Chapter 10: Muscloskeletal System

Question 1

What is rheumatoid arthritis?

What are the symptoms?

Answer 1

• Autoimmune disease where the immune system mistakenly attacks the synovium (lining of the joints).
• joint pain and swelling, usually affects hands, feet and wrists.

Question 2

What medicines are indicated for the stiffness and pain resulting from inflammatory rheumatic disease?

Answer 2

NSAIDS
Paracetamol
Codeine

Question 3

What is given for a new diagnosis of RA and when is it started?

Answer 3

• Methotrexate (MTX) + other DMARD + short term corticosteriods
• given ideally within 3 months of the onset of persistent symptoms.

Question 4

What does DMARD stand for?

List the drugs included in this class

Answer 4

Disease modifying anti rheumatic drugs

• sulfasalazine
• Penicillamine
• Gold (sodium aurothiomalate)

Question 5

List the antimalarial DMARDS used in RA?

Answer 5

Hydroxychloroquine/ chloroquine

Screening for ocular toxicity needed

Question 6

List the drugs affecting immune response DMARDs

Answer 6

• MTX
• Azathioprine
• Cyclosporin (nephrotoxic)
• Leflunomide (hepatotoxic. Effective contraception during and 3 months after treatment in men).
• cyclophosphamide (cytotoxic anthracycline: urothelial toxicity i.e. heamorragic cystitis )

Question 7

List cytokine modulator DMARDs and their side effects

Answer 7

Infliximab, Entanercept

blood dyscrasias, report symptoms of TB e.g. persistent cough, weight loss, fever

Question 8

How does MTX work? (HIGH RISK DRUG)

Answer 8

Antifolate: inhibits the enzyme dihydrofolate reducase to make tetrahydrofolate needed to make purines and pyrimadines and therefore DNA.

Prevents cellular replication

Question 9

What are the cautions relating to MTX?