Rheumatology - Treatments Flashcards
Osteoarthritis 1st line
Holistic approach: weight loss, physiotherapy and occupational therapy
Topical analgesia e.g. topical capsaicin
Plus: Intra-articular corticosteroid injections - methylprednisolone
Osteoarthritis 2nd line
Paracetamol + topical analgesia
Osteoarthritis 3rd line
NSAID + paracetamol + topical capsaicin
Rheumatoid arthritis - Mild disease
1st - Disease-modifying anti-rheumatic drugs (DMARDs) e.g. methotrexate, sulphasalazine, leflunomide
Adjunct: Corticosteroid - Prednisolone/methylprednisolone
NSAID - Ibuprofen
RA - severe disease
Biological treatments: Anti-TNF medications
Rituximab: Anti-CD20 and anti-B cell
Abatacept: Anti-T cell
Tocilizumab: Anti-IL6
Gout - Acute
1st line
Colchicine - inhibits phagocyte activation/inflammation
2nd line
Interleukin IL-1 inhibitor e.g. anakinra or canakinumab
Gout - Chronic
1st
Lifestyle changes e.g. weight loss, avoid offal, seafood, sugary drinks, fatty food and alcohol
Allopurinol - lowers uric acid in the body
Plus NSAIDs e.g. ibuprofen or naproxen
2nd
Febuxostat
Pseudogout - Acute
1st Intra-articular corticosteroids Paracetamol If joints are injectable NSAIDs or paracetamol 2nd Colchicine - works by tubulin disruption
Pseudogout - Long term
If acute treatment if not affective then disease modifying antirheumatic drugs can be trialled e.g. methotrexate or hydroxychloroquine
Synovectomy
Surgery - joint replacement
Osteoporosis
1st - Bisphosphonates e.g. alendronic acid
Plus Ca2+ and Vit D supplementation
2nd - Women
HRT
2nd - Men
Testosterone
Ankylosing spondylitis - 1st
Physiotherapy
NSAIDs
Adjunct: paracetamol (1st) or codeine (2nd)
Plus: Intra-articular corticosteroid injection, sulfasalazine or methotrexate
Ankylosing spondylitis - 2nd
Ongoing or NSAID refractory
Recombinant monoclonal antibody e.g. secukinumab or ixekizumab
TNF-alpha inhibitor e.g. certolizumab or infliximab
Psoriatic arthritis - 1st
Early intervention with DMARDs e.g. methotrexate, leflunomide or sulfasalazine
Plus: NSAIDs
Psoriatic arthritis - 2nd
TNF-alpha inhibitors e.g. Etanercept, infliximab and adalimumab
IL12/23 blockers e.g. ustekinumab
Reactive arthritis
Depends on infective organism
Symptomatic relief
1st: NSAIDs - naproxen or ibuprofen
2nd: Corticosteroids e.g. prednisolone or methylprednisolone
Reactive arthritis - Salmonella and shigella
Ciprofloxacin (RNA polymerase inhibitor) and azithromycin (interferes with protein synthesis by binding to 50s ribosomes)
Chlamydia
Doxycycline - inhibits protein synthesis by inhibiting 30S ribosomes
Septic arthritis - Sepsis
IV therapy depending on organism for 2 weeks and then switch to oral AB therapy for a further 4 weeks
Septic arthritis - S.aureus
Cephalosporins such as vancomycin, cefazolin, nafcillin
Septic arthritis - Neisseria gonorrhoeae
Ceftriaxone as an injection
Septic arthritis - Group A strep
Penicillin or amoxicillin
E.coli
Doxycycline
Osteomyelitis
Combination of
Surgical debridement of bone and tissues
Antibiotic therapy
- Prolonged course
6 weeks of flucloxacillin possibly with rifampicin or fusidic acid for the first 2 weeks
Chronic = 3 months or more ABs
Osteomyelitis - Penicillin allergy
Clindamycin
Osteomyelitis - MRSA
Vancomycin or teicoplanin
Giant cell arteritis
Prompt corticosteroids
Prednisolone
Methylprednisolone (IV) → If visual symptoms
Methotrexate and/or tocilizumab can be considered in patients with high risk of corticosteroid toxicity
Systemic lupus erythematosus - 1st line
No cure - symptom management NSAIDs Steroids - prednisolone Hydroxychloroquine Suncream and sun avoidance
Systemic lupus erythematosus - severe lupus
DMARDs - Methotrexate, Leflunomide, Ciclosporin
Immunosuppressants e.g. Mycophenolate mofetil, Azathioprine, Tacrolimus
