Management of MSK Disease Flashcards
What are the benefits of education in the management of MSK disease and how is it done?
Proven to reduce pain/disability
Reduces healthcare costs of many MSK conditions
1-1 discussion/written literature/group classes
What are the benefits of physiotherapy in the management of MSK disease and how is it done?
Aerobic training = reduces pain/disability, improve sleep, aids wt loss
Local strengthening exercises = reduces pain/disability
What are the benefits of reducing adverse mechanical factors in the management of MSK disease and how is it done?
Pacing of activities related to functional ability
Shock-absorbing footwear to reduce impact loading
Contralateral walking sticks take wt off damaged joints
What are the benefits of physical treatments in the management of MSK disease and how are they done?
Local heat/cold treatments provide temporary relief
What are the benefits of coping strategies in the management of MSK disease and how are they done?
Relaxation techniques, distraction techniques improve pain
What is the MoA of Corticosteroids?
Inhibit transcription of COX-2, cytokines, ILs
Increase annexin-1 production, anti-inflammatory effects
What are the side effects of Corticosteroids?
Infection/poor wound healing Peptic ulceration Acute adrenal insufficiency upon withdrawal Cushing's syndrome Diabetes mellitus Osteoporosis Avascular necrosis Psychological effects Inter-scapular fat pad
What is the preferred Corticosteroid for MSK disease?
IM methylprednisolone
-depot effect that self-tapers down
What should patients on long-term Corticosteroids be co-prescribed?
Gastro protection (PPIs)
Vit D
Bisphosphonates
What is the benefit of intra-articular injections?
Diagnostic & therapeutic effect
- preparation contains LA, if pain resolves w/i short period of time can be confident pain coming from structure
- do not repeat 3x in 6mo
- systemic absorption/side effects possible
What are DMARDs?
Disease modifying anti-rheumatic drugs
- Methotrexate
- Sulfasalzine
- Hydroxychloroquine
- Penicillamine
- Gold compounds
What are the benefits of DMARDs?
Reduces pain/disability score & RF level
How are DMARDs initiated?
As soon as diagnosis of inflammatory arthritis reached
Clinical effect slow
-steroids used to cover induction phase
Combination therapy superior
What is Methotrexate?
1st line DMARD
Folic acid antagonist
What are the benefits of Methotrexate?
Quick onset of action
Once weekly dosing (oral/IM)
-take folic acid on any other day
What are the signs of Methotrexate toxicity?
Bruising
Infection
SOB
What are the common side effects of Methotrexate?
Nausea
Headaches
Tingling
How should Methotrexate treatment be monitored?
Bloods every 10wks
- FBC
- LFTs
- U&Es
In which pts is Methotrexate unsuitable?
Pregnancy
Males /Females attempting to conceive
How long does Sulfasalazine take to produce a response?
8wks
What are the common side effects of Sulfasalazine?
Nausea & dyspepsia Rashes Blood dyscrasias Azoospermia Yellow-orange discolouration of urine/contact lenses
How should Sulfasalazine treatment be monitored?
3 monthly
- FBC
- LFTs
- U&Es
How long does Hydroxychloroquine take to produce a response?
6 wks
-least effective, least toxic
How should Hydroxychloroquine treatment be monitored?
Baseline visual acuity
Annual re-check
What are the common side effects of Hydroxychloroquine?
Rash
GI disturbances
Peripheral neuropathy
Retinal damage
What are the most common biologics?
Anti TNF agents
- Infliximab
- Etanarcept
What are the contraindications to the use of biologics?
Active infection Latent TB Malignancy Pulmonary fibrosis Severe heart failure
What are the common adverse effects of biologics?
Opportunistic infections
Non-melanoma skin cancers
Injection site reactions
How should the risk of infections be managed when treating patients with biologics?
Vaccinate patients each year
CXR require to exclude TB prior to commencing treatment
Present early if signs of potential infection
What are the general contraindications to performing surgery in MSK disease?
Actively infected joint
Recurrently infected joint
What are the general complications of orthopaedic surgery?
Wound infection DVT MI Local neurovascular injury Compartment syndrome Periprosthetic fracture Complex regional pain syndrome
In which patients are nutripharmaceuticals & alternative medicines most useful?
Pts w/ complaints of chronic back pain/fibromyalgia w/ no demonstrable pathological cause
What alternative techniques are available for the management of MSK disease?
Glucosamine for OA Chiropody & Osteopathy Relaxation techniques Acupuncture Massage
