RA, OA and Fibromyalgia diagnosis and treatments

Question 1

What is the class of drugs called that are used as first line treatment for RA?

Answer 1

DMARDs (Disease Modifying Anti-Rheumatic Drugs)

Question 2

What is the downfall of prescribing DMARDs (i.e. why do we refer to a rheumatologist?)?

Answer 2

They have a lot of side effects

Question 3

What drugs are classified as DMARDs and are to be used to treat RA?

Answer 3

hydroxychloroquine (plaquenil), methotrexate, sulfasalazine, azothioprine (imuran)

Question 4

What is the major side effect of hydroxychloroquine (plaquenil)?

Answer 4

Macular damage–need for annual retinal exam

Question 5

What is the major side effect of methotrexate?

Answer 5

cytotoxicity, hepatic fibrosis, pulmonary infiltrates. Monitor CBC and liver functions.

Question 6

What is the major side effect of sulfasalazine?

Answer 6

myelosuppression

Question 7

How do you monitor someone on sulfasalazine?

Answer 7

Monitor CBC, liver, and kidney function every 2-4 weeks for the first 3 months, then every 3 months after that

Question 8

What level of treatment is azothioprine (imuran) considered and why?

Answer 8

2nd or 3rd line, they do not typically induce remission of RA

Question 9

What two classes of drugs can be used to help break through until DMARDs take effect?

Answer 9

NSAIDs and Corticosteroids

Question 10

What drugs are considered NSAIDs? Which is a Cox II inhibitor? What is the catch to NSAIDs (2)?

Answer 10

ibuprofen, naproxen sodium, indomethacin. Celebrex is a Cox II inhibitor. NSAIDs may cause GI upset and they do not improve prognosis, just treat the symptoms

Question 11

What do corticosteroids do? And how often are they given? What are the side effects?

Answer 11

May lessen pain and bridge gap prior to DMARD effect, given no more than 3x per year, side effects are weight gain and osteoporosis

Question 12

What drugs are considered anticytokines and what are their high risk side effects?

Answer 12

Etanercept (Embrel), Infliximab (Remicaid), Adalimumab (Humira). Risks are skin infections and cancer.

Question 13

What tests are used to diagnose RA?

Answer 13

ESR, CRP, CBC, RF, anti CCP antibodies

Question 14

Walk through diagnosis with RF test

Answer 14

RF is present in 80% of patients with RA, usually later in the disease. May be positive in SLE or other AI dz as well. RF (-)? Try anti-CCP. Presence of RF and anti-CCP is highly specific for RA. If (+), can diagnose RA EVEN IF RF IS (-)

Question 15

What is the first line treatment for OA?

Answer 15

Analgesics such as Tylenol (acetominophen) or Aspirin (ASA)

Question 16

What is the second line treatment for OA?

Answer 16

NSAIDs due to local joint inflammation. Start low.

Question 17

What disease is 10x more crommon in females?

Answer 17

Fibromyalgia

Question 18

What is the cardinal symptom of fibromyalgia?

Answer 18

Diffuse musculoskeletal pain

Question 19

What symptom is comorbid with fibromyalgia in 90% of cases?

Answer 19

fatigue

Question 20

What is the only physical exam finding for fibromyalgia? How do you reach a diagnosis?

Answer 20

excessive muscle tenderness, 11 out of 18 predefined points of tenderness must be id’ed

Question 21

What classes of medications are used to treat fibromyalgia?

Answer 21

NSAIDs, SSRIs, Tricyclic antidepressants, corticosteroid injections