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Ortho Tx 2


Tx of choice: acute gout NSAIDs (indomethacin, celecoxib)
Acute gout: other tx colchicine (esp for prophylaxis); c’steroids (oral, IV, intra-art) for pt who cannot take NSAIDs;
Gout tx: never: start a drug to tx elevated uric acid in midst of acute attack; don’t stop prophylactic tx (if already on it) during acute; tx arthritis first, then hyperuricemia (not both at once)
Indications for gout prophylaxis: 2 or more attacks/yr; erosive dz on plain film; uric acid nephropathy/ nephrolithiasis; chronic polyarticular gout
gout prophylaxis: Pharmacology: colchicine; uricosurics (probenecid); xanthine oxidase inhibitors (allopurinol, Uloric)
Enteropathic arthritis: Tx NSAIDs (indomethacin: AS); DMARDs for chronic / refractory; Abx if nec; Ct guided intra-art injections; PT & lifestyle mod
Psoriatic arthritis: Tx Pts have 2 chronic dz; NSAIDs (or combo NSAIDS & sulfasalazine); Physical therapy; Methotrexate in refractory
OA tx that are not effective wedged insole (esp not for severe); unloader brace; some thermal (diathermy, infrared)
OA tx: patellar taping for P-F compartment, for medial pull of patella only; combo w/VMO exercise
Useful thermal tx OA US (only modality to increase hip temp); microwave (deeper)
OA alt tx: glucosamine / chondroitin (safe, won’t slow progression); doxycycline, vit C,D; acupuncture?
Tx: fish oil (re: arthritis) evidence for RA (not OA)
OA: surg tx wedge osteotomy okay; Arthro debridement no (except for torn meniscus); microfx (not LT cure); Carticel; OATS; joint replacement
Gono arthritis: Tx: hospitalize pt; ceftriaxone 1gm (IM or IV) q 24 hours until clinical improvement; po cefixime or cefpodoxime > 1 wk
Nongono arthritis gram pos Rx: Nafcillin or cefazolin (vanc for MRSA)
Nongono arthritis: gram neg esp Enterobacteriaceae; IVDU; & neutropenic (also pseudomonas) ; ceftazidime or genta; IV 2wks & po 4 wks
TB arthritis: Tx same as for pulmonary dz: multiple agents for at least 9 months
Lyme arthrtitis: Tx oral doxycycline or amox x 1-2 mo; or IV ceftriaxone for 2-4 wks
Fungal arthritis: Tx Ampho B (IV +/- intra-art)
Infxs arthritis: prosthetic joint: Tx aggressive debridement (early), removal of prosthesis (late), and prolonged Abx tx
Fibromyalgia: Tx multifaceted; Self-care/ pt ed (exercise, yoga, support grp); CBT; Sleep improvement
Fibromyalgia: Tx: antidepressants TCA; SSRIs (fluoxetine, paroxetine); SNRIs (duloxetine / milnacipran)
Fibromyalgia: Tx: analgesics: tramadol, gabapentin, pregabalin
Fibromyalgia: Tx: muscle relaxers: cyclobenzaprine
Fibromyalgia: Tx (genl) NSAIDS, prednisone not helpful; combination therapy best
Nonspecific NSAIDs: Side effects: HTN, GI, altered renal function, MI (ibuprofen and diclofenac)
Rheumatoid Arthritis: Rx: DMARDs, steroids
Joint & Soft Tissue Injections/ Aspirations: CI Intra-tendinous injections (future rupture likely); drug allergies; steroids are immunosuppressive
Joint & Soft Tissue Injections/ Aspirations: Side effects Tendon rupture, Infection, Hypopigmentation, Fat atrophy, Steroid flare; caution in diabetics
Created by: Adam Barnard Adam Barnard