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10. Drugs used in the treatment of Musculoskeletal and Joint Diseases

10.1 Drugs used in rheumatic diseases and gout

10.1.1 Non-steroidal anti-inflammatory drugs benorilate (for the treatment of osteoarthritis and rheumatoid arthritis in accordance with NICE guidance and also for use by Mr Jari post- operatively for a maximum course of two weeks duration) (Rheumatology only) (Rheumatology only) (Obs & Gynae only)

Intra-articular injections hyaluronan (Ostenil® and Ostenil Mini®) (Rheumatology and Orthopaedic surgery only)

Viscoseal® (Orthopaedic directorate only)

10.1.2 Corticosteroids

see Chapter 6 10.1.2.1 Systemic steroids

hydrocortisone acetate 10.1.2.2 Local corticosteroid injections methylprednisolone acetate

triamcinolone hexacetonide

adalimumab (Rheumatology consultant only) - 10.1.3 Drugs which suppress the rheumatic Follow restricted high cost drug procedure when prescribing adalimumab disease process chloroquine phosphate (Rheumatology only) etanercept (in accordance with NICE guidance) - Follow restricted high cost drug procedure when prescribing etanercept hydroxychloroquine sulphate (Rheumatology only) infliximab (in accordance with NICE guidance) - Follow restricted high cost drug procedure when prescribing infliximab leflunomide (Rheumatology only) methotrexate (Rheumatology only) mycophenolate – for systemic sclerosis (By Dr Herrick) and other inflammatory rheumatological conditions (Rheumatologists only) penicillamine (Rheumatology only) sodium aurothiomalate (Rheumatology only) sulfasalazine (Rheumatology only)

allpurinol 10.1.4. Gout and cytotoxic induced colchicine hyperuricaemia probenecid (named patient drug) rasburicase (consultant haematologist only)

10.1.5 Miscellaneous CMW2® bone cement with gentamicin eptotermin [OP1] (Named orthopaedic surgeons only - hold here for details) - Follow restricted high cost drug procedure when prescribing eptotermin gentamicin sponge Palacos® bone cement Palacos R Gentamicin® bone cement Septopal Chain® Simplex® antibiotic bone cement

10.2 Drugs used in neuromuscular disorders

10.2.1 Drugs which enhance distigmine neuromuscular transmission edrophonium neostigmine pyridostigmine

10.2.2 Skeletal muscle relaxants baclofen dantrolene sodium diazepam tizanidine (Neurology only)

10.3 Drugs for the relief of soft tissue inflammation

10.3.1 Enzymes hyaluronidase

10.3.2 Rubefacients and other topical (Difflam®) cream antirheumatics