Acute gout treatment – NSAIDs (indomethacin or naproxen), colchicine, or corticosteroids are first-line; begin
treatment ASAP after symptom onset.
Preferred NSAIDs – Indomethacin and naproxen; avoid aspirin because it affects uric acid excretion.
Colchicine – Give within 36 hours; 1.2 mg initially, then 0.6 mg 1 hour later, followed by 0.6 mg once or twice daily if
needed.
Xanthine oxidase inhibitors – Allopurinol and febuxostat decrease uric acid production for chronic gout prevention;
not for acute pain relief.
Therapeutic uric acid level – Goal <6 mg/dL (<5 mg/dL for patients with tophi).
Allopurinol teaching – Start at low dose, titrate slowly, maintain hydration, report rash immediately (SJS risk).
OA – Degenerative "wear-and-tear" arthritis causing cartilage loss, pain, and stiffness.
Preferred OA treatment – Exercise, weight loss, topical NSAIDs first, oral NSAIDs if needed.
OA with CKD – Acetaminophen or topical NSAIDs preferred; avoid chronic oral NSAIDs.
Topical OA medications – Diclofenac gel is first-line; capsaicin cream is another option.
Acetaminophen – Good for pain but not inflammation; max 4 g/day (prefer ≤3 g/day in older adults).
RA – Chronic autoimmune inflammatory disease causing symmetric joint destruction; treat early to prevent disability.
DMARDs – Slow disease progression and prevent joint damage; methotrexate is first-line.
Methotrexate ADRs – Hepatotoxicity, bone marrow suppression, stomatitis, pulmonary toxicity.
Methotrexate teaching – Weekly dosing only, take folic acid daily, monitor CBC, LFTs, and creatinine.
Methotrexate contraindications – Pregnancy, severe liver disease, alcoholism, significant renal impairment.
Hydroxychloroquine – Used for mild RA or combination therapy; major risk is retinal toxicity.
Hydroxychloroquine teaching – Baseline and annual eye exams; avoid in existing retinal disease.
JAK inhibitors – Tofacitinib, baricitinib, upadacitinib; block inflammatory cytokine signaling.
JAK inhibitors – Can be combined with methotrexate but not biologic DMARDs.
JAK boxed warnings – Serious infection, malignancy, thrombosis, and major cardiovascular events.
Biologic DMARDs – Adalimumab, etanercept, infliximab, etc.; suppress inflammatory cytokines.
Biologics teaching – Screen for TB and hepatitis B before starting; avoid live vaccines; monitor closely for infection.
Osteoporosis – Progressive loss of bone density leading to fragility fractures.
DEXA interpretation – Osteopenia = T-score -1.0 to -2.5; Osteoporosis = ≤ -2.5.
Calcium/Vitamin D – Calcium 1,200 mg/day and Vitamin D 800–1,000 IU/day.
Exercise – Weight-bearing and resistance exercises improve bone strength.
Bisphosphonates – Alendronate, risedronate, zoledronic acid; inhibit osteoclast-mediated bone resorption.
Bisphosphonate contraindications – Esophageal disorders, inability to sit upright 30–60 minutes, hypocalcemia,
severe renal impairment.
Bisphosphonate teaching – Take first thing in the morning with plain water on an empty stomach; remain upright
30–60 minutes before eating or taking other medications.
Rare ADRs – Osteonecrosis of the jaw and atypical femur fractures.
SERM therapy – Raloxifene is used for postmenopausal osteoporosis and reduces breast cancer risk.
SERM contraindication – History of DVT or pulmonary embolism due to thromboembolism risk.
PTH analogs – Teriparatide and abaloparatide stimulate new bone formation; daily SQ injection for a maximum of 2
years.
RANKL inhibitor – Denosumab is given SQ every 6 months; correct hypocalcemia first and continue calcium/Vitamin
D.
Corticosteroids – Prednisone is commonly used for short-term inflammation control or RA bridge therapy.
Long-term steroid ADRs – Osteoporosis, hyperglycemia, infection, adrenal suppression, cataracts, weight gain.
Steroid teaching – Never stop abruptly; taper dose gradually and take with food.
NSAIDs – Reduce pain and inflammation by inhibiting COX enzymes and prostaglandin synthesis.
NSAID ADRs – GI bleeding, renal impairment, hypertension, fluid retention.
Avoid NSAIDs – CKD, peptic ulcer disease, uncontrolled heart failure.
Celecoxib – Lower GI risk than traditional NSAIDs but avoid with sulfa allergy.
Aspirin – Low dose for antiplatelet therapy, high dose for inflammation; avoid in gout and children (Reye syndrome).
Adult pain scale – Numeric Rating Scale (0–10).
Pediatric pain scales – Wong-Baker FACES; FLACC for infants or nonverbal children.
