Mx of MSK disease Flashcards
What are the core non-pharmacological interventions in people with MSK disease?
Patient education - self efficacy and coping strategies
Exercise - strengthening and aerobic conditioning (improves well-being)
Reduce adverse mechanical factors
Local treatments - heat, cold, acupuncture, pulsed electrical stimulation
Invasive procedures - arthroscopic lavage (not recommended)
Surgery
How can mechanical factors be reduced to reduce symptoms?
Weight loss if obese, modification of work/leisure activities
Pacing of activities related to functional ability
Appropriate footwear - shock absorbing
Walking stick (on contralateral side), aids, appliances
Modification of home environment
What types of surgery are used in MSK disease?
joint surgery for persistent severe pain/disability reconstructive surgery (e.g. rup[tured tendons) removal of inflamed synovium to prevent damage
How do corticosteroids act?
inhibit COX-2, cytokines and ILs
increase annexin-1 production, which has anti-inflammatory effects
What are the widespread side effects of corticosteroids?
infection/poor wound healing peptic ulceration acute adrenal insufficiency upon withdrawal cushing's syndrome DM osteoporosis avascular necrosis psychological effects inter-scapular fat pad
What should be prescribed alongside long term corticosteroids?
PPI
vitamin D
bisphosphonates
What are the benefits of intra-articular injections?
can have a diagnostic and therapeutic effect
injections into joints/periarticular structures provide pain relief
How can intra-articular injections be diagnostic?
the preparation often contains local anaesthetic and so if pain resolves within a short period of time, we can reasonably confident that the pain is coming from the structure injected
What are the disadvantages of intra-articular injections?
do not repeat more than 3 in 6 months
there can be systemic absorption and side effects
What are the benefits of physiotherapy in MSK disease?
aerobic training - reduces pain and disability, improves restorative and helps with weight loss
Local strengthening exercises - can reduce pain and disability over compromised joints
What is a DMARD?
disease monitoring anti rheumatic agents
eg methotrexate, sulfasalazine, hydroxychloroquine, penicillamine and gold compounds
When are DMARD drugs used?
initiated as soon as a diagnosis of inflammatory arthritis is reached, they reduce pain score, disability score and RF level
How do DMARDs act?
clinical effect is slow so steroids are used to ‘cover’ the induction phase
What is combination therapy?
two drugs used together generally appear superior to monotherapy.
for example: methotrexate plus hydroxychloroquine for less severe / methotrexate plus for more severe presentations
How is methotrexate given?
once weekly dosing (oral/IM)
folic acid should be taken on the other days
