Chapter 65 - Psoriatic Arthritis and Reactive Arthritis

Question 1

TABLE 65-1
The Classification Criteria for PsA (CASPAR)

ENTRY CRITERIA?

Answer 1

ENTRY CRITERIA: INFLAMMATORY ARTICULAR DISEASE OF THE JOINTS, SPINE, OR ENTHESES

Question 2

TABLE 65-1
The Classification Criteria for PsA (CASPAR)

Point/s

Classification Criteria
1. Psoriasis (mutually exclusive categories for scoring)
- Current
- Personal history
- Family history (first- or second-degree relative)

Answer 2

• 2 points
• 1 point
• 1 point

Question 3

TABLE 65-1
The Classification Criteria for PsA (CASPAR)

Point/s

Classification Criteria
2. Nail dystrophy typical of psoriasis (onycholysis, pitting, hyperkeratosis), must be current

Answer 3

1 point

Question 4

TABLE 65-1
The Classification Criteria for PsA (CASPAR)

Point/s

Classification Criteria
3. Negative rheumatoid factor (any method except latex)

Answer 4

1 point

Question 5

TABLE 65-1
The Classification Criteria for PsA (CASPAR)

Point/s

Classification Criteria
4. Dactylitis (current, or historical if recorded by a rheumatologist)

Answer 5

1 point

Question 6

TABLE 65-1
The Classification Criteria for PsA (CASPAR)

Point/s

Classification Criteria
5. Juxtaarticular new bone formation (ill-defined ossification near joint margins excluding osteophytes) on plain hand/feet radiographs

Answer 6

1 point

Question 7

TABLE 65-1
The Classification Criteria for PsA (CASPAR)

A classification of PsA is met if the final score is equal to or more than ___ points.

Answer 7

A classification of PsA is met if the final score is equal to or more than 3 points.

Question 8

TABLE 65 2
Psoriatic Arthritis Phenotypes

Percent

Oligoarthritis

Answer 8

> 70%

Question 9

TABLE 65 2
Psoriatic Arthritis Phenotypes

Percent

Polyarthritis/symmetric

Answer 9

15%

Question 10

TABLE 65 2
Psoriatic Arthritis Phenotypes

Percent

Distal interphalangeal joint predominant

Answer 10

5%

Question 11

TABLE 65 2
Psoriatic Arthritis Phenotypes

Percent

Spondyloarthritis

Answer 11

5%

Question 12

TABLE 65 2
Psoriatic Arthritis Phenotypes

Percent

Arthritis mutilans

Answer 12

5%

Question 13

TABLE 65-4
Medications

DRUG (2)

PSORIATIC DISEASE SPECIFIC INDICATIONS
- SKIN
- ARTHRITIS

Answer 13

1. Methotrexate
2. Leflunomide

Question 14

TABLE 65-4
Medications

DRUG (2)

PSORIATIC DISEASE SPECIFIC INDICATIONS
- ARTHRITIS

Answer 14

1. Sulfasalazine
2. Abatacept

Question 15

TABLE 65-4
Medications

DRUG (1)

PSORIATIC DISEASE SPECIFIC INDICATIONS
- SKIN
- NAIL
- ARTHRITIS
- AXIAL SPONDYLOARTHRITIS

Answer 15

Etanercept

Question 16

TABLE 65-4
Medications

DRUG (2)

PSORIATIC DISEASE SPECIFIC INDICATIONS
- SKIN
- NAIL
- ARTHRITIS
- DACTYLITIS
- ENTHESITIS
- AXIAL SPONDYLOARTHRITIS
- Uveitis
- IBD

Answer 16

1. Infliximab
2. Adalimumab

Question 17

TABLE 65-4
Medications

DRUG (1)

PSORIATIC DISEASE SPECIFIC INDICATIONS
- SKIN
- NAIL
- ARTHRITIS
- DACTYLITIS
- ENTHESITIS
- AXIAL SPONDYLOARTHRITIS
- IBD [Crohn disease]

Answer 17

Certolizumab

Question 18

TABLE 65-4
Medications

DRUG (1)

