MSK Health Flashcards
Frequency of FBC, U+Es and LFTs monitoring in patients on methotrexate?
Every 1-2 weeks until therapy stabilised, then 2-3 monthly.
Name of criteria used to make clinical diagnosis of complex regional pain syndrome?
Budapest criteria
If a patient with RA is affected by lung fibrosis which area of the lungs would you expect to be affected?
lower lobes
Drugs that can raise plasma urate levels?
diuretics e.g. BFM ACE-Is beta blockers tacrolimus ciclosporin ritonavir pyrizinamide
Treatment of acute gout attack if poor renal function?
PO colchicine-note can be taken for up to 1 week to relieve sx
warn patients about diarrhoea
if normal eGFR could offer NSAID 1st line at max dose and continue for 1-2days after acute attack has resolved
Recommended follow up after acute gout attack?
R/v in 4-6 weeks and:
- check serum urate (optimum time to measure is 2 weeks after acute attack has resolved)
- measure BP
- bloods for HbA1c and lipids and U+Es
- identify and manage DM, HTN, hyperlipidaemia or renal impairment, assess overall CVS risk
- advise smoking cessation, reducing alcohol, weight, diet, exercise
- consider advance px for future gout attacks
- discuss urate lowering therapy
When should allopurinol be considered to start for pt with acute gout?
after 1st attack has resolved, can be considered if attacks so frequent this is not possible
Febuxostat=alternative, ensure LFTs checked before starting
Starting dose of allopurinol for gout?
100mg daily, titrate upwards by 100mg every 4 weeks until serum urate less than 300 micromol/L
also check U+Es every 4 weeks whilst uptitrating
once serum urate in range check levels and U+Es annually
max dose 900mg/day
When can the dose of urate lowering treatment in gout be reduced?
after some years of tx, once serum uric acid below 300 and acute attacks stopped and tophi resolved, can consider reducing to aim serum urate between 300 and 360
For which groups of patients is Vit D supplementation advised?
adults >65yrs
pregnant and breastfeeding women (10mcg/day)
those at risk due to less sun exposure
children aged 6mnths-5yrs (not if on >500mls of formula milk)
How long should women avoid pregnancy for after stopping MTX?
at least 6 months
similarly men should use contraception for at least 6 months post stopping MTX
Sx of meralgia paraesthetica?
paraesthesia over lateral aspect of thigh, caused by entrapment of the lateral femoral cutaneous nerve
If suspect new dx of RA in primary care when should a GP refer and by when should the dx be made in secondary care?
GP referral within 3 working days of presentation and specialist assessment to confirm dx within 3 weeks of referral.
GP to r/f within 3 working days if any of the below present:
-small joints of hands or feet affected
->1 joint affected
-delay of 3 months or more from initial sx to GP presentation.
Initial management of suspected RA in primary care?
Consider NSAID with PPI cover at lowest effective dose for shortest possible time before rheumatology can see patient.
Definition of treat to target in management of RA?
Aim to achieve a target of remission or low disease activity if remission cannot be achieved. DAS-28 >5.1 =high disease activity 3.2-5.1= moderate disease activity 2.6-3.1= low disease activity <2.6= disease remission
As per NICE when should patients with new diagnosis of RA start a DMARD?
Should start conventional DMARD monotherapy e.g. MTX, leflunomide, sulfasalazine, within 6 weeks of referral, with monthly monitoring until treatment target met.
Duration of disabling fatigue for diagnosis of chronic fatigue syndrome/ME?
6 months
