Rheumatology Flashcards
Name the Tissue Necrosis Factor Inhibitors and their side effects (the person who came up with questions was legitimately as sadist)
Adalimumab (Humera)
Indications for use: moderate to severe RA, psoracic arthritis, Ankylosing Spondylitis, Plaque Psoriasis, Crohn’s disease, Ulcerative Colitis, Hidradinitis supprative. Uveitis.
Dose for RA 40mg SC twice weekly.
Side effects:
>10% Injection site pain, URTI, Raised CPK, Headache, Rash, Sinusitis.
Management of psoriatic arthritis
NSAIDs
Sulphasalazine - moderately effective
MTX - very effective for skin disease
Cyclosporin - better for skin disease
Leflunomide
Anti-TNFs - highly effective for both skin and joint disease
Ustekinumab - humanised mAb against IL-12/23
Management of gout
acute flare:
aspirate - confirm negatively birefringent monosodium rate crystals, exclude septic arthritis
NSAIDs, Colchicine, steroids
- may need intra-articular steroid but must exclude septic arthritis
long-term management:
diet and lifestyle changes
- avoid beer, fructose, meat, seafood
- weight loss
after 2 attacks of gout initiate prophylaxis
TREAT TO TARGET!!!
target uric acid
Management of RA
Confirm diagnosis - longer than 6 weeks, typical joint involvement, positive serology (anti-CCP/RF) Education PT/OT Splinting of joints to prevent deformity Manage acute flares with steroids and anti-inflammatories - consider local steroid injections Early use of DMARDs for active disease - good regimes are: triple therapy MTX, sulphasalazine, hydroxychloroquine or MTX plus lefluonmide If not controlled with above consider anti-TNF therapy Monitor for adverse effects: - FBC (myelosuppression from drugs) - LFTs (hepatotoxicity) - opthalmology (hydroxychloroquine) - interstital lung disease - rash Surgical - joint replacements - relief of contractures
Management of OA
Educate Physiotherapy, walking aids Lifestyle: weight loss, excercise Analgesia Local steroid injections Surgery: joint replacements
