Table 4

Case descriptions

CaseHistory/symptomsRecommendation(s)
119-year-old male student:History of psoriasis.Presented with disabling bilateral Achilles tendonitis and right plantar fasciitis.Unable to bear weight.Initial treatment (without sustained relief) included two different NSAIDs, a 10-day course of oral corticosteroids, physiotherapy and plantar fascia injection.Symptoms have been present for 10 weeks.Mild scalp psoriasis that is well controlled with topical agents.This patient has severe enthesitis and mild skin disease (see table 3), and he has failed therapies for mild and moderate enthesitis; a TNF inhibitor should be considered.
234-year-old male:Moderate to severe psoriasis since childhood.2-year history of inflammatory back pain with unilateral grade 2 sacroiliitis on a plain film of the AP pelvis; his BASDAI is 5.6.Used topical agents and phototherapy for psoriasis; has been treated with two different NSAIDS and an exercise program with no change in the BASDAI.No loss of function but mild impairment in QoL.Percentage of BSA with plaque is 5%, which is having a significant negative impact on QoL, more than the back pain.DLQI is 7.2.This patient has moderate axial disease and moderate skin involvement (see table 3). For his axial disease, it is recommended that he have education, analgesia and sacroiliac injection. For his skin disease, a systemic agent is warranted. If the combination of axial and skin disease is severely impairing QoL and/or function, a TNF inhibitor may be considered