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MSK > Rheumatology + Common Drugs Used > Flashcards

Rheumatology + Common Drugs Used Flashcards

1
Q

Pathology of arthritis

A 
Inflammed synovium
Cartilage thinning
Destruction of bone 
Inflammed joint capsule
T cell + MO + neutrophil
Neoangiogenesis
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2
Q

What is included in Rheumatology

A 
RA
OA
Sero -ve arthritis
Cystal arthritis
Connective tissue disease
Vasculitis
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3
Q

What are typical Sx of arthritis

A 
Inflammation 
Pain
Stiffness 
Swelling 
Deformity
Loss of function
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4
Q

What is key Sx in the MSK Hx

A 
Pattern of involved joints
Symmetry?
Morning stiff >30 minutes (suggest inflammatory over mechanical) 
Pain
Swelling
Any erythema or warmth 
Any deformity 
Loss of function 
Neurological 
- Paraesthesia
- Weakness
- Wasting
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5
Q

What are extra-articular features to look for or examine

A 
Skin and nail - rash / Raynaud
Dry eyes or mouth
Iritis 
Enlarged nodes
Lung signs / kidney / heart
GI and GU - Diarrhoea / Mouth / genital ulcer
Weight loss
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6
Q

Family history

A

Skin conditions

Autoimmune

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7
Q

What is most important investigation for mono arthritis

A

Joint aspiration

Send for gram stain, WCC, microscopy for crystals and culture

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8
Q

When is aspiration CI

A

Overlying skin infection

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9
Q

What blood tests

A

FBC, urate, U+E, CRP + ESR
Blood culture if septic
Consider RF, anti-CCP, ANA, HLA-B27
If think reactive - viral serology / urine / chlamydia / PCR / hepatitis/. hIV

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10
Q

What radiology

A

X-ray
USS / MRI if effusion
CXR if RA / vasculitis / TB / sarcoid

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11
Q

What are important questions to ask

A 
Pain or stiffness
Can you dress yourself
Can you walk up and down stairs
Hand dominance
Baseline function
Occupation
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12
Q

What are AE of Azathioprine

A

Bone marrow depression
N+V
Pancreatiits
Non-melonma skin cancer

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13
Q

What does interact with and how do you monitor

A

Allopurinol to increase effects so use lower dose
Check TPMT level before starting to make sure body is able to break down or else would get pancytopenia’s
FBC + LFT before Rx and 3 monthly

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14
Q

What is a useful drug to use in pregnancy

A

Hydroxychloroquine
Sulfasalasine
NOT in psoriasis - won’t treat skin

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15
Q

What are AE of hydroxychloroquine

A

Bull’s eye retinopathy
So ask about visual Sx + monitor acuity annual
Requires ophthalmology screen before start

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16
Q

When should you be careful with Sulfasalazine

A

G6PD deficiency

Allergy to aspirin / sulphonamide - co-trimox

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17
Q

What are AE

A 
SJS
Infertility in males 
Pneumonitis / lung fibrosis 
Fibrosis
Myelosuppression
Anaemia
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18
Q

AE of penicillamine and when is it used

A

RA
Rash
Taste
Proteinuria due to membranous GN

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19
Q

What are SE of methotrexate

A 
Myelosuppression
Mucostis / ulcers  
Pneumonitis
Pulmonary fibrosis - LL 
Liver fibrosis - regular LFT 
Teratogenic
B12 / macrocytic deficiency
20
Q

If pregnant or wanting to conceive

A

M+F both avoid for 6 months

21
Q

If prescribing methotrexate what is required

A

Weekly FBC, U+E, LFT then 2-3 months when established
Must take folic acid
CXR before starting

22
Q

What drugs increase toxicity so avoid

A

Anti-folate drugs
Trimethoprim
Co-trimoxazol
High dose aspirin

23
Q

When do you start biologic

A

If 2+ DMARD been tried and unsuccessful or if 2 NSAID in AS

24
Q

What does ritixumab do and SE

A

B cell depeltor - CD20

  • Severe infections
  • Thrombocytopenia
  • Liver and lung toxicity
  • Peripheral neuropathy
  • Night sweats
25
What does infliximab do
Anti-TNF - Vulnerability to severe infections - Reactivation of TB
26
What do you education patient
``` Action on immune Increased infection risk / reactivation Hypersensitivity reaction PML Demyelination Increased cancer risk (skin / lymphoma) Can develop Ab to drug and stop working ```
27
What do you do prior to starting
``` Check TB status with quantiferon blood CXR if +ve Varicella and shingles status Screen for hep B and C Bloods - FBC, U+E, LFT, CRP, ESR ```
28
How are biologics given
Infusion Often with prednisone Monitor for signs of anaphylaxis
29
Function of synovial
Maintain tissue surface Lubricate cartilage Control synovial fluid volume - increases in inflammation Nutrition of chondrocytes
30
Pathology of rheumatoid joint
``` Inflammatory cells in synvoium damage joint Erosions into bone Dense synovium Increased synovial = swelling + heat Muscles and ligaments sublux Thinning of cartilage = late ```
31
Pathology of OA joint
Mainly cartilage Cartilage thins and wears away so bone on bone Osteophyte Little inflammation / swelling of synovium Muscles and ligaments normal
32
How do you detect synovitis
USS
33
When should you beware of using steroid
DM as upset control
34
Main SE methotrexate
Pulmonary fibrosis
35
Main SE leflonimide
Hypertension | Peripheral neuropathy
36
Main SE sulfasalsine
Male infertility
37
Main SE hydroxycholoquine
Reduced acuity - Bull's eye retinopathy | Nightmares
38
Main SE Anti-TNF
Reactivation TB or hep B
39
Main SE ritxuimab
Night sweats | Thrombocytopenia
40
SE ciclosporin
Nephrotoxic Hepatotoxic Fluid retention
41
If pain all over
Suggest diffuse disease e.g. connective tissue / Fibromyalgia / PMR
42
If local
Suggests more joint issue even if polyarticuar
43
If diffuse tenderness all over but no stiffness
Fibromyalgia ME Malignancy
44
If local tenderness but no stiffness
OA Bursitis Tendonitis
45
If diffuse tenderness and stiff
PMR Dermatomyositis Polymyositis
46
If local tenderness and stiff
SA = mono ``` Mono or poly RA SLE Gout Sero-ve Post viral ```

MSK (21 decks)

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