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REMEDY : BNSSG referral pathways & Joint Formulary

BNSSG Adult Joint Formulary

10.5 Soft tissue and joint disorders

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10.5.1 Local inflammation of joints and soft tissue


First line drugs Second line drugs Specialist drugs Secondary care drugs

 

Link to BNF Corticosteroids, inflammatory disorders

Corticosteroids

  • Treatment with corticosteroids in rheumatic diseases should be reserved for specific indications e.g. when other anti-inflammatory drugs are unsuccessful. 
  • Corticosteroids may reduce bone density and increase the risk of low impact fracture and can induce osteoporosis. Patients taking (or who are likely to take) an oral corticosteroid at an equivalent dose of 5mg prednisolone or more, for 3 months or longer should be assessed using the FRAX® algorithm and where necessary offered appropriate given prophylactic treatment. See BNF section 6.6  

Prednisolone (TLS Green)

Alternative:

Methylprednisolone (TLS Blue)

 

Local Corticosteroid Injections

Hydrocortisone acetate (Hydrocortistab®) (TLS Green)

Triamcinolone acetonide (Kenalog®) (TLS Green)

Methylprednisolone acetate (Depo-Medrone®) (TLS Green)

Methylprednisolone acetate / Lidocaine (Depo-Medrone® with Lidocaine) (TLS Green)

 

10.5.2 Soft tissue disorders

Link to BNF Soft-tissue disorders

 

Enzymes

Hyaluronidase (TLS Blue)

  • Not the intra-articular preparation e.g. Synvisc®

Collagenase (TLS Red)

  • NICE TA459 collagenase clostridium histolyticum for treating Dupuytren's contracture

 

Miscellaneous

Dibotermin alfa (TLS Red)

 

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