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33 Cards in this Set
- Front
- Back
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What is the first line treatment for mild form psoriatic arthritis?
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acetaminophen-NSAIDS
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What is the treatment for most severe forms of psoriatic arthritis?
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methotrexate
azathioprine sulfasalazine |
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Name 2 other treatments for psoriatic arthritis and what they help with.
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UV A light-used for dermatitis, but may help arthritis in peripheral joints
-Anti-TNF for skin and joints in pts unresponsive to other tx |
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Name a biologic DMARD and describe when it is used to treat psoriasis |
-TNF inhibitor -It is first line agent in patients with severe disease at presentation and it is used when there is inadequate response to conventional non biologic DMARD |
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What is mechanism of action of Apremilast and when is it used to treat psoriasis? |
-Apremilast inhibits phosphodiesterase 4 (PDE4) specific for cyclic adenosine monophosphate (cAMP) which results in increased intracellular cAMP levels and regulation of numerous inflammatory mediators - An alternative agent for use in patients with mild PsA and multiple comorbidities, particularly in patients who wish to avoid DMARD therapy, infusions, or injections |
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Name 5 TNF inhibitors used to treat psoriasis |
Etanercept Infliximab Adalimumab Golimumab Certolizumab pegol |
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What steroids are used for PsA? |
-corticosteroids -intermittent steroid injections for disease flares -low dose oral steroids as adjunct to DMARD therapy |
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What surgeries can help PsA? |
- synovectomy - joint replacement surgery - arthrodesis - osteotomy |
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What are non pharmacological treatment strategies for psoriasis arthritis |
Exercise, physical therapy, occupational therapy, weight reduction and patient education |
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Summarise the treatment options of PsA |
- NSAIDs - DMARDS - Biological therapy, anti TNF - Corticosteroids - Intra-articular steroid injections - Pain relief - conservative management- surgery |
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How do you treat Polymyalgia Rheumatica ? |
Glucocorticoids are initial therapy in patients diagnosed with PMR Start with Prednisone 15- 20 mg daily PO, patients respond quickly within 7 days of starting treatment with steroids Taper in small decrements to avoid flare |
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What is duration of glucocorticoid treatment for patient with Polymyalgia rheumatica |
Polymyalgia rheumatica runs a self-limited course, and glucocorticoid therapy can eventually be discontinued. Often, treatment can be discontinued after one to two years |
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What are causes of relapse in PMR patients and how do you treat it |
Larger initial doses of steroids and Faster rating of tapering are associated with relapse Resumption of Glucocorticoids either at lower dose or at dose which symptoms were controlled |
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Are steroid sparing medications effective in treating PMR |
Medications other than glucocorticoids, such asmethotrexate (MTX) or tumor necrosis factor (TNF) inhibitors, and interleukin (IL)-6 receptor antagonists have not been conclusively proven effective in PMR. |
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How do you diagnose steroid induce myopathy |
Diagnosis is based upon the history and timing of glucocorticoid exposure and upon the absence of other causes of myopathy. The diagnosis is generally established by demonstrating improved strength within three to four weeks after appropriate dose reduction. |
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What is typical presentation of steroid induced myopathy |
Affected patients typically present with gradual onset over several weeks of proximal muscle weakness accompanied by muscle wasting. A common manifestation is difficulty getting up from a chair or climbing stairs. |
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Name 2 situations when diagnosis of Steroid induced myopathy becomes difficult |
In patients with an underlying inflammatory myopathy, and in those treated with neuromuscular blocking agents. |
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What is course of Steroid induced Myopathy |
Muscle strength begins to improve within three to four weeks after appropriate dose reduction and eventually resolves in virtually all patients if glucocorticoid therapy can be discontinued |
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T or F: Myopathy is a dose dependent effect to statins. |
True |
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Treatment of Rhabdomyolysis |
Saline Infusion Urine alkalinization Mannitol |
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How do you diagnose Statin induced myopathy |
diagnosis of symptomatic and more severe statin-associated muscle events with elevated serum creatine kinase [CK]) is typically straightforward and based on a temporal association for both onset with initiation of statin therapy and resolution with statin withdrawal
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T or F: Myopathy can appear anytime during statin therapy, even years after initiation.
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True |
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What are clinical features that aid in diagnosis of Anserine bursitis |
-Medial knee pain -Rapidly mounting knee pain in a patient with knee OA. -Tenderness over the upper medial tibia between the pes anserinus and the tibial joint line -Absence of local swelling or induration The transition of pain with activity to pain at night in a patient with known knee OA. |
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What is initial therapy of Anserine bursitis |
-weight-reduction program, -quadriceps-strengthening exercises, = use of an -analgesic and/or short-term nonsteroidal antiinflammatory drugs (NSAIDs),
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How do you treat patients who do not respond to Initial therapy |
Patients who do not improve with initial therapy, a local glucocorticoid injection typically is administered |
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What are the antibodies seen in limited cutaneous systemic sclerosis |
ANA, Anti centromere antibodies |
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How do you treat OA of hip? |
NSAIDS intra-articular steroids arhthroscopy (debridement of loose stuff) arthroplasty |
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What are risk factors for osteonecrosis of the hip? |
trauma corticosteroid use alcohol sickle cell RA Lupus |
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What is seen on physical exam in patient with osteonecrosis of the hip? (test/gait)
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+ FABER test antalgic gait |
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What imaging study must be done for staging and diagnosis of osteonecrosis of the hip? |
MRI |
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T/F on an early X-ray, sclerosing femoral head, seen in osteonecrosis of the hip, will be normal |
True |
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How do you treat early osteonecrosis of the hip? |
protective weight-bearing removing offending agent cortical drilling pain management referral |
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What is a last resort treatment for osteonecrosis of the hip?
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arthroplasty |
