Fichas
Management Principles
Fichas del conjunto (13)
- 1What are the general management aims of rheumatological diseases?Patient education
Pain relief
Optimise function
+/- process modifications
+/- 'cure' - 2What are the broad categories of pain relief drugs?Simple analgesics (i.e. paracetamol)
Stronger/combination analgesics
Oral NSAIDs
Topical (NSAIDs, capsaicin, rubefacients)
Local injection (corticosteroid, radiocolloids, hyaluronic acid)
Antidepressants (low dose amitriptyline) - 3How long do the DMARDs take to take effect?Weeks/months
- 4How do the DMARDs work?They have no direct symptomatic benefit
But they may reduce the acute phase response, inflammatory clinical signs and may modify the outcome by reducing tissue damage - 5What are the indications for DMARDs?Persistent synovitis
Extra-articular disease
Drug-sparing effects (NSAIDs, corticosteroids) - 6What are the first line DMARDs?Methotrexate
Hydroxychloroquine - 7What are some other DMARDs?Salazopyrin
Gold
Penicillamine
Azathioprine
Cyclophosphamide
Cyclosporin
Biological agents - anti-TNF - 8What are the benefits of oral corticosteroid therapy in RA?Works quickly to reduce inflammation
Low doses may reduce early joint damage of RA - 9What are some disadvantages of oral corticosteroid therapy in RA?High incidence of side effects
(e.g. osteoporosis, muscle atrophy, altered fat distribution, skin bruising, hypertension, cataract, enhanced GI gut toxicity from NSAIDs, iatrogenic Addison's) - 10What is the place of oral corticosteroid therapy in RA?The cornerstone of early treatment
Often used for the first few months to gain short-term control of inflammation while awaiting benefit from slow-acting drugs - 11What are the 2 'curable' major rheumatic diseases? How are they cured?Septic arthritis/osteomyelitis - parenteral antibiotics
Gout - hypouricaemic agents to hold the serum uric acid in the lower half of the normal range - 12What percentage of gout patients are treated correctly and therefore cured?10%
- 13What surgical options are there for rheumatic disease?Joint surgery for persistent severe pain/disability (joint replacement is the only cure for OA)
Reconstructive surgery (for e.g. ruptured tendons)
Removal of inflamed synovium to prevent damage