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Advanced MSK - physio > medical management > Flashcards

medical management Flashcards

1
Q

what are the key features of RA?

A

-symmetrical - ie affect both joints
-pain in small joint of hands
-swelling
-morning stiffness more than 1 hr
-rheumatoid factor / CCP

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2
Q

what are the main causes of death of patients w/ RA?

A

-main cause is heart attacks and stroke
-Rx reduces this risk

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3
Q

what is a disease activity score?

A

numerical tool for quantifying and assessing disease activity in rheumatoid arthritis (RA)
-asseses 28 joints, takes into account a blood marker of inflammation eg CRP or ESR & patients are asked to rate their disease activity and overall health on numerical scale (0-10)

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4
Q

what values of DAS indicate remission, low activity, moderate and high activity?

A

-remission - less than 2.6
-2.6-3.1 - low disease state
-3.2-5.1- moderate
more than 5.1= high disease activity

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5
Q

what enzyme do NSAIDS target ?

A

they inhibit cyclooxygenase

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6
Q

what are the main hand joints affected in RA?

A

the PIP and MC joints
not DIP (that’s OA)

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7
Q

what drugs are prescribed to treat symptoms for RA?

A

-NSAIDS - symptomatic relief
-low dose prednislone (steroid) - risk of OP w/ long term use - so add Ca, vit D or biophosphonates
-intraarticular / parenteral steroids- for flare ups

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8
Q

why do NSAIDS cause gastric side effects?

A

because NSAIDS reduce prostaglandins by blocking COX-1, thereby impairing mucus and bicarbonate production and adversely affecting acid secretion and blood flow in the stomach

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9
Q

what conditions does glucocorticoids treat?

A

-used in almost all inflam cond eg RA, gout, asthma, IBD etc

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10
Q

what are examples of Side effects of glucocorticoids?

A

-glucose intolerance
-HTN
-obesity
-thinning of skin
-osteoporosis
-infection
-cataract formation
-peptic ulcer disease

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11
Q

what drugs can be used to reduce the need for NSAIDS and steroids?

A

DMARDS & biologics

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12
Q

what are DMARDS?

A

-disease modifying anti-rheumatic drugs
-they modify the course of the disease, reduce joint damage & deformity, reduce long term disability

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13
Q

what is the therapeutic strategy for DMARDS?

A

-start with mono therapy - methotrexate
-if mono therapy dosent work, combinations of DMARDS +/- biologic agents

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14
Q

what are examples of DMARDS?

A

-methotrexate
-sulfasalazine
-hydroxychloroquine
-leflunomide

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15
Q

why is methotrexate normally given with a folic acid supplement?

A

as the med blocks folic acid metabolism

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16
Q

what cells does methotrexate affect?

A

cells that rapidly turnover
eg mucosal cells, hair follicles, immune cells

hence the side effects

17
Q

what are examples of side effects of methotrexate?

A

-alopecia
-mouth ulcers
- GI problems eg nausea
-hepatotoxicity

18
Q

what is the dose of methotrexate?

A

once a week

19
Q

what are things that need to be avoided with methotrexate?

A

-alcohol consumption needs to be reduced
-needs to be stopped at least 3 months before conception / pregnancy

20
Q

what is an example of a biologic used for RA?

A

-anti TNF therapy
-target tumour necrosis factor

21
Q

what are the side effects of TNF therapy?

A

-infection (patients w/ co-morbidities)
-TB
-antibody formation - autoimmune disease eg SLE
-neuro - MS, seizures, inflammation

22
Q

how does B cell depletion therapy work?

A
  • B cells cannot act as an antigen presenting cell to activate T cells
    -they can’t produce RF
    -they cant release cytokines
23
Q

what is an example of anti b cell therapy?

A

rituximab

24
Q

what are the main principles of RA management?

A

-patient education
-symotomatic relief
-turn off inflammation
-early use of DMARDs
-measure of inflammation and disease activity
-treat to target if remission or low disease state
-minimise medication

25
Q

do DMARDS work for spinal inflammation?

A

no

26
Q

what are examples of seronegative arthritis?

A

-psoriatic arthritis
-reactive arthritis
-ankylosing spondylitis (spine)
-enteropathic arthritis

27
Q

what is the first line biologic Rx for inflammatory spinal disease?

A

-anti TNF

28
Q

other than anti-TNFs, what are other Rx for inflammatory spinal disease?

A

-NSAIDS - reduce disease progression
-intensive physio - home exercise for flexibility

29
Q

what does BASDAI stand for?

A

Bath Ankylosing Spondylitis Disease Activity Index (BASDAI)
questionnaire

Advanced MSK - physio (23 decks)

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