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BOF: 23 A 35-year-old female presents with a mutilating arthritis of the hands with associated pitting of the nails. In treating this patient a) Sulphasalazine is unlikely to be effective b) Methotrexate is unlikely to be effective c) Antimalarials are best avoided d) Tumour necrosis factor alpha antagonists are not effective e) Oral corticosteroids should be the drugs of first choice as they help the nail condition as well Answer: c) The patient has psoriatic arthropathy. Treatment is usually with non-steroidal anti-inflammatory drugs although there is a risk of worsening the psoriasis. Sulphasalazine and methotrexate are useful in this condition. Tumour necrosis factor alpha antagonists are effective but are expensive to use. Steroids are seldom needed and may provoke worsening of the psoriases on withdrawal. Antimalarials are best avoided as they can cause an acute psoriatic skin reaction. |
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