Passmed Rheumatology - Pharmacological Managements

Question 1

Ankylosing spondylitis

Answer 1

NSAIDs
Anti-TNF in rare cases

Question 2

Anti-phospholipid syndrome

Answer 2

Primary prophylaxis = low-dose aspirin
Secondary prophylaxis = lifelong warfarin INR 2-3, if recurrent VTE INR 3-4

Question 3

Azathioprine

Answer 3

Bone marrow suppression + pancreatitis
Don’t use with allopurinol
Safe in pregnancy

Question 4

Gout

Answer 4

Acute = NSAID or colchicine, oral/intra-articular steroid if peptic ulcer disease
Chronic = allopurinol with initial colchicine cover

Question 5

Hydroxychloroquine

Answer 5

Retinopathy
Safe in pregnancy

Question 6

Osteoarthritis

Answer 6

1st - Paracetamol +/- topical NSAID (if knee or hand)
2nd - oral NSAIDs/COX-2 inhibitors
Can also consider opioids, IA steroids, capsaicin cream

Question 7

Osteomalacia

Answer 7

Vit D supplementation +/- calcium supplementation if needed

Question 8

Osteoporosis

Answer 8

Alendronate
If can’t tolerate = risedronate or etidronate
If can’t tolerate = strontium ranelate, raloxifene

Question 9

Paget’s disease of the bone

Answer 9

Oral risedronate or IV zoledronate

Question 10

Polymyalgia rheumatica

Answer 10

Oral prednisolone

Question 11

Reactive arthritis

Answer 11

Analgesia
NSAIDs
IA steroids

Question 12

SLE

Answer 12

Hydroxychloroquine

Question 13

Temporal arteritis

Answer 13

No visual loss = oral high-dose prednisolone
Visual loss = IV methylprednisolone

Question 14

Sulfasalazine

Answer 14

Myelosuppression, oligospermia
Safe in pregnancy + BFing