Muscoskeletal

Question 1

What is Rheumatoid Arthritis? Symptoms?

Answer 1

Joint pain

With morning stiffness lasting more than 30 mins

Weight loss

Fatigue

Symmetrical pain on both sides of the body, right and left

Question 2

Treatment for arthritis?

Answer 2

Methotrexate
Sulfasalazine
Azathioprine
Ciclosporin

Question 3

Dmards

Answer 3

• Patient referred for treatment ASAP
• Take 2-6 months minimum
• Stop RA from getting worse
• Stopping DMARDS could mean stopping or reducing the dose of NSAIDs

Question 4

Osteoarthritis

Answer 4

1st line paracetamol
If it’s in your hand/knee then topical NSAIDs or Capsaicin 0.025%
Oral NSAID
Recommend weight reduction and exercise

Question 5

Comparison of rheumatoid arthritis and osteoarthritis

Answer 5

Joint pain on waking, morning stiffness for more than 30 mins, weight loss and fatigue, symmetrical pain on both sides = Rheumatoid

Joint when moving or putting on weight, morning stiffness less than 30 mins, one sided

Question 6

WHAT IS GOUUUTTT?

Answer 6

-Uric acid build up in blood = Urate crystals
- Built up in joints
- worsened by diuretics

Question 7

Symptoms of Gout

Answer 7

Needle like crystals in the joint
Sudden and severe episodes
Tenderness
Redness
Warmth
Swelling
Most common in big toe

Question 8

ACUTE

Answer 8

Not Aspirin (can change uric acid levels and make gout worse)

High dose NSAID

Naproxen 750mg immediately, 250mg three times a day until attack passes

Or Colchicine if NSAID is contraindicated

Question 9

Dose of colchicine

Answer 9

500mcg ONE tablet
2-4 times a day until symptoms relieved, max 6mg per course. 6mg=12 tablets

Once course of 12 tablets finished, don’t repeat within 3 days

Side effects = diarrhoea

Question 10

Colchicine toxicity side effect

Answer 10

Diarrhoea

Stop and refer to GP

Question 11

Colchicine stop what?

Answer 11

STOP statins

Increased risk of muscle death

Stop suring taking colchicine + 2 days after course finished

Question 13

Long term

Answer 13

• Let acute attack of gout get better
• Before starting long term treatment wait 1-2 weeks

1st line - Allopurinal if it doesn’t help

2nd line - Febuxostat

Continue treatment imdefinietly to prevent further gout

Question 14

Steven’s Johnson syndrome

Answer 14

• Rash
• If patient develops a rash, stop and refer to GP
• Potiental for Steven Johnson syndrome
• Rare side effect of allopurinol/febuxostat
• Flu like symptoms
• Red purple rash spreads and forms blisters

Question 15

Neuromuscular disorder - Myasthenia Gravis

Answer 15

Rare long term condition

Muscle weakness

Treatments include anticholinestesterases eg. Meostigmine and pyridostigmine

Question 16

SPASMS - Baclofen

Answer 16

• Avoid stopping abruptly, withdrawal may worsen spasticity, hyperthermia (increase body temp),psychiatric reactions

MHRA warning

Reduce over 1-2 weeks

Methocarbamol is an alternative

Question 17

Examples of NSAIDS

Answer 17

Aspirin
Ibuprofen
Naproxen
Clecoxib

Advise patients to have with food or after food

Can worsen symptoms of asthma

Question 18

NSAIDs can be what and what?

Answer 18

Selective and non selective

Selective = less Gi risk but more cardiovascular risk - celecoxib

Non selective = More Gi risk but less cardiac risk

Question 19

What do we mean by cardiovascular risk?

Answer 19

Risk increases with dose

Risk of thrombotic events (blood clots/heart attack/stroke)

Highest risk in order to

Celecoxib,diclofenac,ibuprofen