Psoriasis with psoriatic arthritis — MCCQE Part 1 MCQ

Correct answer: A — Diagnose psoriatic arthritis and refer for rheumatology/dermatology-directed systemic therapy

Diagnose psoriatic arthritis and refer for rheumatology/dermatology-directed systemic therapy is best because dactylitis and nail disease in psoriasis suggest psoriatic arthritis. Treat with topical therapy only despite systemic or red-flag features is suboptimal because local treatment alone is inadequate when systemic disease is possible; Delay assessment for several months is suboptimal because red-flag musculoskeletal or dermatologic presentations require timely assessment; Use antibiotics for every presentation is suboptimal because many rashes and painful joints are inflammatory, malignant or mechanical rather than bacterial; Provide opioids or reassurance as the sole management is suboptimal because symptom relief alone does not address diagnosis, function or safety. Joint involvement changes psoriasis management.

Reference: Canadian Rheumatology Association psoriatic arthritis guidance