Chapter 10 - Musculoskeletal Systems

Question 1

What can be used for pain and stiffness in rheumatoid arthritis?

Answer 1

NSAIDs
Paracetamol
Codiene

Question 2

What is a DMARD?

Answer 2

Disease Modifying Antirheumatic Drugs that influence the rheumatic disease process

Question 3

Name the 11 DMARDs used in rheumatic arthritis?

Answer 3

Methotrexate 
Cytokine Modulators 
Azathiprine 
Ciclosporin 
Cyclophosphamide 
Leflunomide
Penicillamine 
Gold
Chloroquine 
Hydrochloroquine 
Sulfasaline

Question 4

Name the DMARDS used to treat Psoriatic Arthritis.

Answer 4

Sulfasaline 
Gold
Azathioprine 
Methotrexate 
Leflunomide
Cytokine modulators

Question 5

Which DMARDS use do to treat Rhematiod arthritis are not used in Psoriatic Arthritis?

Answer 5

Ciclosporin 
Cyclophosphamide 
Penicillamine 
Chloroquine 
Hydrochloroquine

Question 6

What can be used for pain relief in osteoarthritis?

Answer 6

Paracetamol first - can be taken regularly
Then topical NSAIDs or topical capsaicin 0.025% (particularly in knee and hand osteoarthritis)
Oral NSAIDS can then substitute or be used in addition to paracetamol
If further pain relief is required then consider an opioid

NOTE: an opioid analgesic should be considered BEFORE an NSAID is the patient is on long term low dose aspirin

Question 7

When are intra-articulated corticosteroids injections of benefit?

Answer 7

In osteoarthritis esp. if it associated with soft tissue inflammation
Note - its temporary

Question 8

Name the non-drug measures for osteoarthritis management

Answer 8

Weight-loss

Exercise

Question 9

Which of the following is NOT recommended for the treatment of osteoarthritis?

a) paracetamol
b) Naproxen
c) Glucosamine
d) Codiene
e) capsaicin 0.025%

Answer 9

c) Glucosamine

Question 10

What is sodium hyaluronate licensed for?

Answer 10

The relief of pain and optimisation of recovery following ankle sprain and for the relief of chronic pain and disability associated with tennis elbow

Question 11

How long may hyaluronic acid injections reduce pain for ?

Answer 11

1-6months

However there is a short term increase in knee inflammation

Question 12

Which is used for symptomatic control in rheumatoid arthritis?

a) DMARDS
b) NSAIDSs

Answer 12

b) NSAIDs

Question 13

How long does it take for DMARD treatment to reach full therapeutic response?

Answer 13

2 - 6 Months

Question 14

Which has better efficacy?
Methotrexate 
Sulfasaline
IM Gold
Penicillamine

Answer 14

TRICK QUESTION

All have similar efficacy

Question 15

Which may be better tolerated?
Methotrexate 
Sulfasaline 
IM Gold
penicillamine

Answer 15

Methotrexate or sulfasaline

Question 16

What should be given to a patient with newly diagnosed active Rheumatoid Arthritis?

And within what time frame?

Answer 16

At least 2 DMARDs and a short-term corticosteroid
(Methotrexate + another DMARD)

Ideally within 3 months of the onset of persistent symptoms

Question 17

Treatment for palindromic rheumatism

Answer 17

Gold / penicillamine

Question 18

If no benefit is seen, how long before a DMARD is changed to another?

Answer 18

6 months

Question 19

Gold for the treatment of rheumatoid arthritis

Answer 19

Given IM and the area gently massaged.
Test dose first, then dosing at weekly intervals until definite evidence of remission.

In patients who respond, the interval between injections should be increased to 4 weeks and treatment continued for up to 5 years after complete remission

If relapse occurs decrease dosing frequency

Question 20

If there’s no response seen with Gold treatment after how long should alternative treatment be sought?

Answer 20

2 months

Question 21

If patient experience a complete relapse whilst on gold therapy should they try again?

Answer 21

No

After complete relapse a second course of Gold is not usually effective

Question 22

Which of the following has similar action?
Methotrexate 
Cytokine Modulators 
Azathiprine 
Ciclosporin 
Cyclophosphamide 
Leflunomide
Penicillamine 
Gold
Chloroquine 
Hydrochloroquine 
Sulfasaline

Answer 22

Gold and Penicillamine

Question 23

How long until improvement is seen once initiation with penicillamine is started?

Answer 23

6 - 12 weeks

Question 24

If there’s no response seen with penicillamine treatment after how long should treatment be stopped ?

Answer 24

1 year

Question 25

How does sulfasaline work?

Answer 25

It suppresses the inflammatory activity of RA

Question 26

Haematological abnormalities and sulfasaline

Answer 26

Occurs within the first 3 - 6 months of treatment. Reversible in cessation of treatment.

Question 27

Which antimalarials are used in rheumatoid arthritis, and which is used more frequently?

Answer 27

Hydrochloroquine and chloroquine.

Hydrochloroquine is used more frequently whilst chloroquine in reserved for use if other drugs have failed

Question 28

For which type of arthritis should chloroquine and hydrochloroquine not be used for?

Answer 28

Psoriatic arthritis

Question 29

Which two are better tolerated?
Gold
Hydrochloroquine 
Chloroquine 
Penicillamine

Answer 29

Hydrochloroquine and chloroquine are better tolerated than the other two

Question 30

Retinopathy and antimalarials

Answer 30

Rarely occurs provided that the recommended doses are not exceeded.

Note: in the elderly it is difficult to distinguish drug-induced retinopathy from changes of aging