3 - MSK Medicine

Question 1

Rheumatoid Arthritis Management

Answer 1

1. Physio
   - Rest + Splinting
   - Passive movements
2. DMARDS
   Conventional:
   - Hydroxychloroquine 400-600 mg PO
   - Sulfasalazine 500-1000mg PO -> 2g
   - Methotrexate (+folate) 7.5-20mg PO 1/52
   - Leflunomide 20mg PO (Loading 100mg 3/7)

Biologics (Eg. Anti-TNFa)

• Etanercept 50mg SC 1/7
• Infliximab 3mg/kg IV 2/52 eg
• Adalimumab 40mg sc 2/52

2. Bridging steroids
   - Prednisolone 1-10mg PO
   - Methylprednisolone acetate 4-80mg intra-articular (IART)
3. Analgesia
   - NSAIDS (lowest possible + PPI)
   - Codeine