PSORIATIC DISEASE SPECIFIC INDICATIONS
- SKIN
- NAIL
- ARTHRITIS
- DACTYLITIS
- ENTHESITIS
- AXIAL SPONDYLOARTHRITIS
- IBD [Ulcerative colitis]

Answer 18

Golimumab

Question 19

TABLE 65-4
Medications

DRUG (2)

PSORIATIC DISEASE SPECIFIC INDICATIONS
- SKIN
- NAIL
- ARTHRITIS
- DACTYLITIS
- ENTHESITIS

Answer 19

1. Apremilast
2. Ixekizumab

Question 20

TABLE 65-4
Medications

DRUG (1)

PSORIATIC DISEASE SPECIFIC INDICATIONS
- SKIN
- NAIL
- ARTHRITIS
- DACTYLITIS
- ENTHESITIS
- IBD [Crohn disease]

Answer 20

Ustekinumab

Question 21

TABLE 65-4
Medications

DRUG (1)

PSORIATIC DISEASE SPECIFIC INDICATIONS
- SKIN
- NAIL
- ARTHRITIS
- DACTYLITIS
- ENTHESITIS
- AXIAL SPONDYLOARTHRITIS

Answer 21

Secukinumab

Question 22

TABLE 65-4
Medications

DRUG (1)

PSORIATIC DISEASE SPECIFIC INDICATIONS
- SKIN
- NAIL
- ARTHRITIS
- DACTYLITIS
- ENTHESITIS
- IBD [Ulcerative colitis]

Answer 22

Tofacitinib

Question 23

TABLE 65-4
Medications

DRUG

SIDE EFFECTS AND SPECIAL CONSIDERATIONS
Risk of mucosal ulcerations, hepatotoxicity, teratogenic.
Liver function tests, blood counts and renal function need to be monitored
Folic acid 1 mg daily mandatory for the duration of therapy

Answer 23

Methotrexate

Question 24

TABLE 65-4
Medications

DRUG

SIDE EFFECTS AND SPECIAL CONSIDERATIONS
Monitor liver function, blood counts
Reversible azoorspermia
Folic acid supplementation indicated

Answer 24

Sulfasalazine

Question 25

TABLE 65-4 Medications DRUG SIDE EFFECTS AND SPECIAL CONSIDERATIONS Risk of hepatotoxicity, teratogenic. Monitor liver function, blood counts. Long half-life, stores in adipose tissue.

Answer 25

Leflunomide

Question 26

TABLE 65-4 Medications DRUG (5) SIDE EFFECTS AND SPECIAL CONSIDERATIONS Drug induced SLE, Demyelinating disease, CHF, cancer

Answer 26

1. Etanercept 2. Infliximab 3. Adalimumab 4. Certolizumab 5. Golimumab

Question 27

TABLE 65-4 Medications DRUG SIDE EFFECTS AND SPECIAL CONSIDERATIONS Weight loss (10%) Depression (1%)

Answer 27

Apremilast

Question 28

TABLE 65-4 Medications DRUG SIDE EFFECTS AND SPECIAL CONSIDERATIONS Increased risk of eosinophilic pneumonia, cancer

Answer 28

Ustekinumab

Question 29

TABLE 65-4 Medications DRUG SIDE EFFECTS AND SPECIAL CONSIDERATIONS Increased risk of candidiasis, exacerbation of IBD

Answer 29

Secukinumab

Question 30

TABLE 65-4 Medications DRUG SIDE EFFECTS AND SPECIAL CONSIDERATIONS Increased risk of candidiasis, exacerbation of IBD, neutropenia

Answer 30

Ixekizumab

Question 31

TABLE 65-4 Medications DRUG SIDE EFFECTS AND SPECIAL CONSIDERATIONS Increased risk of elevated LDL and HDL (10-19%), pulmonary embolism, herpes zoster, neutropenia, lymphopenia, GI perforation, cancer

Answer 31

Tofacitinib

Question 32

TABLE 65-4 Medications DRUG SIDE EFFECTS AND SPECIAL CONSIDERATIONS Chronic obstructive pulmonary disease exacerbation, cancer

Answer 32

Abatacept