Musculoskeletal System Flashcards
What is rheumatoid arthritis
Chronic systemic inflammatory disease affecting the joint synovial membrane
Pain and stiffness worsen with rest, inactivity and heat in the joints
- symptoms includes nodules, swelling, tenderness, malaise, fatigue, fever and weight loss
What is the non-drug therapy for rheumatoid arthritis
Physiotherapy, exercise, relaxation and stress management
What is the drug treatment for rheumatoid arthritis
Drug therapy is DMARDs:
First line: Methotrexate, leflunomide or sulfasalazine (hydroxychloroquine in mild)
Second line: MoAbs: adalimumab, etanercept, infliximab, toclizumab, baricitinib
Bridge with corticosteroids when rapid suppression is needed
NSAIDs can be used as a pain relief- withdraw when response to DMARDs is enough
Can you give methotrexate and ibuprofen together
OTC definitely not
But prescription can be issued
What is methotrexate
Taken once weekly
Prescription and the label should be clearly shown the dose and the frequency
Methotrexate is commonly co-prescribed with folic acid
- not to be taken the same day as each other either 24 after or 24 hours before and must be taken on the same day every week
Patients should advised to immediately report and signs of blood disorders, liver toxicity and respiratory effects
What are the side effects of methotrexate
Blood disorders
- sore throats, bruising and mouth ulcers
Liver toxicity
-nausea, vomiting, abdominal pain discomfort, dark urine, jaundice and itchy skin
Pulmonary toxicity
-SOB and coughing
Gastro intestinal toxicity
- stomatitis and diarrhoea
What is the toxicity antidote
Folinic acid
(Calcium folinate)
What is the monitoring requirement and screening of methotrexate
Full blood count, renal function test, liver function tests:
- every 1-2 weeks until stable
- every 2-3 months thereafter
Screen out pregnancy prior to the treatment
-anti folate- harmful for the foetus development
- use effective contraception during treatment and for at least 6 months after for both men and women
What are the interactions of methotrexate
Nephrotoxic drugs (methotrexate reduces renal function)
-NSAIDs: no over the counter ibuprofen
Anti-folate
- trimethoprim and phenytoin and cotrixamole
Hepatotoxic drugs
-rifampicin, antifungals etc
Omeprazole and esomeprazole
- reduces clearance- increases toxicity
What is meant by hyperuricaemia and gout
Raised uric acid concentration in the blood ( hyperuricaemia) and the deposition of irate crystals in joints and other tissues
Can be caused by:
- diet (high salt intake)
-medications such as bendroflumethiazide and chemotherapy drugs
What treatment has exacerbated someone’s gout
Bendroflumethiazide
What is the treatment acute gout
Start treatment as soon as possible
Treat with colchicine or high dose of NSAID + PPI (excluding aspirin)
- colchicine: 500mcg 2-4 times max 3 days - do not repeat course within 3 days
NSAIDs induces fluid retention (interaction with diuretics ) and you would use colchicine instead
Alternative:
- short course of oral corticosteroid
- IM injection of corticosteroid or canakinumab
What is the treatment for chronic gout
Offered in frequent acute attacks of gout (2 or more in a year)
Uric acid maybe induced with xanthine-oxidase inhibitors
First line: allopurinol
Second line: febuxostat
If acute attack happens during treatment, continue chronic treatment as well as treating the acute attack treated separately
What is allopurinol
When starting, flare-prophylaxis with colchicine/ NSAID is recommended
Common side effects: rash
- discontinue- if mild restart carefully but stop immediately if it reoccurs
Interactions of allopurinol
Allopurinol + azathioprine/ mercaptopurine
- reduces dose of aza/merc
What is nocturnal leg cramps
Use Quinine sulphate- may reduce the frequency of nocturnal leg cramps
Potential toxicity- quinine is not routinely recommended
- use if cramps regularly disrupt sleep, are very painful or other treatment hasn’t worked
- trial for 4 weeks , if there is benefit then continue
Stop treatment every 3 months as assess need for further treatment