Morphine – Schedule II opioid for moderate-to-severe acute, chronic, or cancer pain.
treatment ASAP after symptom onset.
Preferred NSAIDs – Indomethacin and naproxen; avoid aspirin because it affects uric acid excretion.
Colchicine – Give within 36 hours; 1.2 mg initially, then 0.6 mg 1 hour later, followed by 0.6 mg once or twice daily if
needed.
Xanthine oxidase inhibitors – Allopurinol and febuxostat decrease uric acid production for chronic gout prevention;
not for acute pain relief.
Therapeutic uric acid level – Goal <6 mg/dL (<5 mg/dL for patients with tophi).
Allopurinol teaching – Start at low dose, titrate slowly, maintain hydration, report rash immediately (SJS risk).
OA – Degenerative "wear-and-tear" arthritis causing cartilage loss, pain, and stiffness.
Preferred OA treatment – Exercise, weight loss, topical NSAIDs first, oral NSAIDs if needed.
OA with CKD – Acetaminophen or topical NSAIDs preferred; avoid chronic oral NSAIDs.
Topical OA medications – Diclofenac gel is first-line; capsaicin cream is another option.
Acetaminophen – Good for pain but not inflammation; max 4 g/day (prefer ≤3 g/day in older adults).
RA – Chronic autoimmune inflammatory disease causing symmetric joint destruction; treat early to prevent disability.
DMARDs – Slow disease progression and prevent joint damage; methotrexate is first-line.
Methotrexate ADRs – Hepatotoxicity, bone marrow suppression, stomatitis, pulmonary toxicity.
Methotrexate teaching – Weekly dosing only, take folic acid daily, monitor CBC, LFTs, and creatinine.
Methotrexate contraindications – Pregnancy, severe liver disease, alcoholism, significant renal impairment.
Hydroxychloroquine – Used for mild RA or combination therapy; major risk is retinal toxicity.
Hydroxychloroquine teaching – Baseline and annual eye exams; avoid in existing retinal disease.
JAK inhibitors – Tofacitinib, baricitinib, upadacitinib; block inflammatory cytokine signaling.
JAK inhibitors – Can be combined with methotrexate but not biologic DMARDs.
JAK boxed warnings – Serious infection, malignancy, thrombosis, and major cardiovascular events.
Biologic DMARDs – Adalimumab, etanercept, infliximab, etc.; suppress inflammatory cytokines.
Biologics teaching – Screen for TB and hepatitis B before starting; avoid live vaccines; monitor closely for infection.
Osteoporosis – Progressive loss of bone density leading to fragility fractures.
DEXA interpretation – Osteopenia = T-score -1.0 to -2.5; Osteoporosis = ≤ -2.5.
Calcium/Vitamin D – Calcium 1,200 mg/day and Vitamin D 800–1,000 IU/day.
Exercise – Weight-bearing and resistance exercises improve bone strength.
Bisphosphonates – Alendronate, risedronate, zoledronic acid; inhibit osteoclast-mediated bone resorption.
Bisphosphonate contraindications – Esophageal disorders, inability to sit upright 30–60 minutes, hypocalcemia,
severe renal impairment.
Bisphosphonate teaching – Take first thing in the morning with plain water on an empty stomach; remain upright
30–60 minutes before eating or taking other medications.
Rare ADRs – Osteonecrosis of the jaw and atypical femur fractures.
SERM therapy – Raloxifene is used for postmenopausal osteoporosis and reduces breast cancer risk.
SERM contraindication – History of DVT or pulmonary embolism due to thromboembolism risk.
PTH analogs – Teriparatide and abaloparatide stimulate new bone formation; daily SQ injection for a maximum of 2
years.
RANKL inhibitor – Denosumab is given SQ every 6 months; correct hypocalcemia first and continue calcium/Vitamin
D.
Corticosteroids – Prednisone is commonly used for short-term inflammation control or RA bridge therapy.
Long-term steroid ADRs – Osteoporosis, hyperglycemia, infection, adrenal suppression, cataracts, weight gain.
Steroid teaching – Never stop abruptly; taper dose gradually and take with food.
NSAIDs – Reduce pain and inflammation by inhibiting COX enzymes and prostaglandin synthesis.
NSAID ADRs – GI bleeding, renal impairment, hypertension, fluid retention.
Avoid NSAIDs – CKD, peptic ulcer disease, uncontrolled heart failure.
Celecoxib – Lower GI risk than traditional NSAIDs but avoid with sulfa allergy.
Aspirin – Low dose for antiplatelet therapy, high dose for inflammation; avoid in gout and children (Reye syndrome).
Adult pain scale – Numeric Rating Scale (0–10).
Pediatric pain scales – Wong-Baker FACES; FLACC for infants or nonverbal children.
Morphine – Schedule II opioid for moderate-to-severe acute, chronic, or cancer pain.
