A 54-year-old farm worker presents for review. She has recently been diagnosed with osteoarthritis of the hand but has no other past medical history of note. Despite regular paracetamol she is still experiencing considerable pain, especially around the base of both thumbs.
What is the most suitable next management step?
Correct Answer C: Osteoarthritis - paracetamol + topical NSAIDs (if knee/hand) first-line.
The 2008 NICE guidelines suggest the use of paracetamol and topical NSAIDs first-line:
Osteoarthritis: management:
NICE published guidelines on the management of osteoarthritis (OA) in 2008:
What is the role of glucosamine?
A 24-year-old female is investigated for intermittent pain and swelling of the metacarpal phalangeal joints for the past 3 months. An x-ray shows loss of joint space and soft-tissue swelling. Rheumatoid factor is positive and a diagnosis of rheumatoid arthritis is made.
What is the most appropriate management to slow disease progression?
Correct Answer D: The 2009 NICE guidelines recommend that patients with newly diagnosed active RA start a combination of DMARDs (including methotrexate and at least one other DMARD, plus short-term glucocorticoids). Women of child-bearing age should be given effective contraception for the duration of treatment and for 3 months after methotrexate has been stopped.
Rheumatoid arthritis: management: The management of rheumatoid arthritis (RA) has been revolutionized by the introduction of disease-modifying therapies in the past decade. NICE has issued a number of technology appraisals on the newer agents and released general guidelines in 2009.
Patients with evidence of joint inflammation should start a combination of disease-modifying drugs (DMARD) as soon as possible. Other important treatment options include analgesia, physiotherapy and surgery
Initial therapy:
DMARDs:
TNF-inhibitors:
Rituximab:
Abatacept:
A 40-year-old woman who is known to have systemic lupus erythematosus is reviewed with an exacerbation of wrist pain.
Which one of the following is the most useful marker for monitoring disease activity?
Correct Answer D:
SLE: investigations:
Immunology:
Monitoring:
Which one of the following is not associated with carpal tunnel syndrome?
Correct Answer C:
Carpal tunnel syndrome: Carpal tunnel syndrome is caused by compression of median nerve in the carpal tunnel.
History:
Examination:
Causes:
Electrophysiology:
Treatment:
A 34-year-old kitchen worker presents with a two week history of pain in her right wrist. She has recently emigrated from Ghana and has no past medical history of note. On examination she is tender over the base of her right thumb and also over the radial styloid process. Ulnar deviation of the wrist recreates the pain.
What is the most likely diagnosis?
De Quervain's tenosynovitis:
De Quervain's tenosynovitis is a common condition in which the sheath containing the extensor pollicis brevis and abductor pollicis longus tendons is inflamed. It typically affects females aged 30 - 50 years old.
Features:
Management:
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