Soft tissue and joint disorders Flashcards
Local Inflammation of Joints & Soft Tissue
Systemic Corticosteroids:
- Improve symptoms in Rheumatoid Arthritis Short-term treatment corticosteroids
- Long-term use only after other treatment options considered
- Corticosteroids induce osteoporosis Prophylaxis required in long-term treatment
- Severe Life-threatening (to induce remission) High initial dose corticosteroids
Then DMARDs commenced with pulse doses of corticosteroids
Local Corticosteroid injections:
- For Anti-inflammatory effect + Also provide symptomatic relief whilst waiting for DMARDs to take effect.
Other uses: Tennis/Golfer’s elbow, Tendinitis (into tendon sheath), Skin Lesions (into soft tissues).
- Hydrocortisone or one of the synthetic analogues is generally used for local injection
Soft Tissue Disorders
- Extravasation is leakage of drugs / IV fluids from veins or inadvertent administration into SC or sub-dermal tissue. It can cause tissue necrosis (cytotoxic drugs commonly cause extravasation injury)
- Prevention: Use central line, Resit cannula at regular intervals in patient receiving repeated doses, ask patient to REPORT pain or burning at injection site immediately
- Management: STOP infusion but don’t remove cannula until area aspirated (to remove as much of drug)
- Inflammation Can give corticosteroids
- Symptoms relief Can give antihistamines or analgesics.
- After this Specialist management e.g. depends on substance: localise & neutralise / spread & dilute. Administer antidote + Apply cold compresses TDS-QDS
Cytokine modulators: e.g. + patient advice
Adalimumab, Etanerccept, Infliximab
Patient advice: If used to treat hidradenitis suppurativa, use a daily topical antiseptic wash on lesions during treatment with adalimumab.
- TB: if symptoms of TB (e.g. persistent cough, weight loss, fever) develop, seek medical attention.
- Blood disorders: report if: fever, sore throat, bruising, bleeding, cough, weight loss develop
