MBBS Revision: Drugs and Arthritis

Side effects of some common medications...

Statins: Headache, constipation or diarrhoea, dizziness, nausea, paraesthesia, nightmares, joint pain, memory loss, sexual dysfunction, hepatotoxicity, myositis, hypersensitivity reaction.

Long term steroids: Increase appetite, weight gain, mood changes, insomnia, fluid retention, osteoporosis, hypertension, diabetes, weight gain, infection, cataracts, glaucoma, thinning of the skin, purple striae, bruising, muscle weakness, adrenal insufficiency.

ACEi: Bradykinin cough, hypotension, hyperkalaemia, hepatotoxicity, renal impairment, angioedema, gynacomastia.

Beta-blockers: Bradycardia, bronchospasm, cold peripheries, heart failure, impotence, headache, nightmares, depression, lethargy, reduced glucose.

Antiepileptic medication: Side effects can be divided into

1/Systemic eg. nausea and vomiting, rash, changes in bowel habit

2/Neurotoxic eg. drowsiness, lethargy

3/Drug specific

Following are some side effects unique to some of the more common drugs. They mostly fall under category 2 or 3 above.

Barbiturate (eg phenobarbital) à dependence and tolerance, sedation, behavioural changes and altered sleep cycles.

Carbamazapine à Blurred or double vision, agranulocytosis, aplastic anaemia, pancreatitis, hepatotoxic, stevens-johnson syndrome and serum sickness.

Ethosuxamide à sleep disturbance, drowsiness and hyperactivity

Gabapentin à ataxia, dizziness, somnolence

Lamotrigine à Gingival hypertrophy, hirsutism, lymphadenopathy, slurred speech, double vision, ataxia, osteomalacia, confusion

Sodium valproate à weight gain, hair loss, tremor, tiredness, pancreatitis, thrombocytopenia, liver failure (in children < 2). Bone loss, menstrual irregularity and PCOS seen in long term use.

Now for some radiological features: OA Vs. RA

Osteoarthritis