Drugs & Doses: Rheumatology

Question 1

Acute Gout Treatment

Answer 1

NSAID eg Ibuprofen 400mg oral 8 hrly for 3-5 days OR
Pred 15mg daily for 5 days OR
Colchicine 1mg oral then 0.5mg 1 hour later as a single one day course

Question 2

Long-Term Gout Prophylaxis

Answer 2

Allopurinol (start/continue) – start LOW + titrate up – 50-100mg daily for 2-3 weeks then increase

• Max dose 900mg daily, average 300mg (lower for renal failure)
• Aim urate <0.36 or <0.3 if gouty top
• If not enough, add probenecid 250mg BD and titrate up to max 2g daily

Flare prophylaxis - colchicine has best evidence - 500mcg 1-2x/day, at least 6 mos

Question 3

Polymyalgia Rheumatica Treatment

Answer 3

Prednisolone oral 15mg/day for 4 wks, then reduce by 2.5mg every 4 wks until 10mg daily, then reduce daily by 1mg every 4-8 wks then stop (treat for 12 months)

SOME need Methotrexate start at 10mg then up to 25mg weekly PLUS 5-10mg weekly folate

Question 4

Rheumatoid Arthritis Management

Answer 4

Methotrexate – weekly PO/SC, 10mg up to 25mg
- Leflunomide if MTX CI’d
+ Folate 5-10mg

And/Or
DMARDS – including biologics
- Hydroxychloroquine, sulfasalazine or leflunomide

Question 5

Giant Cell Arteritis Management

Answer 5

Prednisolone 40-60mg daily (in 2 doses) for minimum 4 weeks then tapering regime over several months (If visual loss - IV Methylprednisolone 0.5-1g over an hour daily for 3 days first)

Aspirin 100mg daily

SOME – need Methotrexate also start 10mg then increase to 25mg weekly PLUS 5-10mg folate/wk

Question 6

Acute Rheumatic Fever Treatment (+ if allergies? + prophylaxis)

Answer 6

Benzathine penicillin 900mg IM single dose (kids <20kg: 450mg) OR
Phenoxymethylpenicillin oral 500mg BD x 10 days (kids 15mg/kg)
Azithromycin if allergies
PLUS aspirin 50-60mg/kg day for arthralgia

Prophylaxis - monthly IM benzathine penicillin until >21yo or for at least 10yrs, whichever is greater
- 900mg (>20kg), 450mg (<20kg)

Question 7

Angioedema Treatment

Answer 7

Prednisone 25-50mg daily for 3/7

Question 8

Raynauds Treatment

Answer 8

Nifedipine CR 30-120mg 
OR
Amlodipine 5-10mg daily
OR
GTN 2% ointment topically

Question 9

Chillblains Treatment

Answer 9

Betamethasone diproprionate 0.05% BD w/ or without occlusive dressing
Nifedipine CR 20-60mg daily
Evidence lacks for GTN

Question 10

Erythromelalgia Treatment

Answer 10

Aspirin 300mg

Can also treat as per neuropathic pain

Question 11

SLE Treatment

Answer 11

Hydroxychloroquine 200-400mg daily

Question 12

Kawasaki’s Disease Treatment

Answer 12

Aspirin 3-5mg/kg, minimum 6/52 until normal ECHO f/u

IV Ig 2g/kg

Question 13

Erythema Nodosum Treatment

Answer 13

Prednisone 25mg daily for 2/52, then taper