chapter  17
Rheumatology
WithClarissa Pilkington, Kiran Nistala, Helen Lachman, Paul Brogan
Pages 25

New biological therapies have improved the treatment of the inflammatory disorders resulting in better disease control. Genetic breakthroughs in the periodic fever syndromes have led to a better understanding of the autoinflammatory disorders, with improved treatment. Treatment is as for Rheumatoid Factor-negative polyarthritis, with a rapid escalation of therapy in patients failing to respond to methotrexate. Treatment is symptomatic, including rest and analgesia. In children unresponsive to treatment anti-tumour necrosis factor alpha therapy or rituximab have been used. For mild predominantly cutaneous disease, corticosteroid alone may be appropriate, with careful monitoring of clinical and laboratory parameters as this is weaned. The initial aim of treatment is to induce remission, using corticosteroids, cyclophosphamide, plasma exchange. In granulomatosis with polyangiitis cotrimoxazole is used as prophylaxis against opportunistic infection and as a possible diseasemodifying agent, particularly with upper respiratory tract involvement. Treatment is with corticosteroid and cyclophosphamide induction followed by methotrexate.