Rheum

Question 1

ank spond management

Answer 1

Analgesia
Omeprazole if on NSAIDs
Methotrexate for peripheral disease
Biologics: etanercept (TNFa), secukinumab (Il17)
?Jakinib
Surgical: Hip replacement

Question 2

Osteoarthritis management

Answer 2

analgesia
Physio/hand therapy
Aids for daily living
Injected steroids/hyaluronic acid

consider surgery

Question 3

Acute gout management

Answer 3

NSAIDs (naproxen)
Colchicine
Prednisolone
Anakinra injection

Question 4

Chronic gout management

Answer 4

Low purine diet
weight loss and EtOH avoidance
Allopurinol
Consider uricosuric agents (probenecid)

Question 5

Rheumatoid Arthritis Management

Answer 5

Analgesia + omeprazole
Steroids (pred)
DMARDs (MTX, HCQ, SSZ)
Biologics (etanercept, infliximab)
JAK inhibitors (Jakinib)

Question 6

Psoriatic arthritis management

Answer 6

Physio
Smoking, alcohol, weight loss
Analgesia
Steroids + vitamin D analogues (calcitriol)
DMARDs (Methotrexate, sulfasalazine etc.)
Biologics (etanercept, infliximab etc.)

For skin: emollients, phototherapy

Question 7

Reactive arthritis management

Answer 7

Analgesia

Steroids

Question 8

Raynaud’s management

Answer 8

avoid cold
stop smoking
Nifedipine

Question 9

Sjogren management

Answer 9

artificial tears
paracetamol + NSAIDs
hydroxychloroquine

Question 10

Lupus management

Answer 10

Sun protection, exercise, smoking

NSAIDs + PPI

HCQ
Short term pred + IV cyclophosphamide for flares

If bad
Tacrolimus
Rituximab

Monitor C3/4

Consider ACEi if proteinuria

Question 11

Dermatomyositis/polymyositis management

Answer 11

Steroids
Azathioprine
Methotrexate

Question 12

Giant Cell Arteritis management

Answer 12

USS temporal artery +/- biopsy
high dose pred 60mg

Consider Il6 blocker
if vision loss start methylprednisolone 500mg 3 days

Steroid protection: Vit D/Calcium, PPI, bisphosphonate

Question 13

HSP management

Answer 13

Supportive

Should self-resolve

Question 14

Osteoporosis management

Answer 14

physio
HRT if peri/postmenopausal
bisphosphonates
Anti-RANK (denosumab)
PTH analogues (teriparatide)
anti-sclerostin (romosozumab)

Question 15

signs of reactive arthritis

Answer 15

oligoarthritis, uveitis, urethritis
keratoderma blenorrhagicum 
circinate balanitis
enthesitis
mouth ulcers

Question 16

investigation for Sjogren’s

Answer 16

Schirmer’s test

induce tears and see how much liquid travels on Schirmer strip in 5m

Question 17

CREST syndrome

Answer 17

Calcinosis
Raynaud's
Esophageal dysmotility
Sclerodactlyl
Telangiectasia 

skin problems in hands, face and feet only

Question 18

Additional systemic sclerosis symptoms

Answer 18

renal -> acute HTN crisis
lungs -> fibrosis
cardiac -> arrhythmia
oesophageal -> GORD, aspiration, dysphagia

Question 19

Management of sclerosis

Answer 19

Stop smoking
immunosuppression (MTX, azathio, etc)
Raynaud's control
digit ischaemia: sildenafil
oesophageal -> PPI, prokinetics

acute HTN crisis is managed aggressively with ACEi (consider dialysis)

Question 20

septic arthritis investigations

Answer 20

synovial fluid sample
bloods (Gram stain may be false negative in 50%)
cultures
X-ray
USS

Question 21

management of septic arthritis

Answer 21

aspirate joint to dryness
Hip: USS guided aspiration and debridement
IV antibiotics
analgesia
refer to orthopods and consider surgery