Loading…

Flash Player 9 (or above) is needed to view presentations.
We have detected that you do not have it on your computer. To install it, go here.

Like this presentation? Why not share!

GOUT, OSTEOPOROSIS, OSTEOMYLITIS AND Paget's DISEASE

on

  • 2,308 views

 

Statistics

Views

Total Views
2,308
Views on SlideShare
2,308
Embed Views
0

Actions

Likes
0
Downloads
28
Comments
0

0 Embeds 0

No embeds

Accessibility

Categories

Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

    GOUT, OSTEOPOROSIS, OSTEOMYLITIS AND Paget's DISEASE GOUT, OSTEOPOROSIS, OSTEOMYLITIS AND Paget's DISEASE Presentation Transcript

    • GOUT, OSTEOPOROSIS, OSTEOMYELITIS AND Paget’s DISEASE
      J. Steuart Richards, MD
      Assistant Chief, Rheumatology Section
      VAMC, Washington, DC
      Assistant Professor of Medicine
      Georgetown University
    • 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
    • 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
    • Evolution of Hyperuricemia and Gout
      Over time, untreated, chronic hyperuricemia increases
      body urate stores, advancing the severity of the disease
      Painful
      Intercritical
      Segments
      Painless Intercritical
      Segments
      Flares last longer
      Flares occur
      more often
      Pain
      Intercritical
      segments decrease
      Persistent pain
      and stiffness
      Advanced
      Gout
      Asymptomatic
      Hyperuricemia
      Acute Flares
      Time
      Adapted from Klippel et al, eds. In: Primer on the Rheumatic Diseases. 12th ed. Arthritis Foundation; 2001:313.
    • 2
      1
      1
      3
      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.
    • Diagnosis of Gout
      Clinical
      Presence of monosodium urate crystals
      Presence of tophii
      Radiographic features
      Uric acid
    • 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
    • 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
    • Bone Loss with Advancing Age
    • 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
    • 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
    • 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
    • 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
    • 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
    • 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
    • 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
    • Osteomyelitis
      Definition:
      Infection of bone
      Acute or chronic
      Risk Factors:
      Trauma
      Diabetes
      Hemodialysis
      IV drug abuse
      Surgery
      Skin infections
    • Complications
      Sepsis
      Septic arthritis
      Sinus tracts to skin
      Fractures
      Chronic osteomyelitis
      Avascular necrosis
    • 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
    • Paget’s Disease
      Definition:
      Osteitis Deformans
      Focal disorder of bone metabolism
      leading to accelerated remodeling and bone overgrowth
      Involves:
      Pelvis
      Spine
      Skull
      long bone
    • 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
    • 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