question 12 - if you are projecting temporal arteritis with jaw claudication, a temporal headache and muscle stiffness / pain -- before it affects the vision - give prednisone -- do the testing later -- do not wait on prednisone -- ESR is right but at a later time - you do not delay if temporal arteritis is suspected in prednisone administration (courtesy of a neurologist)
Question 11: Colchicine does not treat uric acid levels. It works best in the 1st 24hrs of acute gout attack as an antiinflammatory agent. But because of GIT effects, not the best choice if NSAID is an option, or if presents after 24hrs.
Question 6: On an early ankylosing spondylitis you need to get an MRI of the sacroiliac joint. It takes time before you may see any syndesmophytes by rx
Best NEXT step is spinal XRAY. It is usually normal in early disease, and yes after this you would assess the activity with an MRI; however, you would not do an MRI before a normal spinal XR.
Amruta Ravan, I think you're absolutely correct about giving steroids first. I'm not sure what his reasoning is for running an ESR as first line given there is high index of suspicion of GCA. While ESR would be elevated, it also wouldn't tell us anything about the specific disease, only that there is inflammation. A better choice would be to treat first, but draw blood prior to treatment to test.
I think that is the case with a temporal artery biopsy, not ESR. An ESR is done with a routine blood test anyway and it's very quick. So you should definitely start treating before starting on the biopsy, unless the patient is experiencing amaurosis fugax, in which case, you need immediate treatment, possibly even before the ESR.
Duloxetine, not amitriptyline, is used to treat fibromyalgia. Lyrica also FDA approved. Tramadol also has been shown to be of benefit due to SNRI and weak opioid agonist properties.
I guess there is some debate, but I definitely learned that you administer a high dose of prednisone when there is a high suspicion of giant cell arteritis.
I think u firstly start with annual dose, then ESR After confirmation of the diagnosis then u can give high dose (increase dose of steroids if already started)
Nice little sleight of hand with question 8 lol. None of the options were specific for RA and so it was changed to "most likely to be associated with". Still, great video. Thanks!
Hi Dr. Paul, for question 19, why is the answer prednisone + methotrexate? I think your lecture only mentions corticosteroids as a symptomatic treatment.
+Livvy Liv Behcets Mx is variable depending on the symptoms, the severity and the organs involved. For minor mild manifestations, give colchicine. If you see E.Nodosum/P.Gangrenosum then add steroids. For major organ system involvement (CNS, uveitis), give steroids + Immunosuppressant like AZT, cyclosporine, MTX, INF Hope it helps Excellent videos as always Paul!
Hi, great video. Can you or anyone clarify question 12. Are you sure it's not "B" prednisone first since it's temporal arteritis and it can cause blindness if not managed urgently? Thanks
question 12 - if you are projecting temporal arteritis with jaw claudication, a temporal headache and muscle stiffness / pain -- before it affects the vision - give prednisone -- do the testing later -- do not wait on prednisone -- ESR is right but at a later time - you do not delay if temporal arteritis is suspected in prednisone administration (courtesy of a neurologist)
Hey for question 12 about temporal arteritis. It is said that steroids comes first before diagnosing the condition as it can cause blindness.
Question 11: Colchicine does not treat uric acid levels. It works best in the 1st 24hrs of acute gout attack as an antiinflammatory agent. But because of GIT effects, not the best choice if NSAID is an option, or if presents after 24hrs.
Question 6: On an early ankylosing spondylitis you need to get an MRI of the sacroiliac joint. It takes time before you may see any syndesmophytes by rx
Exactly what I thought as well, on the MRI the SI-inflammation can be visualized.
Best NEXT step is spinal XRAY. It is usually normal in early disease, and yes after this you would assess the activity with an MRI; however, you would not do an MRI before a normal spinal XR.
@@cristinavanloon8028 in germany u would.
Amruta Ravan, I think you're absolutely correct about giving steroids first. I'm not sure what his reasoning is for running an ESR as first line given there is high index of suspicion of GCA. While ESR would be elevated, it also wouldn't tell us anything about the specific disease, only that there is inflammation. A better choice would be to treat first, but draw blood prior to treatment to test.
I think that is the case with a temporal artery biopsy, not ESR. An ESR is done with a routine blood test anyway and it's very quick. So you should definitely start treating before starting on the biopsy, unless the patient is experiencing amaurosis fugax, in which case, you need immediate treatment, possibly even before the ESR.
Predisone caused bone death in my hip
Send blood sample for ESR and start steroids. Once we give steroids, it drastically changes ESR level, and ESR would be of no help.
Duloxetine, not amitriptyline, is used to treat fibromyalgia. Lyrica also FDA approved. Tramadol also has been shown to be of benefit due to SNRI and weak opioid agonist properties.
I guess there is some debate, but I definitely learned that you administer a high dose of prednisone when there is a high suspicion of giant cell arteritis.
I think u firstly start with annual dose, then ESR
After confirmation of the diagnosis then u can give high dose (increase dose of steroids if already started)
Very Helpful for my medic pratice. Your clinical cases are very important
Bactrim is used for PJP prophylaxis with prolonged steroid use, not because of cyclophosphamide use
Hi, a question - couldn't question 7 be Pott's Disease provided he has a latent form of TB? as usual great vids.
Nice little sleight of hand with question 8 lol. None of the options were specific for RA and so it was changed to "most likely to be associated with". Still, great video. Thanks!
Hi Dr. Paul, for question 19, why is the answer prednisone + methotrexate? I think your lecture only mentions corticosteroids as a symptomatic treatment.
+Livvy Liv
Behcets Mx is variable depending on the symptoms, the severity and the organs involved.
For minor mild manifestations, give colchicine. If you see E.Nodosum/P.Gangrenosum then add steroids.
For major organ system involvement (CNS, uveitis), give steroids + Immunosuppressant like AZT, cyclosporine, MTX, INF
Hope it helps
Excellent videos as always Paul!
Question 19:
Wouldn't the initial treatment be Prednisone and Azathioprine?
I thought colchicine and alupurinol are for acute gout and prevention respectively?!
Thank you so much
Question 12 is B, prednisone .
Q3 : i to broad, i found it very difficult. it would have been nice to have sort other common signs like sinusitis or otitis.
Thank you! Great job.
Hello paul where do I can buy the question of rheumatology
thank you very much doctor ❤
Circinate balanitis will not occur in behcets
Where are other rheumatology lectures? I couldn't find in your playlists.
May I ask, Question 19, what was the diagnosis? Didn't catch that. Anyone knows kindly help out, thanks!
It's Behcet Syndrome he talked about it
Hi, great video. Can you or anyone clarify question 12. Are you sure it's not "B" prednisone first since it's temporal arteritis and it can cause blindness if not managed urgently? Thanks
DD migraine :-)