Rheumatology

Question 1

What type of drug is allopurinol?

Answer 1

Xanthine oxidase inhibitor

Question 2

What is allopurinol used for?

Answer 2

Prophylaxis of gout

Question 3

In which patients must allopurinol be used with caution?

Answer 3

Patients with renal impairment. Allopurinol is excreted by the kidney so dose is usually lowered in these patients.

Question 4

What is the mechanism of action of methotrexate?

Answer 4

Competitive inhibition of dihydrofolate reductase

Question 5

What is the dosing regime for methotrexate?

Answer 5

Taken weekly (7.5mg-20mg weekly) and usually taken with folic acid (on the other 6 days)

Question 6

List some side effects of methotrexate

Answer 6

Nausea
Mouth ulcers
Bone marrow suppression
Acute cutaneous reactions
Hepatitis
Pneumonitis
Chronic use can lead to interstitial pneumonitis and liver cirrhosis
Really excreted so be careful in CKD
Teratogenic (needs 3 month wash-out)

Question 7

What are the side effects of hydroxychloroquine?

Answer 7

Corneal and macular retinopathy - need to test vision before and during treatment
GI upset

Question 8

List some side effects of sulfasalazine

Answer 8

GI upset
Headache
Oligospermia
Renal impairment
Haematological dyscrasias
Hypersensitivity reactions

Question 9

What is the aim of biological agents in terms of disease progression in rheumatoid arthritis?

Answer 9

Biological agents aim to reduce DAS28 by >1.2 at 6 months

Question 10

When would you consider using a biological agent for the treatment of rheumatoid arthritis?

Answer 10

• Patients who have active disease on 2 occasions (DAS28 >5.1) > 1 month apart
• Patients who have tried at least 2 DMARDs in 6 months with no effect