MSK Flashcards
(36 cards)
Symptoms of rheumatoid arthritis?
● Joint pain
● Morning stiffness > 30mins
● Weight loss
● Fatigue
● Symmetrical pain (pain on both sides, right and left)
What are the most common treatments for rheumatoid arthritis (RA)?
● Methotrexate
● Sulfasalazine
● Azathioprine
● Ciclosporin
What are the least common treatments for rheumatoid arthritis (RA)?
● Leflunomide
● Penicillamine
● Antimalarials - (chloroquine/hydroxychloroquine)
● Gold
● Cytokine modulators
What are DMARDs for?
Used to stop RA from getting worse
Which medication might need to be stopped if DMARD is started?
NSAIDs
How long do DMARDs take to work?
2-6 months minimum
What are the symptoms of Osteoarthritis (OA)?
● Joint pain when moving or putting weight on the joint(s)
● Morning stiffness < 30mins
● One sided pain
What is the treatment for OA?
● 1st line = Paracetamol 1g QDS
● If it’s in your knee/hand then TOPICAL NSAID or capsaicin 0.025% cream
● Oral NSAID
● If a patient is already taking aspirin, then change to an opioid, WHY? ASPIRIN IS AN NSAID and can cause increased risk of interactions/ulceration/GI bleed
● Weight reduction is also recommend as well as regular exercise
What are the differences between RA & OA?
RA is joint pain upon waking up and stiffness last more than 30 mins.
OA is joint pain when putting weight on it or moving it and stiffness last less than 30 mins.
RA is both sides being painful and OA is one sided.
What is Glucosamine and what is it for?
It is a natural compound found in cartilage.
Can be used to help with OA but there is no evidence.
Who CANNOT use Glucosamine?
Patients that have a shellfish allergy
What is Gout?
A type of arthritis caused by Urate crystals (high uric acid in blood)
It builds up in joints and tissue
What causes gout to get worse?
Diuretics
Aspirin can also worsen gout, by changing the uric acid levels
What are the symptoms of gout?
● Can form needle-like, crystals in a joint
● Sudden, severe episodes of pain
● Tenderness
● Redness
● Warmth
● Swelling
● Most common in big toe !!
What is used for the acute treatment of gout?
- High dose NSAID
- E.g. Naproxen 750mg immediately, 250mg three times a day until attack passes
OR
- Colchicine if NSAID contraindicated
What is the dose for Colchicine?
● 500mcg (ONE tablet)
● 2 - 4 times a day (BD - QDS dosing)
● Use until symptoms are relieved, max 6 mg per course. (6 mg = 12 tablets)
● Once the course of 12 tablets is finished. DO NOT repeat within 3 days.
What is the side effect of Colchicine?
Diarrhoea
What are signs of colchicine toxicity?
Early signs of toxicity include:
- abdominal pain
- diarrhoea
- nausea
- vomiting.
Features after 1 to 7 days include:
- arrhythmias
- bone marrow depression
- confusion
- decreased cardiac output
- hepatic impairment
Which medications need to be stopped when using colchicine? Why and how long for?
Statins - because they increased risk of muscle death.
- STOP statins during colchicine treatment/course and TWO days after
the course has finished
What is the long term treatment of gout?
(Let acute attacks of gout get better)
● Before starting long term treatment, wait ONE to TWO weeks after acute
attack
- 1st line = Allopurinol, if not effective then
- 2nd line = Febuxostat
● Continue treatment indefinitely to prevent further relapse of gout
Which medication can cause Stevens-Johnson syndrome?
Allopurinol & Febuxostat
What are the symptoms of Stevens-Johnson syndrome?
Flu-like symptoms at the start. Then a rah develops.
A red/purple rash spreads and forms blisters.
What is the symptom and treatment for Neuromuscular disorder - myasthenia gravis?
Symptom:
- Muscle weakness
Treatment:
- Neostigmine
- Pyridostigmine
What is Baclofen used for?
Muscle spasms
