1. You currently have 14 patients who are being treated for psoriasis in various stages. How many of these patients should be screened for psoriatic arthritis?
A. 4
B. 7
C. 10
D. 14
E. Unsure
2. One of your patients who has psoriatic arthritis picks up a prescription for high potency corticosteroid with the directions, “Apply to scalp twice daily for seven days. Then use as directed.” After you provide counseling, he asks for a recommendation for nail fungus product. Why should this raise concerns?
A. Patients who have fungal infections should avoid using topical corticosteroids until the fungal infection has resolved
B. Onychomycosis will make it difficult if not impossible for him to start a biologic if he develops PsA
C. The patient may assume that he has a fungal infection when in actuality, he may have nail dystrophy
D. Patients who have psoriasis and develop onychomycosis tend not to respond to over-the-counter antifungals
E. Unsure
3. Patrick is a 49-year-old male who has had psoriasis for approximately 10 years. Recently, he was diagnosed with psoriatic arthritis. His main symptoms are spondylitis and axial disease. His physician has prescribed NSAIDs and methotrexate. Which of the following statements is TRUE?
A. This drug regimen is in keeping with current standard of care
B. This drug regimen would be in keeping with standard of care if the clinician added phototherapy
C. This drug regimen is too aggressive; the clinician should discontinue the methotrexate
D. A better drug regimen would be NSAIDs plus physical therapy plus and anti-TNF biologic
E. Unsure
4. Elvira is a 62-year-old woman who has had psoriatic arthritis for several years. She is currently on a regimen of NSAIDs when needed for pain, etanercept 50 mg subcutaneously once weekly, and methotrexate. Until recently, she was very satisfied with her response. She indicates that in the last month or so, she is terribly fatigued when she wakes in the morning, and she is experiencing more throbbing pain. Her prescriber asks you to recommend on next step. What would you recommend?
A. Schedule round-the-clock NSAIDs and discontinue the methotrexate
B. Consider switching to a different biologic with a different MOA
C. Stop all medication for a month, and then restart the same regimen
D. Continue the same regimen and add physical therapy
E. Unsure
5. Which of the following is a TNF-alpha inhibitor that is given intravenously and approved for psoriatic arthritis?
A. Adalimumab
B. Brodalumab
C. Golimumab
D. Tofacitinib
E. Unsure
6. Cindy is a patient who is already tried to TNF-? inhibitors and responded initially, but eventually developed increasing pain and decreased mobility. Her insurer will cover secukinumab and ustekinumab. She asks, “What's the difference between the two?” Choose the BEST answer.
A. There's no difference. Secukinumab and ustekinumab are both IL-17 inhibitors and decrease inflammation
B. Secukinumab is an oral drug and ustekinumab is given by IV infusion
C. Secukinumab and ustekinumab have different mechanisms of action, and if one fails, you may be able to use the other later
D. Secukinumab and ustekinumab are medications that are typically used after you have tried apremilast or tofacitinib.
E. Unsure
7. Which of the following medications would be best recommendation for a patient who has needle phobia and also takes a number of CYP3A4 inhibitors that are medically necessary?
A. Infliximab
B. Apremilast
C. Secukinumab
D. Tofacitinib
E. Unsure
8. In the much-anticipated American College of Rheumatology/National Psoriasis Foundation Guideline for the Management of Psoriatic Arthritis guideline, what change do we expect to see?
A. The guideline is expected to recommend a biologic TNF inhibitor over DMARDs as a first line option, eliminating the initial trial of conventional DMARDs
B. The guideline is expected to deemphasize the need for discussion between patients and their healthcare providers
C. The guideline will provide a much more structured approach to treating PsA based on numerous randomized controlled clinical trials
D. The guideline is expected to have an extensive section on switching between parenteral and oral medications
E. Unsure
9. Ralph has psoriatic arthritis with coexistent severe plaque psoriasis. His prescriber decides that he needs a trial on secukinumab. His sister Mary has psoriasis that is also severe, but she does not have psoriatic arthritis. Which of the following statements is TRUE?
A. Ralph's dose of secukinumab will be approximately twice that of Mary's
B. Mary's dose of secukinumab will be approximately twice that of Ralph's
C. Ralph and Mary would receive the same dose of secukinumab (300 mg every four weeks after loading)
D. Ralph and Mary would receive the same dose of secukinumab (150 mg every four weeks after loading)
E. Unsure
10. Select the statement that is TRUE.
A. Only approximately 30% of those with moderate disease and 21.5% of those with severe disease receive biologic therapy, indicating they are underutilized.
B. There is no genetic basis for psoriatic arthritis; it appears that development of this disease is random.
C. Patients who have PsA need to see a rheumatologist so they can be treated with biologics.
D. PsA is undertreated mainly because the screening process is elaborate and difficult to follow in primary care setting.
E. Unsure
Evaluation Questions
11. How confident are you in your recommendations for Elvira above?
A. Not at all confident
B. Somewhat confident
C. Confident
D. Highly confident
12. How confident are you in your decision about treatment for patients Ralph and Mary above?
A. Not at all confident
B. Somewhat confident
C. Confident
D. Highly confident