Unit 8: Musculoskeletal

Question 1

Joints commonly affected in osteoarthritis

Answer 1

Knees, hips, cervical/lumbar spine, distal interphalangeal joints, carpometacarpal joint

Question 2

Pathophys of osteoarthritis

Answer 2

Deterioration of articular cartilage, which usually decreases joint friction during movement; decrease in proteoglycans in extracellular matrix; underlying subchondral bone responds by remodeling; osteophytes form

Question 3

Pain of osteoarthritis

Answer 3

Intermittent, mild; exacerbated by joint movement

Question 4

First line pharmacotherapy for analgesia of osteoarthritis

Answer 4

Acetaminophen

Question 5

Second line therapy for osteoarthritis

Answer 5

NSAIDs

Question 6

Non-acetylated salicylates

Answer 6

Diflunisal

Beneficial in patients with osteoarthritis who are sensitive to GI irritation caused by aspirin or other NSAIDs

Question 7

Topical agents for osteoarthritis

Answer 7

Capsalcin: decreases substance P
Dicloferiac: topical NSAID

Question 8

Corticosteroids for osteoarthritis

Answer 8

Indicated if 1-2 joints are involved and has not responded to 1st or 2nd line treatment

Question 9

Gout

Answer 9

Inflammatory condition that results from mono sodium urate crystals precipitating in synovial fluid between joints due to hyperuricemia

Question 10

Most common cause of gout

Answer 10

Underexcretion of uric acid through insufficient renal clearance

Question 11

First line therapy for chronic gout treatment

Answer 11

Xanthine oxidase inhibitors

Question 12

Xanthine oxidase inhibitors

Answer 12

Allopurinol and Febuxostat
Decrease uric acid levels by selectively inhibiting xanthine oxidase which is primarily responsible for converting xanthine to uric acid

Question 13

Probenecid

Answer 13

Increase excretion of serum uric acid by inhibiting reabsorption of uric acid at proximal tubule
Used if at least one xanthine oxidase inhibitor is contraindicated

Question 14

Treatment of acute gout

Answer 14

Rest joint, apply ice, short course of NSAIDs, steroids or colchicine

Question 15

Colchicine

Answer 15

Inhibits activation, degranulation and migration of neutrophils to area of gout attack
Take within 24 hours of attack

Question 16

Rheumatoid arthritis

Answer 16

Synovial membrane proliferation followed by erosion of the subarticular cartilage and subchondral bone
Morning stiffness in involved joints for 1 hour and subsides with activity

Question 17

NSAIDs for RA

Answer 17

Continue from initial diagnosis until initiation of DMARD

Question 18

Corticosteroids for RA

Answer 18

Low dose steroids (prednisone) beneficial for those starting DMARDs
Higher doses beneficial in acute flares to gain control of inflammation and pain

Question 19

DMARDs

Answer 19

Disease modifying anti rheumatic drugs
Methotrexate, sulfasalazine, hydroxychloroquine, Leflunomide
Should be initiated within 3 months of onset of symptoms

Question 20

Methotrexate

Answer 20

Folic acid antagonist
Affects leukocyte suppresison; decreases inflammation
CI in pregnancy and BF

Question 21

Biologic disease modifying antirheumatic drugs

Answer 21

Tumor necrosis factor inhibitors

Etanercept, infliximab, adalimumab, golimumab, certolizumab

Question 22

First line therapy for low disease activity

Answer 22

Monotherapy DMARD

Question 23

First line therapy for moderate disease activity with poor prognostic factors

Answer 23

Combination of DMARDs

Question 24

First line therapy for high disease activity without poor prognostic factors

Answer 24

DMARD monotherapy or combo methotrexate and hydroxychloroquine

Question 25

First line therapy for high disease activity with poor prognostic factors

Answer 25

Either combo DMARD or anti TNF with or without methotrexate