AUTO - B. ARTHRITIS-COVERED Flashcards
1
Q
Osteoarthritis
A
- cartilage loss (grinding of cartilage)
- knees, hips, small hand joints, spine
- linked to overweight/obesity
2
Q
pain in osteoarthritis
A
- worsened by movement
- eased by rest
- worse at end of day
3
Q
treatment for osteoarthritis
A
- steroid injections into joint to decrease inflammation
too much = loss of cartilage
intra-articular
moderate to severe pain - NSAIDS/COX-2 inhibitors
- surgery for a replacement
4
Q
Rheumatoid arthiritis
A
- autoimmune, chronic inflam disorder
- rheumatoid disease: damage to body aswell as joints
- joint damage, muscle wastage, deformity of joints
- pain, stiffness, joint swelling
- Lab tests
increased WBC count
increased ESR
anaemia
rheumatoid factor (antibodies to IgG)
5
Q
risk factors
A
- 65-75
- premenopausal: f>m, post m=f
- post partum
- stress
- genetic
- smoking (radicals enhance oxidative stress)
6
Q
pain in RA
A
- improves with movement
- worse on waking
- affects small joints (hands, feet)
- affects bilateral joints ie - both sides (hip, knee)
7
Q
Rheumatoid disease
A
- systemic disease
- autoantibodies against structural proteins in joints and body
- joints
- eyes (50%, inflam)
- skin nodules (feet)
- vasculitis
- lungs
- salivary glands (reduced)
- pericarditis
8
Q
aims of treatment
A
- relive pain
- prevent joint destruction
- preserve/improve functional ability
- DMARDs early (take 3 months to produce max effect)
9
Q
treatment options
A
symptomatic
- analgesia
- NSAIDs (and PPI)
slow progression
- steroids to induce remission (reduce chance of active disease)
- DMARDs to maintain remission (delay progression)
- biologicals (for severe)
10
Q
what are DMARDs
A
disease
modifying
anti
rheumatic
drugs
11
Q
DMARDs - 1st line
A
- start in 3 months (use lowest dose possible)
- can take 3 months to be effective
- use with steroids until effective
- reduce cautiously when symptom control achieved
- monitor: FBC, LFT, look for bruising (DNA cell synthesis inhibited)
12
Q
DMARDs counselling points
A
- dose gradually increased
- monitoring
- nausea
- report blood dyscrasia, liver/lung toxicity - bruising
- bone marrow toxicity
- LFTS, FBC, U&E levels before and during treatment
13
Q
Methotrexate
A
- affects rapidly dividing cells hence why we need low dose or other cells will be affected
- inhibits DNA synthesis and hence turnover of cells
- immune disorder = rapid turnover of cells so we want to inhibit production of immune cells and therefore fewer cytokines will be released and inflam dampened down but we don’t want to inhibit turnover of other cells in body
- Dihydrofolate reductase inhibitor
- immunosuppressant
- 7.5mg to 25mg
- weekly dosing (same time same day)
14
Q
Methotrexate toxicity
A
- nausea
- post dose ‘flu’
- hepatoxicity
- alveolitis/fibrosis
- teratogenic as interacts with folic acid turnover so need to prevent pregnancy when on methotrexate
- GIT effects
- renal toxicity (DON’T take NSAIDs with methotrexate)
- blood disorders (bruising, unexplained bleeding)
- folic acid reduces side effects
15
Q
Methotrexate counselling
A
- weekly dose
- folic acid once weekly or daily but not on same day as methotrexate
- regular blood tests
- contraception
- patient info book about methotrexate (write day down)
- injectable methotrexate - cytotoxic, sharps bins, disposal
