Arthritis

Question 1

Drugs for Osteoarthritis?

Answer 1

Non-selective NSAIDs like Diclofenac

COX-2 inhibitor - Celecoxib

Corticosteroids

SYSADOA = intra-articular Hyaluronic Acid

Question 2

MOA of Intra-articular hyaluronic acid?

Answer 2

Large glycosaminoglycan naturally in synovial fluid

Shock absorption, traumatic energy dissipation, protective coating of cartilage, lubrication, reduce pain and stiffness

Induce biosynthesis of HA and ECM

Question 3

Anti-inflammatory agents for Gouty arthritis?

Answer 3

Naproxen
Indometacin
Celecoxib
Prednisolone
Colchicine

Question 4

MOA of Colchicine?

Answer 4

Bind to tubulin

Prevent tubulin polymerization into microtubules

Inhibit leukocyte migration into joints and phagocytosis

Inhibit Leukotriene B4 and Prostaglandin production

Question 5

Uric Acid synthesis inhibitor?

Answer 5

Xanthine Oxidase Inhibitor - Allopurinol 1st line. Febuxostat 2nd line

Question 6

MOA of Allopurinol and Febuxostat?

Answer 6

Anti-hyperuricemic agent, inhibit uric acid synthesis

Question 7

Uses of Colchicine?

Answer 7

Relieve pain and inflammation in acute gouty attack within 24-36 hours

Question 8

ADR of Colchicine?

Answer 8

Diarrhoea, nausea, vomiting, abdominal pain

Muscle weakness

Unusual bleeding, pale lips

Change in urine amount

Question 9

Uses of Allopurinol and Febuxostat?

Answer 9

Debilitating gout attacks

Chronic erosive arthritis

Urate nephrolithiasis

Question 10

ADR of Allopurinol and Febuxostat?

Answer 10

Allopurinol Hypersensitivity Syndrome (AHS)
1. Severe cutaneous adverse reaction (SCAR)
2. Risk factors:
- Renal impaired with creatinine clearance <60ml/min
- Thiazide therapy
- HLA-B 58:01 genotype. Common in East Asians

1. Nausea, stomachache, vomiting, diarrhoea
2. Fever, sore throat
3. Skin rash
4. Dark urine, jaundice

Question 11

Uricosuric agent name?

Answer 11

Probenecid

Question 12

MOA of Probenecid?

Answer 12

Increase Uric acid excretion

Inhibit proximal tubule anion transport

Inhibit uric acid re-absorption

Question 13

Uses of Probenecid?

Answer 13

When allopurinol is contraindicated in tophaceous gout

In increasingly frequent gouty attack

Start 2-3 weeks after an acute attack

Question 14

Which drugs are only for prevention of gouty episode?

Answer 14

Allopurinol
Febuxostat
Probenecid.
Do not start during acute attacks due to risk of kidney stones

Question 15

ADR of Probenecid?

Answer 15

Nausea, vomiting
Painful urination
Lower back pain
Allergic reactions, rash

Take plenty of fluid to minimize renal stone formation
Keep urine pH >6.0 by administration of alkaline (e.g. potassium citrate)”