Ahhhh.....
it will never end and I am just starting!
Just trying to stay afloat.
Learning about Rheumatoid Arthritis right now and guess how fun the pharmacology part is? Non. Zero. Pain.
• Acetaminophen
• NSAIDs
• Corticosteroids
• DMARDs-disease modifying anti-rheumatoid drugs
o Methotrexate
o Antimalarial drugs
o Sulfasalazine
o Leflunomide
o Etanercept
o Infiximab
o Adalimumab
o Rituximab
For one disease. And ohhh...their names make no sense? No sh@t! Plus, for every drug name, there are 1-10 trade names that are unrelated. Talk about a pain in my arse.
Medicine.
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3 comments:
If your board exam asks which drug to treat new-onset RA with no erosive joint changes on x-ray you should choose the NSAID. Even though real life research suggests it's best to start with combo therapy that includes either prednisone or infliximab to prevent erosive joint changes. I don't know what the latest research says (obviously go with whatever your lecturer tells you), but for old skool boards NSAIDs (even aspirin!) are first line for new onset RA barring erosive changes. Of course I got this practice question incorrect b/c there's NFW I'd start w/an NSAID if I knew I had RA!
Also for RA upper extremity joint involvement includes:
-MCPs (huge knuckles!)
-PIPs
-wrist
-spares DIPs
vs osteoarthritis (OA, non-erosive) hand joint involvement:
-PIP (Bouchard's nodes) joints
-DIP (Heberden's nodes) joints
-trapeziometacarpal & 1st MCP joints (usually spares other MCPs).
Once you see someone w/long-standing RA you won't forget that RA mainly sticks to the middle or more proximal joints...and though it's simple stuff you'll almost certainly have a question about this on boards so it's worth getting straight! :-)
Thanks for the info!
Funny that NSAIDs are the DOC on boards since we just got a whole lecture on how the treatment pyramid has been completely INVERTED in the last few years with methotrexate being used almost immediately.
Funny tid bit-
I am glad I blogged about these specific drugs last night as it worked in my advantage today by making me remember them tonight in the ED.
I was standing there with an attending at 11pm on a sunday night and we had just examined a RA patient in for a GI bleed when the trade name for Etanercept came up. (the patient had been laying on her floor for 8 hours! after not being able to stand up after a syncopal episode). The attending did not know the drug and I was able to gently slide it in there that I thought it was a DMARD. quite fun
only thing I did know though ;)
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