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33 Cards in this Set

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What is the first line treatment for mild form psoriatic arthritis?
acetaminophen-NSAIDS
What is the treatment for most severe forms of psoriatic arthritis?
methotrexate

azathioprine


sulfasalazine

Name 2 other treatments for psoriatic arthritis and what they help with.
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

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

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

Name 5 TNF inhibitors used to treat psoriasis

Etanercept


Infliximab


Adalimumab


Golimumab


Certolizumab pegol

What steroids are used for PsA?

-corticosteroids


-intermittent steroid injections for disease flares


-low dose oral steroids as adjunct to DMARD therapy

What surgeries can help PsA?

- synovectomy


- joint replacement surgery


- arthrodesis


- osteotomy

What are non pharmacological treatment strategies for psoriasis arthritis

Exercise, physical therapy, occupational therapy, weight reduction and patient education

Summarise the treatment options of PsA

- NSAIDs


- DMARDS


- Biological therapy, anti TNF


- Corticosteroids


- Intra-articular steroid injections


- Pain relief


- conservative management- surgery

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

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

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

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.

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.

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.

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.

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

T or F: Myopathy is a dose dependent effect to statins.

True

Treatment of Rhabdomyolysis

Saline Infusion


Urine alkalinization


Mannitol

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
T or F: Myopathy can appear anytime during statin therapy, even years after initiation.

True

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.

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),




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

What are the antibodies seen in limited cutaneous systemic sclerosis

ANA, Anti centromere antibodies

How do you treat OA of hip?

NSAIDS


intra-articular steroids


arhthroscopy (debridement of loose stuff)


arthroplasty

What are risk factors for osteonecrosis of the hip?

trauma


corticosteroid use


alcohol


sickle cell


RA


Lupus

What is seen on physical exam in patient with osteonecrosis of the hip? (test/gait)

+ FABER test


antalgic gait

What imaging study must be done for staging and diagnosis of osteonecrosis of the hip?

MRI

T/F on an early X-ray, sclerosing femoral head, seen in osteonecrosis of the hip, will be normal

True

How do you treat early osteonecrosis of the hip?

protective weight-bearing


removing offending agent


cortical drilling


pain management referral

What is a last resort treatment for osteonecrosis of the hip?

arthroplasty