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Rheumatology > Rheumatology - Treatments > Flashcards

Rheumatology - Treatments Flashcards

1
Q

Osteoarthritis 1st line

A

Holistic approach: weight loss, physiotherapy and occupational therapy
Topical analgesia e.g. topical capsaicin
Plus: Intra-articular corticosteroid injections - methylprednisolone

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2
Q

Osteoarthritis 2nd line

A

Paracetamol + topical analgesia

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3
Q

Osteoarthritis 3rd line

A

NSAID + paracetamol + topical capsaicin

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4
Q

Rheumatoid arthritis - Mild disease

A

1st - Disease-modifying anti-rheumatic drugs (DMARDs) e.g. methotrexate, sulphasalazine, leflunomide
Adjunct: Corticosteroid - Prednisolone/methylprednisolone
NSAID - Ibuprofen

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5
Q

RA - severe disease

A

Biological treatments: Anti-TNF medications
Rituximab: Anti-CD20 and anti-B cell
Abatacept: Anti-T cell
Tocilizumab: Anti-IL6

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6
Q

Gout - Acute

A

1st line
Colchicine - inhibits phagocyte activation/inflammation
2nd line
Interleukin IL-1 inhibitor e.g. anakinra or canakinumab

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7
Q

Gout - Chronic

A

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

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8
Q

Pseudogout - Acute

A 
1st 
Intra-articular corticosteroids 
Paracetamol 
If joints are injectable 
NSAIDs or paracetamol 
2nd 
Colchicine - works by tubulin disruption
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9
Q

Pseudogout - Long term

A

If acute treatment if not affective then disease modifying antirheumatic drugs can be trialled e.g. methotrexate or hydroxychloroquine
Synovectomy
Surgery - joint replacement

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10
Q

Osteoporosis

A

1st - Bisphosphonates e.g. alendronic acid
Plus Ca2+ and Vit D supplementation

2nd - Women
HRT
2nd - Men
Testosterone

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11
Q

Ankylosing spondylitis - 1st

A

Physiotherapy
NSAIDs
Adjunct: paracetamol (1st) or codeine (2nd)
Plus: Intra-articular corticosteroid injection, sulfasalazine or methotrexate

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12
Q

Ankylosing spondylitis - 2nd

A

Ongoing or NSAID refractory
Recombinant monoclonal antibody e.g. secukinumab or ixekizumab
TNF-alpha inhibitor e.g. certolizumab or infliximab

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13
Q

Psoriatic arthritis - 1st

A

Early intervention with DMARDs e.g. methotrexate, leflunomide or sulfasalazine
Plus: NSAIDs

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14
Q

Psoriatic arthritis - 2nd

A

TNF-alpha inhibitors e.g. Etanercept, infliximab and adalimumab
IL12/23 blockers e.g. ustekinumab

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15
Q

Reactive arthritis

A

Depends on infective organism
Symptomatic relief
1st: NSAIDs - naproxen or ibuprofen
2nd: Corticosteroids e.g. prednisolone or methylprednisolone

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16
Q

Reactive arthritis - Salmonella and shigella

A

Ciprofloxacin (RNA polymerase inhibitor) and azithromycin (interferes with protein synthesis by binding to 50s ribosomes)

17
Q

Chlamydia

A

Doxycycline - inhibits protein synthesis by inhibiting 30S ribosomes

18
Q

Septic arthritis - Sepsis

A

IV therapy depending on organism for 2 weeks and then switch to oral AB therapy for a further 4 weeks

19
Q

Septic arthritis - S.aureus

A

Cephalosporins such as vancomycin, cefazolin, nafcillin

20
Q

Septic arthritis - Neisseria gonorrhoeae

A

Ceftriaxone as an injection

21
Q

Septic arthritis - Group A strep

A

Penicillin or amoxicillin

22
Q

E.coli

A

Doxycycline

23
Q

Osteomyelitis

A

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

24
Q

Osteomyelitis - Penicillin allergy

A

Clindamycin

25
Q

Osteomyelitis - MRSA

A

Vancomycin or teicoplanin

26
Q

Giant cell arteritis

A

Prompt corticosteroids
Prednisolone
Methylprednisolone (IV) → If visual symptoms
Methotrexate and/or tocilizumab can be considered in patients with high risk of corticosteroid toxicity

27
Q

Systemic lupus erythematosus - 1st line

A 
No cure - symptom management 
NSAIDs 
Steroids - prednisolone 
Hydroxychloroquine 
Suncream and sun avoidance
28
Q

Systemic lupus erythematosus - severe lupus

A

DMARDs - Methotrexate, Leflunomide, Ciclosporin

Immunosuppressants e.g. Mycophenolate mofetil, Azathioprine, Tacrolimus

Rheumatology (2 decks)

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