Rheum part 2

Question 1

how do you treat sjogren syndrome

Answer 1

Artificial tears, topical cyclosporine, lifitegrast
Sipping water, sugar free gum, hard candies

Xerostomia = pilocarpine and cevimeline

Avoid taking decongestants and anticholinergics

Maintain good oral hygiene, including fluoride treatment

Prednisone for severe systemic inflammatory manifestations

Question 2

how do you treat rheumatoid arthritis

Answer 2

Refer
NSAIDs
Glucocorticoids until DMARDs (hydroxychloroquine, methotrexate, leflunomide, sulfasalazine) take effect
If needed, TNF inhibitors or JAK inhibitors
Use DAS28 score to monitor treatment response (swollen/tender joints, ESR/CRP, VAS)

Question 3

How do you treat reactive arthritis?

Answer 3

NSAIDs
If NSAIDs don’t work, nonbiological DMARD (sulfasalazine, methotrexate)

Treat underlying cause
Chronic reactive arthritis associated w/ chlamydia may benefit from combo abx: rifampin + doxycycline/azithromycin

Question 4

How do you treat juvenile idiopathic arthritis?

Answer 4

NSAIDs for symptoms
DMARDs
Glucocorticoids if no response

Eye exams routinely
PT

Question 5

gout tx

Answer 5

ACUTE:
NSAIDs first line (indomethacin and naproxen)
Colchicine if symptoms <36 hours
Oral steroids (intra-articular injection for monoarticular) If giving intra-articular steroids, do joint aspiration and gram stain first!
If refractory, IL -1 inhibitor (anakinra)

BETWEEN ATTACKS:
Avoid alcohol (beer), purines (liver, seafood, yeasts), avoid diuretics, niacin, aspirin
Colchicine prophylaxis
Urate lowering = allopurinol + febuxostat (NOT in acute attacks)
probenecid (not in renal issues, inc Uris acid excretion)

Question 6

pseudogout tx

Answer 6

NSAIDs for acute attacks
Joint aspiration
intra-articular steroid injection (triamcinolone) or oral (prednisone)
Colchicine w/n 24 hours and for prophylaxis if >3/year
Short term immobilization
If refractory, IL -1 inhibitor (anakinra)