frank100
Forum Guru
Topics: 48
Posts: 586
|
a 38 y/o woman presents with pain in both wrists and fingers for the past 6 months. she was previously started on NSAIDSs and initially improved, however, now she comes back with worsening joint pain and the new onset of low back pain for the last two weeks. She has difficulty getting out of bed and has morning stiffness. she has a temperature of 99.4 F. both hands have distal interfalangeal joints swelling and wrist tenderness. she also has pitting and onycholysis of the nals. On her scalp she has small, several two centimeter, scaly lesions. her lower back is nontender. On laboratory examination she has a hematocrit of 34% and an ESR of 60 mm/h. her HLA B-27 is positive with a negative rheumatoid factor. X-rays of the hands and wrists show peritoneal new bone formation along the shafts of metacarpals. she is started on a new medication and sent home. she comes back after two weeks with worsening of the joint pains and exfoliative skin lesions on the scalp.
what are these symptoms most likely caused by?
a) gold salts.
b) hydroxycloroquine
c) sulfazalasine.
d) methotrexate.
e) steroids
|
| study_ing
Forum Fanatic
Topics: 180
Posts: 2,509
|
actually confused btw a and c
___________________
If you yourself are at peace, then there is at least some peace in the world.
|
| GDS2008
Forum Elite
Topics: 9
Posts: 144
|
Gold salts and hydroxychloroquine can cause dermatitis. At the same time use of steroids is contraindicated in Psoriatic arthritis as stopping the steroids can cause rebound worsening of psoriasis. However, in this case the medication was never stopped and therefore steroids is not likely. Therefore, the answer is either gold salts or hydroxychloroqunie. I will put my money on a)gold salts
|
| MAZI
Forum Elite
Topics: 8
Posts: 245
|
this patint has psoriatic spondyeloarthropathy
Hydroxycloroquine can exacerbate psorisis
|
| frank100
Forum Guru
Topics: 48
Posts: 586
|
answer B. hydroxychloroquine
this patient presents with psoriatic arthritis, which improved with NSAIDS for a period of about 6 months. she came back with worsening joint painand scaly lesions of the scalp. this is the time when disease modifying medications have to be started. the patient was most likely started on hydroxyhloroquine. althouhg hydroxychloroquine is often successful in producing either amelioration or remission of the disease, it carries a significant risk of he exacerbation of psoriasis and subsequent worsening exfoliation. sulfazalasine has very good efficancy in psoriatic arthritis, 5 to 25 mg of methotrexate per week is recomended, along with folic acid to prevent hematological coplications. Steroids are not used and are not cathegorized at diseace modfying drugs in psoriatic arthritis. Intramuscular gold can be used weekly as a disease modifying drug. None of the other drugs are known to cause worsening of exfoliation, besides the antimalarial medications.
|
| GDS2008
Forum Elite
Topics: 9
Posts: 144
|
Thanks frank for the answer and the explanations -- appreciate it!
|
| juanma0
Forum Senior
Topics: 10
Posts: 146
|
great q. will remember that one.
|
|
| |
| | | | | | | |
