Psoriasis/Psoriatic Arthritis

Question 1

This type of psoriasis is characterized by small (3-5 millimeters) confetti-like, salmon pink, papules with fine scaling. It is most likely to affect the trunk and proximal extremities and often appears suddenly (as an initial manifestation of psoriasis in younger patients) and is often preceded by a strep upper respiratory infection.

Answer 1

Guttate Psoriasis

Question 2

This type of psoriasis is associated with lesions that occur in skin folds (armpits, abdominal, genital, inframammary areas). Due to local moisture, lesions tend to be less scaly and more erythematous and genital involvement is observed in up to 1/3 of patients with psoriasis.

Answer 2

Inverse Psoriasis

Question 3

This type of psoriasis is characterized by white blisters of noninfectious pus surrounded by red skin and may be localized to areas such as palms or sole of feet.

Answer 3

Pustular Psoriasis

Question 4

This is a severe form of pustular psoriasis associated with covering most of the body and fever, chills, severe itching, change in heart rate, fatigue, and muscle weakness.

Answer 4

von Zumbusch variant

Question 5

This type of psoriasis is characterized by generalized erythema, scales, or exfoliation that covers at least 75% of the body. The skin cannot properly maintain temperature, leading to: hypothermia, chills, dehydration from fluid loss, fever, malaise, swelling in the lower legs, congestive heart failure.

Answer 5

Erythrodermic Psoriasis

Question 6

Mild psoriasis is considered to be what % of BSA?

Answer 6

<3%

Question 7

Moderate psoriasis is considered to be what % of BSA?

Answer 7

3-10%

Question 8

Severe psoriasis is considered to be what % of BSA?

Answer 8

> 10%

Question 9

What does PASI stand for?

Answer 9

Psoriasis Area and Severity Index

Question 10

What does PGA stand for?

Answer 10

Physician’s Global Assessment

Question 11

What does NAPSI stand for?

Answer 11

Nail Psoriasis Severity Index

Question 12

What does DLQI stand for?

Answer 12

Dermatology Life Quality Index

Question 13

25% of patients with PsA are HLA-B__ positive

Answer 13

HLA-B27

Question 14

CD__+ cells predominate in psoriatic joints

Answer 14

4

Question 15

In PsA, the most notable contributing Th subsets are?

Answer 15

Th1 & Th17 cells

Question 16

These cells play a central role in PsA pathogenesis?

Answer 16

CD8+ cells

Question 17

ESR is a measure of inflammation that can be used in the diagnosis of PsA when elevated. What does ESR stand for?

Answer 17

Erythrocyte sedimentation rate

Question 18

CRP can be elevated in PsA and is a marker of inflammation. What does CRP stand for?

Answer 18

C-reactive protein

Question 19

What are joint erosions in PsA?

Answer 19

Bony destruction that occurs at the outer borders of a joint space in inflammatory arthritis. It is visible on radiographic images of joints.

Question 20

What is joint space narrowing?

Answer 20

The radiographic appearance of a joint that has lost its surface cartilage. The bones in the joint are not separated by the normal of usually observed distance. They appear to be too close to each other, and they are often eburnated or sclerotic.

Question 21

What is a bony proliferation?

Answer 21

Rapid and repeated reproduction of new bone cells. In radiographic results, bones appear irregular and “fuzzy” around the affected joint.

Question 22

Osteolysis

Answer 22

Softening, absorption, and destruction of bony tissue, a function of the osteoclasts.

Question 23

Pencil-in-cup deformity

Answer 23

A form of osteolysis found in severe inflammatory arthritis, especially in the finger and toe joints. The deformity is characterized by thinning of the phalangeal shaft and widening of its base proximal to the joint space.

Question 24

Acroosteolysis

Answer 24

Congenital condition manifested by palmar and plantar ulcerating lesions with osteolysis involving distal phalanges of the fingers and toes.

Question 25

Ankylosis

Answer 25

The abnormal union of the bones to a joint.

Question 26

Spur formation

Answer 26

A bony growth that arises from the surface of a bone, often involving the ossification of muscular attachments; also called exostosis.

Question 27

Spondylitis

Answer 27

Inflammation of one or more vertebrae.

