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As these drugs are so widely used in clinical

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As these drugs are so widely used in clinical practice it is important we manage this riskappropriately.The most widely followed guidelines are based around the 2002Royal College ofPhysicians (RCP) 'Glucocorticoid-induced osteoporosis:A concise guide to preventionand treatment', a link to which is provided below.The risk of osteoporosis is thought to rise significantlyonce a patient is taking the equivalentofprednisolone 7.5mg a day for 3 or more months.It is important to note thatwe should manage patients in an anticipatory, i.e. if it likely thatthe patient will have to take steroids for at least 3 months then we should start boneprotection straight away, rather than waiting until 3 months has elapsed.A good example is a patient with newly diagnosed polymyalgia rheumatica. As it is very likelythey will be on a significant dose of prednisolone for greater than 3 months bone protectionshould be commenced immediately.Management of patients at risk of corticosteroid-induced osteoporosis:The RCP guidelines essentially divide patients into two groups.1)Patients over the age of 65 years or those who've previously had a fragility fracture should beoffered bone protection.2)Patients under the age of 65 years should be offered a bone density scan, with furthermanagement dependent:T scoreManagementGreater than 0ReassureBetween 0 and -1.5Repeat bone density scan in 1-3 yearsLess than -1.5Offer bone protectionThe first-line treatment is alendronate. Patients should also be calcium and vitamin Dreplete.Septic arthritisOverview:most common organism overall isStaphylococcus aureusin young adults who are sexually activeNeisseria gonorrhoeaeshould also be consideredManagement:[41]
1)synovial fluid should be obtainedbefore starting treatment2)intravenous antibiotics which cover Gram-positive cocci are indicated. The BNF currentlyrecommendsflucloxacillinorclindamycin if penicillin allergic3)antibiotic treatment is normally be given for several weeks (BNF states6-12 weeks)4)needle aspirationshould be used todecompress the joint5)surgical drainagemay be needed if frequent needle aspiration is requiredElbow pain:The table below details some of the characteristic features of conditions causing elbowpain:Lateralepicondylitis(tenniselbow)Features:1)pain and tenderness localised to the lateral epicondyle2)pain worse on resisted wrist extension with the elbow extended or supinationof the forearm with the elbow extended3)episodes typically last between 6 months and 2 years. Patients tend to haveacute pain for 6-12 weeksMedialepicondylitis(golfer'selbow)Features:1)pain and tenderness localised to the medial epicondyle2)pain is aggravated by wrist flexion and pronation3)symptoms may be accompanied by numbness / tingling in the 4th and 5thfinger due to ulnar nerve involvementRadialtunnelsyndromeMost commonly due to compression of the posterior interosseous branch of theradial nerve. It is thought to be a result of overuse.

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Term
Spring
Professor
N/A
Tags
Rheumatology, Systemic lupus erythematosus, methotrexate

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