Différences entre versions de « Arthropathies »
De médecine.top
(→Goutte) |
(→Goutte) |
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=== Goutte === | === Goutte === | ||
| − | * <u>Traitement:</u> | + | * <u>Traitement de la crise de goutte:</u> |
** '''Colchicine''' The simplest is colchicine, 1.2 mg at the first symptoms of a gout attack, followed 1 hour later by a 0.6-mg dose. Colchicine is most effective when used early in attacks (<24 hours after onset) and is less useful when the attack is well established. | ** '''Colchicine''' The simplest is colchicine, 1.2 mg at the first symptoms of a gout attack, followed 1 hour later by a 0.6-mg dose. Colchicine is most effective when used early in attacks (<24 hours after onset) and is less useful when the attack is well established. | ||
** '''AINS''' High-dose NSAID therapy for 5 to 7 days is effective | ** '''AINS''' High-dose NSAID therapy for 5 to 7 days is effective | ||
** '''Glucocorticoïdes''' in any form—intra-articular injection, intramuscular depot injection (for example, depo-methylprednisolone, 40-80 mg), or an oral “burst” of prednisone (for example, 0.5 mg/kg/d, for 5 days). | ** '''Glucocorticoïdes''' in any form—intra-articular injection, intramuscular depot injection (for example, depo-methylprednisolone, 40-80 mg), or an oral “burst” of prednisone (for example, 0.5 mg/kg/d, for 5 days). | ||
| + | ** For patients with severe and refractory attacks, or with contraindications to other treatments, off-label use of IL-1 inhibitors (anakinra or canakinumab) can be considered. | ||
| + | * <u>Traitement hypo-uricémiant:</u> | ||
| + | ** '''Xanthine oxidase inhibitors''' (reduce urate production) | ||
| + | ** '''Uricosuric agents''' (decrease renal urate resorption) | ||
| + | ** '''Pegloticase''' (a uricase). | ||
== Polyarthrite rhumatoïde (PAR) == | == Polyarthrite rhumatoïde (PAR) == | ||
Version du 13 juin 2020 à 14:52
Arthrose
- Caractéristiques radiologiques:
- Pincement articulaire
- Sclérose sous-chondrale
- Ostéophytes
- Géodes
- Traitement: AINS, chirurgical (remplacement prothétique).
- Arthrose du genou: duloxétine. Injection intra-articulaire de glucocorticoïdes ou d'acide hyaluronique dans l'arthrose du genou et de la hanche. Pas de bénéfice du paracétamol dans l'arthrose de la hanche et du genou.
Arthrites microcristallines
Chondrocalcinose
- Synonyme: pseudogoutte
Déposition de cristaux de pyrophosphate de calcium
Goutte
- Traitement de la crise de goutte:
- Colchicine The simplest is colchicine, 1.2 mg at the first symptoms of a gout attack, followed 1 hour later by a 0.6-mg dose. Colchicine is most effective when used early in attacks (<24 hours after onset) and is less useful when the attack is well established.
- AINS High-dose NSAID therapy for 5 to 7 days is effective
- Glucocorticoïdes in any form—intra-articular injection, intramuscular depot injection (for example, depo-methylprednisolone, 40-80 mg), or an oral “burst” of prednisone (for example, 0.5 mg/kg/d, for 5 days).
- For patients with severe and refractory attacks, or with contraindications to other treatments, off-label use of IL-1 inhibitors (anakinra or canakinumab) can be considered.
- Traitement hypo-uricémiant:
- Xanthine oxidase inhibitors (reduce urate production)
- Uricosuric agents (decrease renal urate resorption)
- Pegloticase (a uricase).
Polyarthrite rhumatoïde (PAR)
- Facteur rhumatoïde (FR) positif, anticorps anti-peptide cyclique citrulliné (anti-CCP) positif
- https://www.revmed.ch/RMS/2014/RMS-N-421/Traitement-de-fond-de-la-polyarthrite-rhumatoide
