Arthritis Flashcards
(10 cards)
How do you tx osteoarthritis
Activity modification/splinting, exercise, weight reduction, PT
NSAIDs, topical or oral
Intra-articular injections (steroid, hyaluronate, PRP)
duloxetine (cymbalta) - when NSAIDs CI and multiple joints
Joint arthroplasty sx
How do you treat gout acutely
NSAIDs first line (indomethacin and naproxen)
Oral steroids (intra-articular injection for monoarticular)
Colchicine if symptoms <36 hours
If refractory, IL-1 inhibitor (anakinra)
How do you treat gout between attacks
Avoid alcohol (beer), purines (liver, seafood, yeasts), avoid diuretics, niacin, aspirin
Colchicine prophylaxis
Urate lowering = allopurinol + febuxostat (not acutely)
Uricosurics = probenecid (not in renal issues)
How do you treat refractory gout?
IL-1 inhibitors (anakinra)
Pseudogout tx
Joint aspiration
intra-articular steroid injection (triamcinolone) or oral corticosteroids (if 3+ joints, prednisone)
NSAIDs for acute attacks
Colchicine w/n 24 hours and for prophylaxis (if 3+ attacks annually)
Short term immobilization
If refractory, IL-1 inhibitor (anakinra)
rheumatoid arthritis tx
Steroids – bridge gap between slow acting DMARDs:
→ Methotrexate, but can add sulfasalazine (2nd), leflunomide, hydroxychloroquine
Refractory = janus kinase inhibitors
Biologics – TNF-alpha added to methotrexate (etanercept, infliximab, adalimumab), or nonTNF (abatacept)
Omega 3 supplements, analgesics, splints/therapy, custom shoes
Selective surgery
How do you treat psoriatic arthritis
TNF inhibitor then methotrexate (nonbiological DMARD)
How do you treat enteropathic arthritis
Control intestinal inflammation = eliminate peripheral arthritis, can add NSAID (if not exacerbating)
How do you treat ankylosing spondylitis
NSAIDS, then anti TNF drugs
how do you tx reactive arthritis
NSAIDs, then nonbiological DMARD (sulfasalazine or methotrexate)
Treat underlying cause
