Arthritis

Question 1

Name the 4 S factors for screening early rheumatoid arthritis

Answer 1

• Stiffness: early morning stiffness >30 min
• swelling: persistent swelling of 1 or more joints, particularly hand joints
• squeeze test hands: tenderness on squeezing across all 4 mcp joints
• squeeze test feet: tender on squeezing across all 4 metatarsophalangeal joints

Question 2

Name the characteristic hand features of rheumatoid arthritis (6)

Answer 2

• Symmetrical small joint involvement early on, EXCEPT dip joints usually
• early morning stiff
• hand swelling and tenderness joints
• Ulnar deviation
• buttonhole deformities boutonnière
• Swan neck deformities
• z thumb deformity

Joint pain at rest, swelling, morning stiff. Muscle wasting

Question 3

Treatment for control acute symptoms of rheumatoid arthritis while awaiting referral for specialist management with Disease modifying anti-rheumatic drugs dmard

Answer 3

NSAIDs eg ibuprofen 400 mg 8 hourly with or after meal, continue no longer than 6 months

Question 4

Name 3 complications chronic use NSAIDs

Answer 4

• Git bleed
• renal failure
• cv events: stroke and mi (hypertension cause)

Question 5

Treatment for temporary pain relief rheumatoid arthritis if NSAIDs contraindicated for acute Flares -? eg warfarin, renal dysfunction

Answer 5

Prednisone 7,5 mg for 2 weeks Max

Question 6

Treatment for temporary pain relief rheumatoid arthritis in high risk patients > 65, history pud, on concomitant warfarin, aspirin or corticosteroids

Answer 6

Add ppi eg lansoprazole 30 mg daily while on NSAID

Question 7

Classic signs and symptoms of osteoarthritis (6)

Answer 7

• Weight bearing joints degenerative disorder
• pain with movement
• limited Rom often with crepitus
• post-nest stiffness
• joint may be swollen
• asymmetrical
• swelling dip (Heberden’s nodes)! + pip (Bouchard’s nodes )

Question 8

Pain treatment for osteoarthritis? (2)

Answer 8

• Paracetamol 1g 4-6 hourly when required to max 4 doses per 24 hours
Max 15 mg/kg/dose and 4g in 24h
If respond reduce dose to 500 mg 6-8 hourly when needed
If no response and inflammation, add NSAID eg ibuprofen 400mg 8 hourly with or after meal as needed for 7 days
• methyl salicylate ointment topical

Question 9

Name 5 Common side effects tramadol

Answer 9

• Constipation!
• dry mouth
• sensation spinning or whirling , dizzy
• difficulty sleeping
• temporary redness face and neck
• headache, nausea, vomit

Question 10

What is coxflam and what indicated for?

Answer 10

Meloxicam NSAID cox-2 inhibitor

For pain and inflammation. Ideal in arthritis but not in public

Question 11

Name 5 Common side effects meloxicam

Answer 11

• Abdominal pain, diarrhoea (less than other NSAIDs)
• slightly nephrotoxic
• indigestion or heart burn
• itching or rash
• headache, dizzy
• Nausea

Question 12

What is naproxen?

Answer 12

NSAID