All drugs are used In management of psoariatic arthritis except:
Correct Answer: Chloroquine
Description: Ans: C (Chloroquine) Use of Chloroquine: Psoriatic Arthritis is not mentioned in its use( while it mentioned rheumatoid arthritis. Discoid lupus erythematosus) "-/CDF 7th/823"Methotrexate is an effective agent, especially in patients with psoriatic arthritis"- Harrison 18th/400"NSAlDs are usually sufficient for mild cases. Methotrexate (7.5-20 mg orally once a week) is generally considered the drug of choice for patients who have not responded to NSAIDs; methotrexate can improve both the cutaneous and arthritic manifestations. For cases with disease that is refractory to methotrexate, the addition of TNF inhibitors is usually effective for both arthritis and psoriatic skin disease.A/e/acept, a biologic agent that is administered by subcutaneous injection, blocks the activation and proliferation of memory effector T ceils by binding to CD2; this drug also appears to be effective in the treatment of psoriatic arthritis as well as cutaneous disease. Corticosteroids are less effective in psoriatic arthritis than in other forms of inflammatory arthritis and may precipitate pustular psoriasis during tapers. Antimalarials may also exacerbate psoriasis. Successful treatment directed at the skin lesions alone [eg, by PUVA therapy) occasionally is accompanied by an improvement in peripheral articular symptoms.v- CMDT 06/853Treatment: Psoriatic Arthritis Harrison 19th/2177-78,18th/ 2782# Ideally, coordinated therapy is directed at both the skin and joints in PsA. As described above for AS, use of the anti-TNF-a agents has revolutionized the treatment of PsA. Prompt and dramatic resolution of both arthritis and skin lesions has been observed in large, randomized controlled trials ofetanercept, infliximab, adalimumab, andgolimumab. Many of the responding patients had long-standing disease that was resistant to all previous therapy, as well as extensive skin disease.# The clinical response is more dramatic than in RA, and delay of disease progression has been demonstrated radiographically. Paradoxically, rare cases have been reported of exacerbation or de novo appearance of psoriasis precipitated by anti-TNF therapy for a variety of conditions. In some cases, the therapy can nevertheless be continued.# The anti-T cell biologic agent alefacept, in combination with methotrexate, has shown benefit in both psoriatic arthritis and psoriasis. Ustekinumab, a monoclonal antibody to the shared IL-23/lL-12p40 subunit, has shown promise in treating both psoriasis and PsA in early clinical trials.Other treatment for PsA has been based on drugs that have efficacy in RA and/or in psoriasis. Although methotrexate in doses of 15-25 mg/week and sulfasalazine (usually given in doses of 2-3 g/d) have each been found to have clinical efficacy in controlled trials, neither effectively halts progression of erosive joint disease. Other agents with efficacy in psoriasis reported to benefit PsA are cyclosporine, retinoic acid derivatives, and psoralens plus ultraviolet A light (PUVA).There is controversy regarding the efficacy in PsA of gold and antimalarials, which have been widely used in RA.The pyrimidine synthetase inhibitor leflunomide has been shown in a randomized controlled trial to be beneficial in both psoriasis and psoriatic arthritis.All of these treatments require careful monitoring. Immunosuppressive therapy may be used cautiously in HIV-associated PsA if the HIV infection is well controlled.In one large prospective series, 7% of patients with PsA required musculoskeletal surgery beginning at a mean of 13 years' disease duration. Indications for surgery are similar to those in RA, although there is an impression that outcomes in PsA may be less satisfactory. Table (Harrison 18th/ 400):Biologics Approved for Psoriasis or Psoriatic ArthritisMechanism Administration Agentof ActionIndicationRouteFrequencyWarningsAlefaceptAnti-CD-2PsIMOnce weekly x 12 weeks; may repeatLymphopenia, potential for increased malignancies, serious infectionsEtanerceptAnti TNF-aPs, PsASCOnce or twice weeklySerious infections, neurologic events, hematologic events, potential for increased malignanciesAdalimumabAnti TNF-aPsASCEvery other weekSerious infections, neurologic events, potential for increased malignancies, hypersensitivity reactions, hematologic eventsInfliximabAnti TNF-aPsAIVInitial infusion followed by infusions at week 2, 6, then even,- 8 weeksSerious infections, hepatotoxicity. hematologic events, hypersensitivity reactions, neurologic events, potential for increased malignanciesTablet Harrison 18th/ 400): FDA -A pp ro ved Systemic Therapy for Psoriasis MedicationAdministration AgentGassRouteFrequencyAdverse Events (Selected)MethotrexateAntimetaboliteOralWeeklyHepatotoxicity, pulmonary toxicity, pancytopenia, potential for increased malignancies, ulcerative stomatitis, nausea, diarrhea, teratogenicityAcitretinRetinoidOralDailyTeratogenicity, osteophyte formation, hyperlipidemia, flare of inflammatory bowel disease, bepatoxicity, depressionCyclosporineCalcineurin inhibitorOralTwice dailyRenal dysfunction, hypertension, hyperkalemia, hyperuricemia, hypomagnesemia, hyperlipidemia, increased risk of malignancies
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