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Plaque psoriasis with psoriatic arthritis symptoms — MCCQE Part 1 MCQ

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HardRashPlaque psoriasis with psoriatic arthritis symptomsMCCQE Part 1

A 35-year-old man has thick scaly plaques on the elbows and scalp. He reports 45 minutes of morning stiffness, swollen fingers and heel pain. Nail pitting is present. What is the most appropriate next step in management?

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Correct answer: B — Assess for psoriatic arthritis and refer to rheumatology while treating skin disease

Psoriasis with prolonged morning stiffness, dactylitis, enthesitis and nail pitting suggests psoriatic arthritis, which needs early recognition and rheumatology referral to prevent damage. Joint symptoms are not incidental in this context. Long-term systemic steroids are not first-line and may worsen psoriasis on withdrawal.

Reference: Canadian Rheumatology Association psoriatic arthritis guidance