Chapter 10 - Musculoskeletal Systems Flashcards
What can be used for pain and stiffness in rheumatoid arthritis?
NSAIDs
Paracetamol
Codiene
What is a DMARD?
Disease Modifying Antirheumatic Drugs that influence the rheumatic disease process
Name the 11 DMARDs used in rheumatic arthritis?
Methotrexate Cytokine Modulators Azathiprine Ciclosporin Cyclophosphamide Leflunomide Penicillamine Gold Chloroquine Hydrochloroquine Sulfasaline
Name the DMARDS used to treat Psoriatic Arthritis.
Sulfasaline Gold Azathioprine Methotrexate Leflunomide Cytokine modulators
Which DMARDS use do to treat Rhematiod arthritis are not used in Psoriatic Arthritis?
Ciclosporin Cyclophosphamide Penicillamine Chloroquine Hydrochloroquine
What can be used for pain relief in osteoarthritis?
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
When are intra-articulated corticosteroids injections of benefit?
In osteoarthritis esp. if it associated with soft tissue inflammation
Note - its temporary
Name the non-drug measures for osteoarthritis management
Weight-loss
Exercise
Which of the following is NOT recommended for the treatment of osteoarthritis?
a) paracetamol
b) Naproxen
c) Glucosamine
d) Codiene
e) capsaicin 0.025%
c) Glucosamine
What is sodium hyaluronate licensed for?
The relief of pain and optimisation of recovery following ankle sprain and for the relief of chronic pain and disability associated with tennis elbow
How long may hyaluronic acid injections reduce pain for ?
1-6months
However there is a short term increase in knee inflammation
Which is used for symptomatic control in rheumatoid arthritis?
a) DMARDS
b) NSAIDSs
b) NSAIDs
How long does it take for DMARD treatment to reach full therapeutic response?
2 - 6 Months
Which has better efficacy? Methotrexate Sulfasaline IM Gold Penicillamine
TRICK QUESTION
All have similar efficacy
Which may be better tolerated? Methotrexate Sulfasaline IM Gold penicillamine
Methotrexate or sulfasaline
What should be given to a patient with newly diagnosed active Rheumatoid Arthritis?
And within what time frame?
At least 2 DMARDs and a short-term corticosteroid
(Methotrexate + another DMARD)
Ideally within 3 months of the onset of persistent symptoms
Treatment for palindromic rheumatism
Gold / penicillamine
If no benefit is seen, how long before a DMARD is changed to another?
6 months
Gold for the treatment of rheumatoid arthritis
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
If there’s no response seen with Gold treatment after how long should alternative treatment be sought?
2 months
If patient experience a complete relapse whilst on gold therapy should they try again?
No
After complete relapse a second course of Gold is not usually effective
Which of the following has similar action? Methotrexate Cytokine Modulators Azathiprine Ciclosporin Cyclophosphamide Leflunomide Penicillamine Gold Chloroquine Hydrochloroquine Sulfasaline
Gold and Penicillamine
How long until improvement is seen once initiation with penicillamine is started?
6 - 12 weeks
If there’s no response seen with penicillamine treatment after how long should treatment be stopped ?
1 year
How does sulfasaline work?
It suppresses the inflammatory activity of RA
Haematological abnormalities and sulfasaline
Occurs within the first 3 - 6 months of treatment. Reversible in cessation of treatment.
Which antimalarials are used in rheumatoid arthritis, and which is used more frequently?
Hydrochloroquine and chloroquine.
Hydrochloroquine is used more frequently whilst chloroquine in reserved for use if other drugs have failed
For which type of arthritis should chloroquine and hydrochloroquine not be used for?
Psoriatic arthritis
Which two are better tolerated? Gold Hydrochloroquine Chloroquine Penicillamine
Hydrochloroquine and chloroquine are better tolerated than the other two
Retinopathy and antimalarials
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
