine (protein-rich foods high in purine)

Rx: hydrochlorothiazide (HCTZ)

what are the 4 stage of gout?

asymptomatic hyperuricemia

acute gouty arthritis

intercritical gout

chronic tophaceous gout

what happens in asymptomatic hyperuricemia?

no clinical signs

however, serum urate levels are elevated

no treatment required

what happens in acute gouty arthritis?

weight bearing joints most commonly affected

warm, red, and tender to palpation

great toe most often involved

what is intercritical gout?

intervals between acute attacks, no symptoms

what is chronic tophaceous gout?

advanced deforming gout

tophi develops (deposits of uric acid, WBCs)

acute gouty arthritis: clinical s/s

sudden onset warmth, eythema, tenderness

• may have extreme pain and/or hypersensivity

acute gouty arthritis: tx options

may resolve without treatment in 10-14 days (give time for uric levels to balance)

elevate extremity

immobilize and protect affected joint

cold packs

colchicine (may be used prophylactically)

hydration

chronic tophaceous gout: clinical s/s

numerous, persistently painful joints with swelling and limited ROM

tophi: deposits of uric acid, WBCs

skin ulceration over tophi with exudate/purulent drainage

joint degeneration and deformity

chills and fever

chronic tophaceous gout: tx options

allopurinol

probenecid

sodium bicarbonate

dietary restrictions

early s/s of lyme disease

flu-like symptoms

bull’s eye rash

later s/s of lyme disease

severe headache

neck stiffness

arthritis of large joints

facial palsy

nerve pain

myocarditis

secondary erythema migrans (EM) in other areas

treatment for lyme disease

oral or IV antibiotics

what is rheumatic fever?

onset typically 2-6 weeks after throat infection (related to strep throat)

abnormal immune response to proteins on the microorganisms

peak incidence is between 5 and 15 yr

clinical s/s of rheumatic fever

fever

polyarthritis

muscle spasms

erythema marginatum

carditis: may lead to heart valve injury → chronic cardiac conditions

tx options for rheumatic fever

easy to treat if strep is detected

• antibiotics

• NSAIDs

• corticosteroids