Correct!
4. 1 and 3

The histology would be consistent with rheumatoid arthritis-associated lung disease but also consistent with other connective tissue disease-related disorders including psoriasis (3,4). However, the lack of signs of rheumatoid arthritis, the rheumatoid factors being only very weakly positive and previous reports of psoriatic interstitial lung disease with similar histology suggest psoriasis as the most likely diagnosis. Interstitial pneumonia is relatively rare in the setting of psoriasis. In a series of 392 psoriasis patients there was only an incidence of 2% (5). The mechanism(s) for psoriatic lung disease is poorly understood but may be a result of chronic inflammation (6).

What could be done to treat psoriatic lung disease? (Click on the corrrect answer to be directed to the sixth and final page)

1. There are reports of improvement in psoriatic lung disease with secukinumab.
2. The best choice for therapy is unclear but a trial of methotrexate might be warranted.
3. There are reports of secukinumab exacerbating psoriatic lung disease.
4. 1 and 3
5. All of the above

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