Treatments Flashcards
Kawasaki Disease
First line: IVIG + ASA
Second line: Second dose IVIG, Infliximab, Steroids
Third line: Anakinra, cyclosporine, PLEX
IVIG Resistance: Fever that occurs 36 hours to 7 days after IVIG
CRPS
Spinal cord stimulator
PT: massage/US/Electoracupuncture
NSAIDS/steroids (steroids if it is early disease, pain and swelling are present, and positive bone scan).
Sympathetic blocks
Topical capsaicin
Anticonvulsants
Prevent postsurgical CRPS: Vit C 500mg/day x 50 days
Lyme arthritis
Max 2 times IV abx for one month each
NSAIDS, intra-articular steroids, DMARDs (HCQ), if arthritis persists then can pursue synovectomy
Takayasu
Symptoms: fevers, wt loss, abnormal pulses/bruits (young girl)
High dose steroids with long term taper, if unable to taper then add MTX, Tocilizumab is option, LEF/AZA/MMF/Infliximab/Ustekinumab all reported
CTX is salvage therapy
In addition to immunosuppression need BP control, antiplatelet, tobacco cessation, lipid management
IgG4
Steroids for a long time
Rituximab is often steroid sparing agent
Cryoglobulinemia
HCV related: treat with antivirals and RTX, do PLEX if life threatening
RTX for vasculitis
Cogans
Steroids (topical vs systemic)
MTX/AZA/MMF
CTX for vasculitis
TNFs and tocilizumab also have been used
Relapsing Polychondritis
Remember the association with heme malignancies
NSAIDs, dapsone, low-dose pred for minor episodes
High dose steroids +/- Dapsone (no organ involvement), CTX/MTX/AZA/LEF/MMF/Cyclosporine for organ damage/cytopenias
Infliximab has a large number of case reports, Humira, etanercept, toci, anakinra and abatacept too
RTX doesn’t work!
Male sex, cardiac involvement, MDS all associated with high mortality
PAN
With HBV:
Prednisone 60mg/day x 1 week to control symptoms then tapered over 1 week and off –> PLEX (3x/week x 3 weeks, 2x/week x 2 weeks, then weekly until HBeAg neg) –> HBV tx during plex (off days)
W/o HBV:
Mild: pred 1mg/kg x 4 weeks, AZA, MTX
Mod/Severe: high dose steroids, CTX –> MTX/AZA
once in remission, RTX also works
