Management of MSK disease Flashcards
What type of pain are A fibres responsible for
Sharp, immediate pain
Sensory pathway to brain
Neurons –> dorsal root
Ascend in posterior column
–> Spinothalamic tract
–> thalamic pathway
Which pathway mediates emotional response to pain?
Thalamic pathway
How can patients increased self-management of chronic MSK pain?
Self-assessment
Information
Problem solving
Mechanism of action Corticosteroids
Inhibit COX-2, CK and ILS
Incr annexin-1 (anti-inflammatory)
SE corticosteroids (7)
Infection/decr wound healing Peptic ulcer Acute adrenal insufficiency (when withdrawn) Cushings DM OP Avascular necrosis
To avoid SE, what must you co-prescribe with Corticosteroids? (3)
PPI
Vit D
Bisphosphonates
How do intra-articular injections have a diagnostic effect?
If pain decreases post injection - you know you have got the right area of damage
What are the 2 types of intra-articular injection?
Directly into joint
Peri-articular
What does DMARD stand for
Disease modifying anti-rheumatic drugs
E.g.s of DMARDS (5)
Methotrexate Sulfasalazine Hydroxychloroquine Penicillamine Gold
3 ways DMARDS help people with rheumatoid arthritis
Decr pain
Decr disability
Decr RF level
Is monotherapy or combination therapy better for DMARDS?
Combination therapy
‘Light’ combination therapy DMARDS
Methotrexate + hydroxychloroquine
‘Severe’ combination therapy DMARDS
Methotrexate
Sulfasalzine
Mechanism of action Methotrexate
Folic acid antagonist
How fast is methotrexate’s onset?
Fast - fastest of DMARDS
How often is methotrexate taken?
Once weekly
Adjunct to methotrexate
Folic acid (6x a week)
Warning signs RE toxicity Methotrexate (3)
Bruising
Infection
SOB
How methotrexate is monitored
Monthly FBC LFT U+E
Then 10w
SE Methotrexate (3)
Nausea
Headache
Tingling
How long does Sulfasalazine take to make a difference?
8 weeks
What must you monitor monthly for the first 3 m wit h Sulfasalazine?
FBC
LFT
U+E
SE Sulfasalazine? (6)
Nausea Dyspepsia Rashes Blood dyscrasias Azoospermia Yellow-orange urine
Which DMARD is the least effective?
Hydroxychloroquine
Which DMARD is the least toxic?
Hydroxychloroquine
How long does Hydroxychloroquine take to make a difference?
6 weeks
What must you monitor for Hydroxychloroquine ?
Baseline VA
Annually re-check
SE Hydroxychloroquine (3)
Rash
GI upset
Peripheral neuropathy
C/I Biologics (5)
Active infection Latent TB Malignancy Pulmonary fibrosis Heart failure
Adverse effects biologics (3)
Opportunistic infections
Non-melanoma skin cancer
Injection site reaction
What must you check prior to starting biologics?
CXR for TB
Who are neuropharmaceuticals most useful for?
Chronic back pain/fibromyalgia
