Rheumatology Flashcards

1
Q

What is the approach to management in rheumatological conditions?

A
  1. Individual treatment plan.
  2. No tolerance for inflammation.
  3. Shared care with National Rheumatology team.
  4. 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.
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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
  • 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
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3
Q
A
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