Question 28

CASPAR stands for...

Answer 28

Classification Criteria for Psoriatic Arthritis

Question 29

The _____ criteria define psoriatic arthritis for the purpose of enrolling patients in clinical trials and providing guidance to the clinicians.

Answer 29

CASPAR

Question 30

HAQ-DI

Answer 30

Health Assessment Questionnaire- Disability Index

Question 31

HAQ-DI is considered a _____ status assessment

Answer 31

Functional

Question 32

SF-36

Answer 32

Short Form 36 Health Survey

Question 33

Higher scores on the SF-36 = better health. True or False?

Answer 33

True

Question 34

ACR20

Answer 34

American College of Rheumatology 20

Question 35

The ACR20 requires at least a ___% improvement in the core set measures.

Answer 35

20

Question 36

PASDAS

Answer 36

Psoriatic Arthritis Disease Activity Score

Question 37

This measure is a composite-weighted index including assessment of joints, entheses, dactylitis, the patient's and physician's global health scores, and the SF-36.

Answer 37

PASDAS

Question 38

DAPSA

Answer 38

Disease Activity Index for Psoriatic Arthritis

Question 39

This composite measure is based on the sum of the number of 68 tender and 66 swollen joints, the patient's global assessment of disease activity and pain, and serum levels of C-reactive protein. It does not assess other aspects of PsA.

Answer 39

DAPSA

Question 40

CPDAI

Answer 40

Composite Psoriatic Disease Activity

Question 41

In this index, disease activity is assessed as absent, mild, moderate, or severe in five PsA domains (peripheral arthritis, skin and nails, axial arthritis, enthesitis, dactylitis). Treatment is based on the most active domain while considering disease activity in the others.

Answer 41

CPDAI

Question 42

GRACE

Answer 42

GRAPPA Composite Exercise

Question 43

This is a composite-weighted index that includes assessment of disease activity in the joints, patient and physician global health scores, quality of life, and psoriasis area severity index (PASI).

Answer 43

GRACE

Question 44

DMARD

Answer 44

Disease Modifying Antirheumatic Drugs

Question 45

Methotrexate, Sulfasalazine, and Leflunomide are examples of __________ DMARDs.

Answer 45

Conventional (non-specific)

Question 46

Cimzia (PsA tx) generic name

Answer 46

Certolizumab pegol

Question 47

Cimzia target

Answer 47

TNF alpha

Question 48

Cosentyx generic name

Answer 48

Secukinumab

Question 49

Secukinumab target

Answer 49

IL-17A

Question 50

Enbrel (PsA tx) generic name

Answer 50

Etanercept

Question 51

Etanercept target(s)

Answer 51

TNF alpha and TNF beta

Question 52

Humira generic name

Answer 52

Adalimumab

Question 53

Humira target

Answer 53

TNF alpha

Question 54

Orencia generic name

Answer 54

Abatacept

Question 55

Abatacept target

Answer 55

T cell (binds CD80 and CD86)

Question 56

Otezla generic name

Answer 56

Apremilast

Question 57

Apremilast target

Answer 57

PDE4 (Phosphodiesterase 4 inhibitor)

Question 58

Infliximab brand name

Answer 58

Remicade

Question 59

Infliximab target

Answer 59

TNF alpha

Question 60

Golimumab brand name

Answer 60

Simponi/Simponi Aria

Question 61

Simponi target

Answer 61

TNF alpha

Question 62

Stelara generic name

Answer 62

Ustekinumab

Question 63

Ustekinumab target

Answer 63

IL-12/IL-23

Question 64

Stelara binds to the p__ subunit of IL-12 and IL-23

Answer 64

p40

Question 65

Ixekizumab brand name

Answer 65

Taltz

Question 66

Ixekizumab target

Answer 66

IL-17A

Question 67

Xeljanz generic name

Answer 67

Tofacitinib

Question 68

Tofacitinib target

Answer 68

JAK (small molecule JAK inhibitor)

Question 69

JAK stands for....

Answer 69

Janus Kinase

Question 70

What are the 3 PsA guidelines?

