Rheum Flashcards
Drug treatments OA?
Regular paracetamol
Topical NSAIDs- ibuprofen, especially for knee
Consider NSAID if ineffective- unless on low dose aspirin, give mild opioid. Use lowest effective dose for shortest time
Intra-articular corticosteroids- temporary benefit
How long does it take for anti-inflammatory benefit of NSAIDs to become evident?
3 weeks
What is the first line NSAID?
Ibuprofen- 400mg TDS typically. Lowest incidence GI SEs
Naproxen if hx of CV
Mx RA?
NSAIDs- minimise use
Intra-articular steroids for problematic joints
DMARDs- as early as possible
Biologics in refractory disease- anti-TNFalpha mainly
What are DMARDs?
Methotrexate
Sulfasalazine
Hydroxychloroquine
Azathioprine (rarely used)
Gold (rarely used)
Leflunomide (rarely used)
D-penicillamine (rarely. For Wilson’s disease)
How is methotrexate given?
Once a week
Give folic acid day after to reduce SEs
What is the most significant SE of methotrexate?
Blood dyscrasias
What should be routinely monitored in methotrexate use?
FBC
What are the SEs of sulfasalazine use?
Blood dyscrasias
What is Hydroxychloroquine used for?
Anti-malarial drug, used in moderate RA and mild SLE
What is the SE of hydroxychloraquine?
Ocular toxicity
Mx of acute gout?
NSAIDs- naproxen, indomethacin, ibuprofen. 2-3 days until sx resolve
Colchicine- NSAID intolerance or RF. 3-4 days
Intra-articular steroids. If NSAIDs and colchicine CI
Cause of flair?
What are SEs of colchicine?
Diarrhoea
Abdo cramps
When is the chronic mx of gout indicated?
> 2 attacks/year or if high risk (CKD)
Chronic mx of gout indicated?
Xanthine oxidase inhibitor:
Allopurinol- first line. 1-2 weeks after inflammation settled. Start at 100mg and titrate.
Febuxostat: 2nd line. Expensive.
