Management

Question 1

Ankylosing Spondylitis (3)

Answer 1

1. Encourage exercise

1st Line:
2. NSAIDS

2nd Line:
3. TNF-a Inhibitors (etanercept and adalimumab)

Remember: DMARDS only work for peripheral joint involvment

Question 2

APS (Antiphospholipid Syndrome) (3)

Answer 2

Primary PPx:
1. Low-Dose Heparin

Secondary PPx:
2. Warfarin Lifelong - INR target 2-3

If still thrombus on Warfarin - Add:

3. Aspirin - increase INR to 3-4

Question 3

Discoid Lupus Erethematous (3)

Answer 3

1. Topical Steroids
2. Anitmalarias like hydroxychloroquine
3. Avoid sun exposure

Question 4

Septic Arthritis (1)

Answer 4

1. Abx for 4-6 weeks

Question 5

Reactive Arthritis (4)

Answer 5

1. Simple Analgesia
2. NSAIDS
3. Intraarticular Steroids

FOR PERSISTENT DISEASE:
4. DMARS - Sulfasalazine or Methotrexate

symptoms rarely last beyond a year

Question 6

PMR - Polymyalgia Rheumatica (1)

Answer 6

1. Prednisolone 15mg / od

Respone to steroids is absolutely MAGICAL, if they fail to respond, it’s almost certainly the wrong Diagnosis

Question 7

Gout Flare for patients already on Allopurinol (1)

Answer 7

1. Don’t stop it and do as normal - Colchicine

Question 8

Acute Flares of RA (1)

Answer 8

1. Oral or IM Corticosteroids like - Methyprednisolone IM

Question 9

Rheumatoid Arthritis (5)

Answer 9

1st Line:
1. MONOTHERAPY DMARD - Mrhtotrexate
AND
2. A short bridging course of steroids - Prednisolone

2nd Line:
2. SWAP methotrexate another monotherapy DMARD - Sulfasalazine, leflunomide, hydroxychloroquine

3rd Line:
3. TNF-a inhibitors: like Enterecept or Infliximab

4th Line:
4. Rituximab - anti cd20 which reduces B-Cell number/activity

5. All the while, offer physio etc…

Question 10

Psoriatic Arthritis (4)

Answer 10

1. NSAIDS (if mild)
2. DMARDS - Methotrexate if moderate - severe
3. Ustekinumab - Il-2 and 23 inhibitor
4. PDE4 inhibitor - Aprelimast