Managing MSK disease

Question 1

What are non pharmacological interventions for patients with MSK disease?

Answer 1

Education
Physiotherapy
Reduction of adverse mechanical factors
Physical treatments
Coping strategies
Weight loss

Question 2

How do corticosteroids work?

Answer 2

Inhibit transcription of COX2, cytokines and interleukins

Increase annexin 1 production that has anti-inflammatory effects

Question 3

What are side effects of corticosteroids?

Answer 3

Infection/poor wound healing
Peptic ulceration
Acute adrenal insufficiency if suddenly withdrawn
DM
Osteoporosis
Avascular necrosis
Psychological effects e.g. depression

Question 4

What are intra-articular injections?

Answer 4

Can have diagnostic and therapeutic effect
Do not repeat >3 times in 6 months
Help with pain relief
Contains LA so if pain subsides quickly then can be certain this was source of pain

Question 5

What is the method of action of Methotrexate and what are the side effects?

Answer 5

1st line DMARD
Folic acid antagonist
Once weekly dosing
Folic acid supplments on other days

Common side effects

• nausea
• headaches
• tingling

Toxicity- bruising, infection, SoB

Must monitor LFTs, FBC and U&Es every 10wks once settled

Not suitable in pregnancy

Question 6

What is the method of action and side effects of suldasalazine?

Answer 6

Takes approx 8wks to have a response
FBC, U&Es, LFTs monitored monthly for first 3 months

Side effects

• nausea
• dyspepsia
• rashes
• blood dyscrasia- abnormal condition of blood
• azoospermia
• yellow/orange discolouration of urine

Question 7

What is the method of action and side effects of hydroxychloroquine?

Answer 7

Least effective but least toxic
takes 6wks for response
Monitor for baseline visual acuity

Side effects

• rash
• GI disturbances
• peripheral neuropathy
• retinal damage

Question 8

What are the risks and side effects of biologic therapy?

Answer 8

Anti-TNF agents most common

Contraindications

• active infection
• latent TB
• malignancy
• pulmonary fibrosis
• severe heart failure

Adverse effects

• oppurtunistic infections
• non-melanoma skin cancer
• injection site reactions

Must ensure patient is vaccinated each year

Present early and treat aggressively

Question 9

What are general indications and complications of soft tissue/joint surgery?

Answer 9

General contra indications include active infection or recurrently infected joint

Complications

• wound infection
• DVT
• MI
• Local neurovascular surgery
• Compartment syndrome
• periprosthetic fracture
• complex regional pain syndrome