Answer 70

GRAPPA, EULAR, ACR/NPF

Question 71

GRAPPA (guidelines) stands for?

Answer 71

Group for Research and Assessment of Psoriasis and Psoriatic Arthritis

Question 72

EULAR (guidelines) stand for?

Answer 72

European League Against Rheumatism

Question 73

ACR/NPF (guidelines) stand for?

Answer 73

American College of Rheumatology/National Psoriasis Foundation

Question 74

IGA stands for...

Answer 74

Investigator Global Assessment

Question 75

IGA assesses/measures 3 components, what are they? Hint: I,E,S

Answer 75

Induration, Erythema, Scaling

Question 76

PASI stands for...

Answer 76

Psoriasis Area and Severity Index

Question 77

Unlike the IGA score, PASI takes into account the...

Answer 77

Body Surface Area or Area of Involvement

Question 78

ss-IGA stands for...

Answer 78

Scalp Specific Investigator's Global Assessment

Question 79

NAPSI stands for...

Answer 79

Nail Psoriasis Severity Index

Question 80

IGA scores range from...

Answer 80

0-4 (with 4 being the most severe and 0 being clear)

Question 81

PASI scores range from...

Answer 81

0-72 (with higher scores indicating more severity)

Question 82

PGA stands for...

Answer 82

Fingernail Physician's Global Assessment

Question 83

hf-PGA stands for...

Answer 83

Physician's Global Assessment of Hands and/or Feet

Question 84

DLQI is a PRO that stands for...

Answer 84

Dermatology Life Quality Index

Question 85

PSSD is a PRO that stands for...

Answer 85

Psoriasis Symptom and Sign Diary

Question 86

What is onycholysis?

Answer 86

Separation of nail from underlying nail bed

Question 87

What is leukonychia?

Answer 87

White spots or streaks on nail

Question 88

This is the most common clinical sign of nail psoriasis and can be seen on the nail of digits affected by dactylitis.

Answer 88

Pitting

Question 89

These are locations where the tendon, ligament, or joint capsule inserts into the bone to facilitate joint motion.

Answer 89

Entheses

Question 90

Inflammation at the entheses is called ____.

Answer 90

Enthesitis

Question 91

True or False: with dactylitis the hands are most commonly affected.

Answer 91

False, the feet are most commonly affected.

Question 92

This criteria is the most used classification tool in PsA trials and has 99% specificity.

Answer 92

CASPAR criteria (Classification Criteria for Psoriatic Arthritis)

Question 93

This is the most used PsA clinical assessment tool.

Answer 93

ACR (either 20/50/70)

Question 94

ACR stands for?

Answer 94

American College of Rheumatology

Question 95

Which 2 variables must show improvement when looking at ACR response?

Answer 95

Swollen joint counts (SJC) and Tender joint count (TJC)

Question 96

What are two common assessment tools for axial involvement in PsA?

Answer 96

BASDAI & ASDAS

Question 97

The higher the BASDAI (PRO) score, the _____ (more or less) the patient's disability.

Answer 97

more

Question 98

The IGA which stands for ___ assesses a patient's psoriasis by grading psoriasis lesions for what (hint: 3 components)?

Answer 98

Induration, erythema, and scaling

Question 99

A PASI score greater than what represents severe disease?

Answer 99

10

Question 100

FACIT - F stands for?

Answer 100

Functional Assessment of Chronic Illness Therapy - Fatigue

Question 101

Higher scores on the FACIT-F represent ____ (more or less?) fatigue.

Answer 101

Less

Question 102

The most commonly used radiographic assessment tool in PsA (used to assess joint damage) is?

Answer 102

PsA-modified vdH-Sharp score

Question 103

The Sharp/van der Heijde method is a radiographic assessment in PsA clinical trials, true of false?

Answer 103

True

Question 104

The modified vdH-Sharp score includes assessment of what?

Answer 104

DIP joints

Question 105

What is considered a IGA response?

Answer 105

IGA psoriasis score of 0 or 1 AND greater than or equal to 2 grade-reduction from baseline in the IGA psoriasis score.

Question 106

This is the only enthesitis measure developed specifically for PsA?

Answer 106

Leeds Enthesitis Index of LEI