Rheum part 1 Flashcards
how do you treat polymyalgia rheumatica?
None of the following ”above head” GCA symptoms (headache, jaw pain, scalp tenderness, visual symptoms): Prednisone daily with tapering after 2-4 weeks and low dose for one year
Methotrexate weekly for more successful prednisone taper
Refractory = biologics (IL-6 blockade (tocilizumab))
how do you treat temporal arteritis
Prednisone started immediately for at least one month and then taper
If vision loss → IV methylprednisolone (usually vision loss is permanent :(
Tocilizumab - IL-6 antibody to reduce flares and steroid use
How do you treat fibromyalgia?
Multidisciplinary:
Patient education, CBT, meditation
Exercise programs, massage, therapy
Cannabis, treat depression and anxiety
Amitriptyline, fluoxetine, duloxetine, chlorpromazine, milnacipran, cyclobenzaprine, pregabalin, gabapentin, low-dose naltrexone
FDA approved: pregabalin, duloxetine, milnacipran
How do you treat polyarteritis nodosa?
Mild cutaneous = NSAIDs or colchicine
Severe = high dose IV methylprednisolone
Cyclophosphamide or other immunosuppressive agents lower risk of disease-related death (methotrexate or azathioprine)
Treat Hep B = short course of prednisone + HBV therapy and plasmapheresis
If Genetic form, TNF inhibitors
How do you treat polymyositis?
Prednisone, often long term
Monitor muscle strength and muscle enzymes
immunosuppressive drugs may reduce need for steroids
(methotrexate, azathioprine, mycophenolate)
Refer!
Admit if signs of rhabdomyolysis, dysphagia, respiratory insufficiency
How do you treat lupus
Avoid sun exposure, use sunscreen
Tailor to specific patient and severity!
Skin lesions = topical steroids
Joint pain = rest and NSAIDs
Hydroxychloroquine for initial therapy of rash and joint symptoms
Steroids for controlling complications (acute exacerbations), more severe
Immunosuppression with mycophenolate, azathioprine, methotrexate
Biologics
Flu vaccine annually and pneumococcal vaccine every 5 years
Refer
Admit if rapidly progressing, severe complications, infection
How do you treat Raynaud syndrome
Keep warm: wearing warming clothing will help prevent vasospasms
Protect hands from injury, wounds heal slowly and increase infection
Lubricating lotion
Stop smoking
Avoid sympathomimetic drugs (decongestants, diet pills, amphetamines)
Calcium channel blockers (Slow-release nifedipine, amlodipine)
ARBs, sympatholytics, topical nitrates, PDE-V inhibitors, SSRIs
IV prostacyclin if threat of digital loss
Sympathectomy sx if frequent and severe
How do you treat scleroderma?
Calcinosis can be observed, but topical sodium thiosulfate, colchicine, minocycline can help
Symptomatic + supportive
Raynaud’s = CCB
Esophageal symptoms = liquid/crushed meds only, avoiding late night meals, + PPI
GI bacteria: abx
HTN renal crisis = captopril or other ACE-I
Interstitial lung disease = mycophenolate mofetil or cyclophosphamide
Methotrexate for skin disease
Digital ulceration = bosentan
Pulmonary HTN = sildenafil or prostaglandins
Immunoablative therapy
