By Maurice Barry MB, FRCPI (auth.)
The evaluate and administration of rheumatic illnesses is not easy and plenty of medical professionals are usually not convinced in their talents during this sector. This e-book bargains sensible recommendation and data in case you have to research swiftly the necessities of recent medical rheumatology. Written for senior condo officials and citizens generally (internal) medication, overall healthiness execs in rheumatology, basic care medical professionals and scientific scholars also will locate it helpful. * updated information regarding new treatments * necessities of universal and unusual rheumatic ailments indexed * useful suggestion on choosing applicable assessments, drug prescribing and sufferer details * Patient-centred method of administration * valuable rheumatology web pages indexed * All you would like in a single convenient pocket-sized resource
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Extra resources for Clinical Practice in Rheumatology
Methyl prednisolone 20-40 mg for soft tissue injections. Advice to Patients • • • • Explain risk of infection (approx. 1 :10 000) Rarely pain is worse 24 h after injection Rest joint for 12-24 h Expect relief in 48-72 h Recurrent Problems • Repeated injection is not usually the best management - seek advice How Many Injedions is Safe? • No good data but some rheumatologists wary of more than 3-4 per joint How to Manage Patients 39 How Often? g. knee OA in elderly can give benefit for some years where joint surgery not indicated or contraindicated.
Can produce pain if taken by patients already on other opioids Tramadol • • • For moderate to severe pain Reported to have fewer opioid adverse effects Less constipation, respiratory depression and addiction potential Buprenorphine • • • Agonist and antagonist properties. Can cause withdrawal when given to patients on other opioids Effects only partly reversed by naloxone Transdermal patch now available Fentanyl • • • Transdermal patch, changed every 3 days Potent, long half-life Less addictive, less nausea and less constipating than morphine Morphine • Not commonly used in rheumatology Practice Point If you prescribe a potent or high-dose opioid, prescribe a laxative in addition.
Kneeling Olecranon Bursitis (Student's Elbow) • • Pain, swelling and warmth over the olecranon process Elbow usually has normal range of movement unless the bursa is extremely tense with fluid Subacromial Bursitis • Pain on active shoulder movement, especially abduction, with much less pain or no pain on passive movements. May be difficult to distinguish from rotator cuff tendonitis Treatment • • • If bursa is large and fluid filled, can aspirate Gram stain, culture and sensitivity, when appropriate, to rule out infection.
Clinical Practice in Rheumatology by Maurice Barry MB, FRCPI (auth.)