Osteoporosis
What is the primary goal of osteoporosis treatment
Prevention of fragility fractures and stopping disease progression
What joints are commonly affected
Hands, Feet, Hips, Knees, Lumbar Spine
What are presenting symptoms of RA?
Characterized by inflammation, pain, stiffness, joint swelling, and progressive joint tenderness and destruction of synovial joints
Swelling soft and boggy
Nodules may occur beneath the skin at extensor surfaces of elbows, forearms and hands
Bilateral stiffness that persists > 1 hour in the AM or after naps
Systemic effects such as fatigue; loss of appetite; weight loss; fever
red meat, alcohol, sugary beverages, shell fish
Commonly affects the lumbar spine and SI joints. Healthy tissue is replaced by theossified scar tissue which causes fusion of the joint, loses flexibility of the joint.
Ankylosing Spondylitis
Describe patient instructions for taking a bisphosphonate
Oral bisphosphonates must be taken on an empty stomach with a full (8-oz, 250 mL) glass of water, and the patient must remain upright for at least 30 min and not take anything else by mouth during this time period. If on Calcium supplement- do NOT take at the same time!
Explain the basic patho of OA
Loss of the articular cartilage (weakening of the collagen network followed by bone remodeling (loss of bone )
XR: osteophytes with loss of articular space and subchondral sclerosis
Primary goal of RA treatment
Remission! may also focus on improved quality of life and maintain joint function.
What medication needs to be taken within 24 hours of the initial attack to be effective
colchicine
Pain condition with tender points that has no explicable reason for pain.
Fibromyalgia
Name a common medication class that can increase risk of osteoporosis with long term use
PPI
How long would you see morning joint stiffness in OA
Less than 30 minutes
What specialist should see a patient before starting DMARD therapy
Opthalmology
How are Xanthine Oxidase Inhibitors used?
Daily medication such as allopurinol to help prevent gout attacks
Pharmacological therapy for polymyalgia rheumatica
prednisone
What scan would you order to assess bone mineral density, and what score would indicate osteoporosis
DEXA scan
T score -2.5 or lower
•All patients should be referred to patient education programs such as offered by the Arthritic Society across Canada
•Strength training and aerobic exercise, either land or water based under guidance of physiotherapist
•Weight management (particularly those with BMI > 25 kg/m2)
•Possible splints, braces, taping, orthotics or walking aids
•Acupuncture
•Possible electrical nerve stimulation (TENS)
•Hot/cold therapy
What pharmacological therapy can be used while waiting for DMARD effect
NSAIDS; Glucocorticoids- lowest dose possible for shortest period of time
Should a patient with gout take aspirin?
No - can elevate serum urate. Only take if on for CV prophylaxis.
Exaggerated vascular response occurs in extreme circumstances
Raynaud's
What are the supplements and dosing for osteoporosis
Calcium 1200 mg from diet and supplements
Vitamin D3 800- 2000 units
What is the first line pharmacological therapy
Tylenol - lowest effective dose
•Splints to protect joints
•Hot and cold therapy
•Immunizations important
•Exercise, Strength training
•Weight management
List the 3 medications that are used in the initial presentation of gout
Cotricosteroid, NSAID, colchicine
Why do you start prednisone before biopsy results with giant cell arteritis