Rheumatology Flashcards
1
Q
What is the approach to management in rheumatological conditions?
A
- Individual treatment plan.
- No tolerance for inflammation.
- Shared care with National Rheumatology team.
- MDT approach.
- Switch off inflammation.
- Provide analgesia.
- Maintain joint function.
- Prevent joint deformities.
- Treat complications, extra-articular manifestations.
- Ensure optimal nutrition.
- Rehabilitation.
- Maintain psychological health.
- Educate.
2
Q
What are the principles for switching of inflammation in rheumatological disease?
A
- NSAIDs
- 1st line.
- 1/3 have control with NSAIDs
- Peak action 4-6 weeks.
- Decrease pain and stiffness.
- Monitor FBC, UEC, LFTs and urine.
- Do not alter natural course of disease.
- Corticosteroids
- Useful in short courses.
- Long-term reserved for severe systemic disease or incapacitating polyarthritis.
- Consider malignancy before starting.
- Intra-articular injection can be useful.
- Does not alter natural course of disease.
- DMARDs
- Methotrexate
- Oldest and lease toxic.
- May take 6-12 weeks to see effects.
- Weekly PO or SC
- Effective in uveitis not responsive to steroids.
- Relapse commonly occurs after stopping.
- Give rescue folate.
- Shouldn’t drink alcohol.
- Teratogenic.
- Monitor FBC and LFT’s
- Hydroxychoroquine
- Good safety profile.
- Useful in mild JIA
- Sulfasalazine
- Good safety profile
- Useful in mild JIA
- Leflunamide
- Methotrexate
- Biologics
- Etanercept
- Weak anti-TNF
- Weekly SC injection (doesn’t sting)
- Adalimumab
- Anti-TNF
- Fortnightly SC injection (stings)
- Better for uveitis
- Infliximab
- Anti-TNF
- IV
- Tocilizumab
- Anti-IL-6
- Risk of infusion reaction and mast cell activation
- Etanercept
3
Q
A