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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
Q

What does infliximab do

A

Anti-TNF

  • Vulnerability to severe infections
  • Reactivation of TB
26
Q

What do you education patient

A 
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
Q

What do you do prior to starting

A 
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
Q

How are biologics given

A

Infusion
Often with prednisone
Monitor for signs of anaphylaxis

29
Q

Function of synovial

A

Maintain tissue surface
Lubricate cartilage
Control synovial fluid volume - increases in inflammation
Nutrition of chondrocytes

30
Q

Pathology of rheumatoid joint

A 
Inflammatory cells in synvoium damage joint 
Erosions into bone 
Dense synovium 
Increased synovial = swelling + heat
Muscles and ligaments sublux
Thinning of cartilage = late
31
Q

Pathology of OA joint

A

Mainly cartilage
Cartilage thins and wears away so bone on bone
Osteophyte
Little inflammation / swelling of synovium
Muscles and ligaments normal

32
Q

How do you detect synovitis

A

USS

33
Q

When should you beware of using steroid

A

DM as upset control

34
Q

Main SE methotrexate

A

Pulmonary fibrosis

35
Q

Main SE leflonimide

A

Hypertension

Peripheral neuropathy

36
Q

Main SE sulfasalsine

A

Male infertility

37
Q

Main SE hydroxycholoquine

A

Reduced acuity - Bull’s eye retinopathy

Nightmares

38
Q

Main SE Anti-TNF

A

Reactivation TB or hep B

39
Q

Main SE ritxuimab

A

Night sweats

Thrombocytopenia

40
Q

SE ciclosporin

A

Nephrotoxic
Hepatotoxic
Fluid retention

41
Q

If pain all over

A

Suggest diffuse disease e.g. connective tissue / Fibromyalgia / PMR

42
Q

If local

A

Suggests more joint issue even if polyarticuar

43
Q

If diffuse tenderness all over but no stiffness

A

Fibromyalgia
ME
Malignancy

44
Q

If local tenderness but no stiffness

A

OA
Bursitis
Tendonitis

45
Q

If diffuse tenderness and stiff

A

PMR
Dermatomyositis
Polymyositis

46
Q

If local tenderness and stiff

A

SA = mono

Mono or poly
RA
SLE
Gout
Sero-ve
Post viral

MSK (21 decks)

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