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Case 1
Helen is a 56 year old woman with a 14 year history of psoriatic arthritis. She presented with early morning stiffness, inflammatory neck and lower back pain and dactylitis, with a history of scalp psoriasis. She initially responded well to salazopyrin 1g bd, with intermittent use of diclofenac and short courses of prednisone to control occasional flares, most in the peripheral joints. Salazopyrin was ceased 6 months ago due to a mild neutropaenia (PMN 1.6). She presents with a 2 month history of worsening inflammatory pain in the thoracic and lumbar spines, sacroiliac joints and anterior chest wall pain.
Q. What are the relevant patient assessments and laboratory investigations?
Q. What are the management options?
Case 2
A 21 year old student with psoriatic arthritis presented with a 6 month history of mild pain, stiffness and swelling in her left knee. The right knee had also been mildly swollen for a few weeks. She developed psoriatic arthritis 6 years ago with a large joint, lower limb oligoarthritis affecting knees and ankles. She has been treated with Methotrexate 10 mg weekly and etanercept 25mg twice a week for four years with complete control of disease activity. On examination she had a large effusion in the left knee and a small effusion in her right knee.
Q. What are the other relevant patient assessments and laboratory investigations?
Q. What are the management options?
Case 3
Olive is a 72 year old woman with three year history of seropositive rheumatoid arthritis, that had been well controlled on Methotrexate 15mg weekly and hydroxychloroquine 200mg daily. She has hypertension treated with Accuretic. After a brief admission for severe gastroenteritis, methotrexate was left off her discharge medication list so Olive stopped taking it. She presented 3 months later with synovitis affecting both wrists, index and middle finger MCPJs.
Q. What are the other relevant patient assessments and laboratory investigations?
Q. What are the management options?
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