Management of MSK disease

Question 1

What type of pain are A fibres responsible for

Answer 1

Sharp, immediate pain

Question 2

Sensory pathway to brain

Answer 2

Neurons –> dorsal root
Ascend in posterior column
–> Spinothalamic tract
–> thalamic pathway

Question 3

Which pathway mediates emotional response to pain?

Answer 3

Thalamic pathway

Question 4

How can patients increased self-management of chronic MSK pain?

Answer 4

Self-assessment
Information
Problem solving

Question 5

Mechanism of action Corticosteroids

Answer 5

Inhibit COX-2, CK and ILS

Incr annexin-1 (anti-inflammatory)

Question 6

SE corticosteroids (7)

Answer 6

Infection/decr wound healing 
Peptic ulcer
Acute adrenal insufficiency (when withdrawn)  
Cushings
DM
OP
Avascular necrosis

Question 7

To avoid SE, what must you co-prescribe with Corticosteroids? (3)

Answer 7

PPI
Vit D
Bisphosphonates

Question 8

How do intra-articular injections have a diagnostic effect?

Answer 8

If pain decreases post injection - you know you have got the right area of damage

Question 9

What are the 2 types of intra-articular injection?

Answer 9

Directly into joint

Peri-articular

Question 10

What does DMARD stand for

Answer 10

Disease modifying anti-rheumatic drugs

Question 11

E.g.s of DMARDS (5)

Answer 11

Methotrexate
Sulfasalazine
Hydroxychloroquine
Penicillamine 
Gold

Question 12

3 ways DMARDS help people with rheumatoid arthritis

Answer 12

Decr pain
Decr disability
Decr RF level

Question 13

Is monotherapy or combination therapy better for DMARDS?

Answer 13

Combination therapy

Question 14

‘Light’ combination therapy DMARDS

Answer 14

Methotrexate + hydroxychloroquine

Question 15

‘Severe’ combination therapy DMARDS

Answer 15

Methotrexate

Sulfasalzine

Question 16

Mechanism of action Methotrexate

Answer 16

Folic acid antagonist

Question 17

How fast is methotrexate’s onset?

Answer 17

Fast - fastest of DMARDS

Question 18

How often is methotrexate taken?

Answer 18

Once weekly

Question 19

Adjunct to methotrexate

Answer 19

Folic acid (6x a week)

Question 20

Warning signs RE toxicity Methotrexate (3)

Answer 20

Bruising
Infection
SOB

Question 21

How methotrexate is monitored

Answer 21

Monthly FBC LFT U+E

Then 10w

Question 22

SE Methotrexate (3)

Answer 22

Nausea
Headache
Tingling

Question 23

How long does Sulfasalazine take to make a difference?

Answer 23

8 weeks

Question 24

What must you monitor monthly for the first 3 m wit h Sulfasalazine?

Answer 24

FBC
LFT
U+E

Question 25

SE Sulfasalazine? (6)

Answer 25

Nausea
Dyspepsia 
Rashes
Blood dyscrasias
Azoospermia 
Yellow-orange urine

Question 26

Which DMARD is the least effective?

Answer 26

Hydroxychloroquine

Question 27

Which DMARD is the least toxic?

Answer 27

Hydroxychloroquine

Question 28

How long does Hydroxychloroquine take to make a difference?

Answer 28

6 weeks

Question 29

What must you monitor for Hydroxychloroquine ?

Answer 29

Baseline VA

Annually re-check

Question 30

SE Hydroxychloroquine (3)

Answer 30

Rash
GI upset
Peripheral neuropathy

Question 31

C/I Biologics (5)

Answer 31

Active infection 
Latent TB
Malignancy 
Pulmonary fibrosis 
Heart failure

Question 32

Adverse effects biologics (3)

Answer 32

Opportunistic infections
Non-melanoma skin cancer
Injection site reaction

Question 33

What must you check prior to starting biologics?

Answer 33

CXR for TB

Question 34

Who are neuropharmaceuticals most useful for?

Answer 34

Chronic back pain/fibromyalgia