Arthritis Flashcards
Features of rheumatoid arthritis`
> 4 features for at least 6 weeks
- morning stiffness
- arthritis in >3 joint areas
- arthritis of hand joints
- symmetric arthritis
- rheumatoid nodules
- serum rheumatoid factor
- radiographic changes
Features of osteoarthritis
- advanced age
- different joints affected
- synovial fluid less active
- radiological features
- typical patterns of presentation
Features of acute gouty arthritis
- painful inflamed single joint
- synovial fluid analysis shows negative bifringement needles
- complete resolution of symptoms between attacks
How to choose therapy for RA
- level of disease
- stage of therapy
- regulatory restricrtions
- patient preference
Non-selective NSAIDS for symptomatic relief
- Ibuprofen
- Indomethacin
- Naproxen
Cox-2 selective NSAID
Celecoxib
Weak opioids
- codeine phosphate
- tramadol
Strong opioids
- pethidine
- morphine
How do glucocorticosteroids work as anti-inflammatories?
- increase neutrophils
- decrease lymphs, monos, eosino, and basos
- inhibit tissue macrophages
- inhibit phospholipase A2
- suppress mast cell degranulation
- decrease histamine release
Adverse effects of steroids
- neuropathy
- hypertension
- osteoporosis
- diabetes
- immunosuppression
- cataracts
- mood disturbance
How many intra-articular steroid injections per year max?
4
Intra-articular steroid preparations
- methylprednisone
- betamethasone
- dexamethasone
DMARDS for RA
- methotrexate
- chloroquine
- sulfasalazine
- azathioprine
- cyclosporine
- TNF a blocking agents
MOA of methotrexate
Inhibitrs the activity of key enzymes
- interferes with carbon metabolism, purine and pyrimidine synthesis
- leads to increased adenosine release
Contraindications for methotrexate
- pre-existing blood dyscrasias
- existing renal or hepatic disease
- previous or existing herpes/varicella
- serous effusion
- pregnancy or lactation
Adverse effects of methotrexate
- BM suppression
- mucosal ulceration
- hepatotoxicity
- dermatological (alopecia, skin rashes)
- nephropathy
- hyperuricaemia
- headaches, drowsiness,
Other instructions for patients taking methotrexate
- take folic acid supplementation
- avoid live virus vaccines
- family planning
- drug interactions with NSAIDS and anti-epileptics
Role of sulfasalazine in RA
- reduces radiological progression of RA
- use in conjunction with methotrexate
Adverse effects of sulfasalazine
- nausea and vomiting, headache, rash
- haemolytic anaemia
- methaemoglobinaemia
Adverse effects of chloroquine
- irreversible retinal damage
- haemolysis in G6PD def
Drug treatment of OA
- paracetamol
- NSAIDS
- adjuvants
- intra-articular steroids
- weak opioids
Non-drug treatment of OA
- physio
- exercise
- weight loss
- assistive devices
- braces and insoles
- surgery
Management of acute gouty attack
- NSAIDS
- Colchicine
- corticosteroids
Treatment of intercritical period in gout
- xanthine oxidas inhibitors
- probenecid (improve uric acid excretion
MOA of colchicine
Anti-inflammatory:
- binds intracellular tubulin, inhibiting leukocyte migration
- inhibition of leukotriene B4
Common AE of colchicine
- diarrhoea
- NV
- abdo pain
Uncommon AE of colchicine
- alopecia
- hypersensitivity
- BM suppression
- myopathy
CI of colchicine
- renal impairment
When should allopurinol not be used
In an acute attack or within 4 weeks
Common adverse effects of allopurinol
- hypersensitivity reaction
- severe toxic syndrome in patients with renal impairment
Uncommon AE of allopurinol
- GI disturbance
- drowsiness
- headache
- BM suppression
- peripheral neuropathy
- arthralgia
- jaundice
MOA of probenecid
Prevents uric acid from entering the proximal renal tubule via the OAT1/OAT3 transporter
- increases urinary excretion of uric acid
CI of probenecid
- renal stones
- blood dyscrasias
- ineffective if GFR <50
Drug interactions with probenecid
- penicillin
