Wk 16: Rheumatoid arthritis in practice Flashcards
What is the support given when suffering from Sjörgrens syndrome?
- Lubricating eye drop/ointments
- Artificial saliva replacement
What is the support given when suffering from vasculitis?
- Steroids
- Cyclophosphamide
What are the most common DMARDs?
- Methotrexate
- Sulfasalazine
- Leflunomide
- Hydroxychloroquine
What is given when in contact w/ chicken pox?
VZ immunoglobulin w/in 7 days of contact
What happens when a patient is pregnant?
- Metho + leflunomide = contraindicated
- Azathioprine + hydroxychloroquine recommended
What are the doses of methotrexate?
- 2.5mg tablets
- 27.5mg SC
What can be given when on methotrexate?
- Folic acid to reduce adverse effects
- Once a week on diff day to metho
OR
- 3 times a week
When should you stop on methotrexate when looking at bloods?
- Leucopenia
- Neutropenia
- Fall in WBC/neutrophils >10% on 3 occasions
- Thrombocytopenia
What are the counselling points for methotrexate?
- Not painkiller
- How to take
- Folic acid on diff. day
- NSAID inc toxicity
- Purple book
- S/e: feeling sick, upset stomach, diarrhoea
When should you stop and tell your doctor when on methotrexate?
- Unexplained shortness of breath + dry cough
- Whites of eyes = yellow
- Ulcers
- Never had chicken pox + in contact
- You/your partner become pregnant
Methotrexate rescue therapy
- calcium folinate
- SC filgrastim (severe neutropenia)
- Fluid + electrolyte balance
What is the dose titration of sulfasalazine?
- 500mg OD 7/7
- 500mg BD 7/7
- 1g OM + 500mg ON 7/7
- 1g BD
What are the side effects of sulfasalazine?
- Urine = orange
- Soft contact lenses + tears = yellow
- GI
- Skin rash
When needs to be reported when taking sulfasalazine?
Haematological/liver toxicity:
- Unexplained cough
- Breathlessness
- Abnormal bruising/bleeding
- Severe sore throat
- Unexplained widespread rash
- Oral ulceration
What is the dose for leflunomide?
- Initially: 100mg OD for 3 days
- Then 10-20mg OD
