Master the board step 3

Master the Boards: USMLE Step 3
No single test is specific for
psoriatic arthritis.
Psoriasis involvement of the nail produces
pitting and yellowing, which can be mistaken
for onychomycosis.
Diagnostic Testing
No single test is specific for psoriatic arthritis.
Treatment
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Best initial therapy: NSAIDs
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Methotrexate is used for resistant disease.
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Infliximab and the other anti-TNF agents are effective.
Basic Science Correlate
Mechanism of Anti-TNF Reactivation of TB
Most TB is reactivation TB. Old TB is encased off in granulomas. Granulomas
are held together by TNF. When you start a TNF inhibitor, it breaks open
granulomas and the TB escapes to reactivate.
Juvenile Rheumatoid Arthritis (JRA)
JRA, or adult-onset Still’s disease, presents with:
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Fever
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Salmon-colored rash
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Polyarthritis
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Lymphadenopathy
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Myalgias
This can be a very difficult diagnosis to recognize. Additional minor criteria
are the presence of hepatosplenomegaly and elevated transaminases.
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