Psoriasis

Question 1

treatment of recalcitrant psoriatic arthritis

Answer 1

methotrexate and TNF alpha inhibitor

helps slow progression of radiographic damage including joint space narrowing and erosions

Question 2

second line drug for psoriatic arthritis

Answer 2

if already taking methotrexate at 25 mg weekly, add a TNF alpha inhibitor

Question 3

Do we ever use hydroxychloroquine in psoriasis treatment

Answer 3

no.

hydroxychloroquine is for SLE or RA or dermatomyositis.

Question 4

Do we ever use rituximab for psoriasis?

Answer 4

No it’s for RA, vasculitis and malignancy

it’s holy water of oncology

Question 5

clinical features of psoriatic arthritis

Answer 5

distal interphalangeal joints, asymmetric oligoarthritis
symmetrical polyarthritis, similar to RA
arthritis mutilans (deforming and destructive arthritis)
spondyloarthritides (sacroiliitis and spondylitis)

Question 6

soft tissue and nail involvement seen with psoriatic arthritis?

Answer 6

enthesitis (inflammation at the site of tendon insertion into bone)
dactylitis “sausage digits of toe or finger
swelling of hands or feet with pitting edema

Question 7

skin lesions seen with psoriatic arthritis

Answer 7

arthritis that precedes skin disease in 15% of pts

skin lesions are present but not yet diagnosed in 15% of pts.

Question 8

Hand XR pf a patient with psoriasis show

Answer 8

erosive changes with new bone formation, lysis at the terminal phalanges and joint destruction and pencil-in-cup appearance and joint lysis with ankylosis.

Question 9

destructive arthritis mutilans and pencil cup appearnce and pitting of nails and onycholysis may point to

Answer 9

psoriasis.

Question 10

hemochromatosis may have arthritis and see on physical exam and XR

Answer 10

see MCP joints and see distribution similar to pseudogout with (calcium pyrophosphate crystal deposition)

See chondrocalcinosis and hooked osteophytes in MCP

Question 11

treatment of mild to moderate plaque psoriasis is

Answer 11

topical corticosteroids and emollients

tar, topical retinoids, and topical vitamin D (Calcipotriene and calcitoriol)

Question 12

most common form of psoriasis

Answer 12

plaque psoriasis - sharply demarcated erythematous plaques over a thick silvery scale

Question 13

treatment of plaque psoriasis is

Answer 13

based on severity of disease, sites of involvement, relevant comorbidities, pt preference, efficiency and patient response

Question 14

treatment of facial or intertriginous plaque psoriasis

Answer 14

topical tacrolimus or pimecrolimus as a steroid sparing agent as chronic steroid cream to the face or skin folds can cause harm effects like atrophy, telangiectasia and perioral dermatitis.

Question 15

moderate to severe plaque psoriasis treatment

Answer 15

needs dermatologist but will need phototherapy.

Question 16

contraindications to phototherapy for severe plaque psoriasis are:

Answer 16

history of melanoma, extensive nonmelanoma skin cancer

Question 17

when to give methotrexate, cyclosporin, or biological agents like etancercept for treatment of severe plaque psoriasis?

Answer 17

people who fail phototherapy and moderate to severe disease and psoriatic arthritis.

‘they need systemic therapy

Question 18

features of psoriasis are:

Answer 18

ethesitis,
dactylitis (sausage digits),
tenosynovitis,
arthritis of distal interphalangeal joints
asymmetric oligoarthritis and spondylitis

Question 19

can see what on XR with psoriatic arthritis?

Answer 19

new bone formatio nand pencil in cup deformities on radiographs.

Question 20

nail changes with psoriasis

Answer 20

nail pitting and onycholysis (nail splitting) and trachyonychia (roughened surface)