Your SlideShare is downloading. ×
GOUT, OSTEOPOROSIS, OSTEOMYLITIS AND Paget's DISEASE
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×
Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

GOUT, OSTEOPOROSIS, OSTEOMYLITIS AND Paget's DISEASE

1,586
views

Published on


0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
1,586
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
29
Comments
0
Likes
0
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  • 1. J. Steuart Richards, MD Assistant Chief, Rheumatology Section VAMC, Washington, DC Assistant Professor of Medicine Georgetown University
  • 2. Definitions  Gout is a syndrome caused by an inflammatory response to the formation of mono-sodium urate monohydrate crystals which develop secondary to hyperuricemia  Hyperuricemia occurs when the serum uric acid level is > 7.0 mg/dl (420 μmol/L)  Asymptomatic hyperuricemia occurs when serum uric acid is elevated but there are no signs of gout or renal calculus
  • 3. Prevalence of Gout  Overall prevalence is 4.6% in men and 2% in women > 451  6%-7% of VA population is estimated to have gout  Incidence of gout estimated at 45.9/100,000 in 1995 -96 vs. 20.2/100,000 in 1977-782  Contributing factors include - ↑ longevity, ↑ HTN, ↑ obesity, ↑ metabolic syndrome, ↑ ESRD, ↑ aspirin, ↑ transplantation use of cyclosporine 1US National Health Survey of 1996 on self reported prevalence 2Arromedee et al J Rheumatol 2002;29:2403-06
  • 4. Evolution of Hyperuricemia and Gout Asymptomatic Hyperuricemia Acute Flares Advanced Gout Painless Intercritical Segments Painful Intercritical Segments Pain Time Over time, untreated, chronic hyperuricemia increases body urate stores, advancing the severity of the disease Flares last longer Flares occur more often Intercritical segments decrease Persistent pain and stiffness Adapted from Klippel et al, eds. In: Primer on the Rheumatic Diseases. 12th ed. Arthritis Foundation; 2001:313.
  • 5. 1 1. Photos courtesy of Brian Mandell, MD, PhD, Cleveland Clinic. 2. Photo courtesy of N. Lawrence Edwards, MD, University of Florida. 3. ACR Clinical Slide Collection on the Rheumatic Diseases, 1998. 21 3
  • 6. Diagnosis of Gout  Clinical  Presence of monosodium urate crystals  Presence of tophii  Radiographic features  Uric acid
  • 7. Causes of Disability in Gout Acute  short term limitation of activity  Dependent on: ○ Location ○ Severity ○ Number of joints ○ Frequency of attacks ○ Duration of attacks Chronic  Chronic limitation of activity  Dependent on: ○ Location ○ Number of joints ○ Severity of joint damage ○ Superimposed flares
  • 8. Definition  Osteoporosis is a skeletal disorder characterized by compromised bone strength predisposing to an increased risk of fracture  Bone strength reflects the integration of bone density and bone quality  Bone density is grams of mineral/area or volume measured by DXA  Bone quality encompasses architecture, bone turnover and damage accumulation NIH Consensus Development Panel. JAMA 2001
  • 9. Bone Loss with Advancing Age
  • 10. Secondary Causes of Osteoporosis  Alcohol  Cigarette smoking  Low BMI  Low vitamin D and Calcium intake  Immobilization/ sedentary lifestyle  Hypogonadism  Hyperthyroidism  Hypercalciuria  Thalassemia/ Hemochromatosis  Corticosteroids  Anticonvulsants
  • 11. Clinical  Osteoporosis is asymptomatic unless a fracture occurs  Hip fractures cause loss of mobility, dependence on assistive devices for walking, NH placement and increased mortality  Vertebral fractures result in loss of height, change in posture, pain, sleep disturbance and increased mortality
  • 12. Osteoporosis in Men  3% - 6% of men > 50 have osteoporosis  28% - 47 % of men > 50 have osteopenia1  Rates were highest for Caucasian and Asian men compared with AA men, Hispanic men were intermediate  Mortality rate following hip fractures is almost double that of women 31% vs. 17%2 1Looker AC et al J Bone Miner Res 11997; 2:1761-1768 2Forsen L et al Osteoporosis Int 1999;10:73
  • 13. VA Perspective  Prevalence of Osteoporosis in Men in a VA Rehabilitation Center Arthur Swislocki, MD; Jon A. Green, MD, PhD; Gerhard Heinrich, MD; Charles A. Barnett, MD; Ivan D. Meadows, MD; Ernest B. Harmon, BS; Mary F. Rank, RN, FNP; and Robert H. Noth, MD
  • 14. Hip Fractures  1.6 million hip fractures occurs worldwide  28% occur in men  Highest incidence in Caucasians  50% of men require institutionalization  1 year mortality post hip fracture for men is 31% vs. 17% for women Forsen L et al Osteoporosis Int 10:73, 1999
  • 15. Vertebral Fractures  Increases after the age of 55  Men and women have a similar rate of vertebral fractures  Association with poor sleep, pain, social isolation functional impairment  Increased mortality
  • 16. Disability and Osteoporotic Fractures Vertebral Fractures  Pain  Sleep disturbance  Loss of height  Respiratory disease  Depression  Loss of mobility Hip Fractures  Loss of ambulation  Need for walking aids or wheelchair  Loss of independence, unable to live alone  Chronic pain
  • 17. Osteomyelitis  Definition:  Infection of bone  Acute or chronic  Risk Factors:  Trauma  Diabetes  Hemodialysis  IV drug abuse  Surgery  Skin infections
  • 18. Complications  Sepsis  Septic arthritis  Sinus tracts to skin  Fractures  Chronic osteomyelitis  Avascular necrosis
  • 19. Disability from Osteomyelitis Acute  Pain  Limitation of function of affected bone  Restricted movement for treatment with IV antibiotics Chronic  Pain  Fatigue  Loss of function of affected limb  Amputation  Social isolation  Depression
  • 20. Paget’s Disease  Definition:  Osteitis Deformans  Focal disorder of bone metabolism leading to accelerated remodeling and bone overgrowth  Involves: ○ Pelvis ○ Spine ○ Skull ○ long bone
  • 21. Paget’s Disease  Often asymptomatic  Symptoms depend on the bone involved:  Pain  Skeletal deformities  Osteoarthritis  Fractures  Tumors  Heart Failure  Neurological symptoms  Deformity of the affected bone
  • 22. Disability from Paget’s Disease  Osteoarthritis  Pain  Limitation of movement  Requiring assistive devices – cane, walker, wheelchair  Sleep disturbance  Heart Failure  Limitation of work and exercise capacity  Sleep disturbance