Autoimmune diseases Flashcards
Clinical features of rheumatoid arthritis
- Insidious onset of pain
- Stiffness and swelling in the small joints of the hands and feet
- Most high in the morning up on waking
- Spindling of the fingers
Analgesia of RA
- Paracetamol with or without weak opioid
- NSAIDs
Corticosteroids for RA
Prednisolone 7.5mg for 2-4 years after which treatment should be tapered off to reduce long-term effects.
Intra articular injection injected locally.
Acute inflammatory reaction develops occassionally.
DMARDs for RA
Should be used within 3-6 month of onset to prevent long term irreversible effects.
- Methotrexate, pencillamine and azathioprine are most effective
- Methotrexate is first choice
- Hydroxychloroquine, sulfasalazine and auranofin are less effective but safer
1st line for RA
Methotrexate or sulfasalazine
2nd line for RA
Methotrexate and sulfasalazine
Clinical features of osteoarthritis
- Pain which is made worse by movement and relieved by rest
- Stiffness occurs after sitting down for a short period and waking in morning
- Creaking and cracking in joints related to movement
Self-management for osteoarthritis
- Exercise
- Weight loss if overweight/obese
- Use of suitable footwear
- Application of heat/cold packs to site of pain
Analgesia for osteoarthritis
- Paracetamol
- TopicalNSAIDs
- Oral NSAIDs
- Opioids
Treatment for osteoarthritis
- Topical capsaicin
- Intra-articular corticosteroid injections
Clinical features of gout
- Pain in the affected joint
- Reddening of surrounding skin which feels hot and may look shiny
- Attack commonly starts during night or early hours
- May also be accompanied by a fever, leucocytosis, raised ESR and CRP
Treatment options for gout
- NSAIDs
- Colchicine
- Corticosteroids
- Monoclonal antibodies
NSAIDs in gout
- Diclofenac, Indometacin, Ketoprofen, Naproxen, Sulindac, Etoricoxib
- Aspirin should be avoided as it causes uric acid retention
- Usually required for 7-14 days
Long-term control of gout
Allopurinol
- Inhibits uric acid formation by inhibiting xanthine oxidase
- Preferably after food
Febuxostat - stop in cases of severe hypersensitivity reactions
Sulfinpyrazone - instead of or in combination with allopurinol (CI in patients with renal failure or uric acid stones in kidney)
Osteoporosis treatment
Alendronic acid
Tablet swallowed whole with plenty of water, 30 minutes before breakfast
