Rheumatology

Question 1

How do you manage OA?

Answer 1

STEPWISE APPROACH

1. Oral paracetemol and topical NSAIDS
2. Add oral NSAIDS and consider prescribing a PPI
3. Consider opiates- codeine and morphine

Question 2

What are the two scoring systems used to check on RA?

Answer 2

DAS28= disease activity score which is based on the assesment of 28 points- swollen/tender/ESR/CRP 
HAQ= measures functional ability, using this at diagnosis to check the response to treatment

Question 3

In RA what two scoring systems should be used to monitor response to treatment?

Answer 3

DASQ28

CRP

Question 4

How do you treat RA?

Answer 4

FIRST LINE= DMARDS
SECOND LINE= 2 DMARDS IN COMBINATION
THIRD LINE= METHOTREXATE + BIOLOGICAL THERAPY (TNF INHIBITOR)
FOURTH LINE= METHOTREXATE + RITUXIMAB

Question 5

What DMARDS could you use in pregnancy?

Answer 5

SULFASALAZINE AND HYDROXYCHLOROQUINE

Question 6

Give examples of biological agents

Answer 6

TNF inhibitors= adalimumab, infliximab and etanercept

Question 7

How does methotrexate work?

Answer 7

Inhibits IL-6 and IL-1 and also has anti folate affects

Question 8

What are some notifiable side effects of methotrexate?

Answer 8

Mouth ulcers and mucositis 
Liver toxicity 
Pulmonary gibrosis 
Bone marrow suppresion and leukopenia 
Tetarogenic (Harmful to pregnancy) and needs to be avoided prior to conception in both mothers AND fathers

Question 9

How does leflunomide work? What are the side effects

Answer 9

Immunosuppresion drug which works by interefering with the production of pyrimidine (an important part of DNA/RNA)

Mouth ulcers and mucositis 
Increased BP 
Rashes 
PERIPHERAL NEUROPATHY
Liver toxicity 
Bone marrow suppresion and leukopenia 
It is teratogenic

Question 10

What are the side effects of sulfasalizine?

Answer 10

Temporary male infertility

Bone marrow suppression

Question 11

How does hydroxychloroquine work and what are the notable side effects?

Answer 11

Traditionally a anti malarial
Interfers with toll like receptors, disrupting antigen presentation and increasing the pH in the lysosomes of immune cells

Nightmares
reduced visual acuity (macular toxicity)
liver toxicity
skin pigmentation

Question 12

What are the treatment options for psoriatic arthrtitis?

Answer 12

NSAIDS for pain
DMARDS
Anti-TNF meds (biologics)

Question 13

How is reactive arthritis treated?

Answer 13

NSAIDS
Steroid injections into the affected joint
Systemic injections
DMARDS/ Anti TNF for recurrent cases

(basically same for AS)

Question 14

What is the treatment of SLE?

Answer 14

mild cases- hydroxychloroquine are used
NSAIDS, steroids (pred)
Suncream and sun avoidance for photosensitive malar rash
Biological therapies are considered for patients with severe disease or where the patient haven’t responded to other treatmen)- rituximab nand belimumab

Question 15

What can be used to treat raynauds?

Answer 15

Nifedipine

Question 16

What is diffuse cutaneous systemic sclerosis?

Answer 16

This is limited cutaneous systemic sclerosis (CREST syndrome) which also affects internal organs…

CVD- hypertension and CAD
Lung problems- pulmonary fibrosis and pulmonary hypertension
Kidney problems- glomerulonephritis and scleroderma renal crisis

Question 17

How do you manage diffuse cutaneous systemic sclerosis?

Answer 17

Manage the complications 
Non medical management 
- Avoid smoking 
Gentle skin stretching to maintain range of motion 
regular emollients 
Avoiding cold triggers for Raynauds 
Physio to maintain healthy joints 
occupational therapu 

Medical management
- Nigedipine
Anti acid medications- PPIs and pro- motility medications for GI symptoms
Analgesia for joint pain
Abx for skin infections
Antihypertensives can be used to treat hypertension
Treatment for pulmonary artery hypertension
Supportive management of pulmonary fibrosis