Musculoskeletal answers:

1) NSAIDs (not aspirin) or colchicine

2) PPI
3) At least 3 attacks in the previous 12 months
4) All patients
5) Xanthine oxidase inhibitor, it reduces the formation of uric acid from purines via the
enzyme xanthine oxidase. NB never start during an acute attack, start 1-2 weeks
after
6) If mild, reintroduce slowly, stop if the rash occurs again.
7) ¼ to ½ reduction
8) Febuxostat
9) After the inflammation in an acute attack has settled. NB: the initiation or up
titration of a urate lowering therapy may precipitate an acute attack and therefore
colchicine should be considered as prophylaxis as an option. NSAIDs low dose with
PPI is an alternative
10) 6mg per course
11) 3 days
12) Statins, fibrates, digoxin and ciclosporin
13) Serious hypersensitivity reactions with febuxostat including SJS usually in the first
month. Stop if occurs.
14) Baclofen, tizanidine, diazepam
15) RA pain is worsened by periods of inactivity/rest
16) Hyperuricaemia (diuretics, ciclosporin, tacrolimus, cytotoxics, cancer)
17) DMARD- either oral methotrexate, leflunomide or sulfasalazine
18) 2-3 months, NB: up titrate to the max tolerated dose
19) A corticosteroid to provide rapid symptomatic control
20) Hydroxychloroquine
21) Add another DMARD i.e. methotrexate, leflunomide, sulfasalazine and
hydroxychloroquine
22) Orange/brown
23) For 2 years after treatment for women and 3 months after for men
24) Inhibits the conversion of dihydrofolate to tetrahydrofolate- which is needed to
make purines and pyrimidines and therefore DNA – prevents cellular replication
25) Once weekly
26) Blood dyscrasias: low WBC, anaemia, thrombocytopenia. Hepatotoxicity.
Nephrotoxicity. Pulmonary toxicity: report SOB and cough and fever. GI toxicity-
report stomatitis, first sign of GI toxicity.
27) During and three months after for both men and women
28) Simple analgesia- paracetamol and topical NSAIDs, regular rather than PRN if pain
uncontrolled. When topical isn’t controlling- use oral NSAIDs, then opoiods
29) Muscle weakness- a neuromuscular disorder. Commonly affects muscles of eyes,
eyelids, facial expressions, chewing, swallowing and speaking. Autoimmune
30) Anticholinesterases: neostigmine, pyridostigmine. Anticholinesterases are first line
and as an adjunct to immunosuppressive therapy.
Immunosuppressants: corticosteroids, azathioprine, methotrexate.
corticosteroids are used when anticholinesterases cannot control symptoms
 completely. A second line immunosuppressant is used frequently to reduce dose of
corticosteroid.
31) Muscarinic- increased sweating, salivary and gastric secretions, GI, uterine motility
and bradycardia
32) Quinine
33) Because of toxicity, it is toxic in overdoses and accidental fatalities have occurred; it
should only be prescribed when it has caused regular disruption to sleep and cramps
are really painful.
34) QT prolongation, convulsions, arrhythmia
35) Reminder of dose dependent QT prolonging effects, caution in patients with risk
factors for QT prolongation or in those with atrioventricular block
36) Stomach, intestines, kidneys and platelets. IE so if we have this we will need mucosal
protection and have reduced renal blood flow.
37) Inflammatory sites, macrophages
38) Etoricoxib (celecoxib slightly less cox 2 specific)
39) Low dose ibuprofen or naproxen (NO to diclofenax or COX 2 specific)
40) Ketoprofen, piroxicam
41) Oral NSAIDs, paracetamol alone is ineffective. A weak opioid can be used if the
NSAID is ineffective or not tolerated.
42)