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Flashcards in Chaper 10 Musculoskeletal Deck (73)
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1

Pain and Stiffness resulting for inflammatory rheumatic disease

NSAID

2

Other analgesics in RA

Paracetamol or Codeine can also be used

3

DMARDs

Drugs used to influence the rheumatic disease process its self

4

DMARDs include:

Methotrexate
Cytokine Modulators
Azathioprine
Cyclosporin
Cyclophosphamide
Leflunomide
Penicillamine
Gold
Antimalarials ( chloroquine and hudroxychloroquine)
Sulfasalazine

5

Which two antimalarials can be used as DMARDs?

Chloroquine and Hydroxychloroquine sulfate

6

Corticosteroids have a significant role in?

Rheumatoid Arthritis

7

Drugs which may affect the disease process in psoriatic arthritis include:

Sulfasalazine,
Gold,
Azathioprine,
Methotrexate,
Leflunomide,
Cytokine modulators

8

For pain relief in osteoarthritis and soft tissue disorders what should be used first?

Paracetamol and may need to be taken regularly

9

Topical NSAID or topical capsaicin 0.025%

Should be considered particularly in knee or hand osteoarthritis

10

Can be substituted for or used in addition to paracetamol in OA

Oral NSAID

11

Further pain relief in OA

The addition of an opioid analgesic may be considered, but with a substantial risk of adverse effects

12

Patient on low dose aspirin

Opioid analgesic considered before a NSAID in patients taking low dose aspirin

13

Intra-articular corticosteroid injections

May produce temporary benefit in osteoarthritis, especially if associated with soft tissue inflammation

14

Non drug measures:

Weight reduction and exercise should be encouraged

15

Not recommended for treatment of OA

Glucosamine and Rubefacients

16

Hyaluronic and its derivative available for OA of the knee

But are not recommended

May reduce pain over 1-6 months

Associated with short term increase in knee inflammation

17

NSAIDs are only used for

Symptom control

18

DMARDs can affect the progression of disease

But may require 2-6 months of treatment for a full therapeutic response

19

Respond to DMARDs may allow

NSAID dose to be withdrawn or reduced

20

All patients with suspected inflammatory joint disease

Should be referred to a specialist as soon as possible to confirm diagnosis and evaluate disease activity; early initiation of DMARDs is recommended to control the signs and symptoms, and to limit joint damage

21

DMARDs similar in efficacy

Methotrexate
Sulfasalazine
Intramuscular gold
Penicillamine

22

DMARDs better tolerated

Methotrexate
Sulfasalazine

23

Patient with newly diagnosed active RA

A combination of DMARDS (including methotrexate and at least one other DMARD) and a short term corticosteroid

24

Treatment initiation to patients with newly diagnosed active RA

Within 3 months of the onset of persistent symptoms

25

If use of a particular DMARD is contraindicated and combination therapy is not possible

Mono therapy with a suitable DMARD should be given and the dose rapidly increased until clinically effective

26

Patients with established and stable RA

Cautiously reduce drug doses to the lowest that are clinically effective

27

When should DMARD be replaced by another

Drug does not lead to objective benefit within 6 months

28

Sodium aurothiomolate

Gold for active progressive RA
Given by deep IM and the area gently massaged

29

Test dose followed by doses at weekly intervals

Until there is definite evidence of remission

30

In patients who do respond

The interval between injections is then gradually increased to 4 weeks and treatment is continued for up to 5 years after complete remission