Correct!
4. 1 and 3

It had been thought that ILD in patients with psoriasis was most often a result of drug-induced lung toxicity associated with medications used to treat psoriasis, such as methotrexate. Recent case series indicate an association of ILD with psoriasis in patients who have not received systemic therapy. Given this, methotrexate seemed to be a poor choice. Lately, there have been several case reports of patients with psoriasis-associated ILD having improvement in lung function after treatment of psoriasis with biologic therapies such as secukinumab an inhibitor of IL-17A (7,8).

The patient lives in Alabama and is now receiving secukinumab (Cosentyx®) through his dermatologist. He reports subjective improvement after 3 months of treatment and will be having follow-up lung function. 

References

1. Tiwari V, Jandu JS, Bergman MJ. Rheumatoid Factor. [Updated 2023 Jul 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532898/ (accessed 2/6/25).
2. De Rycke L, Peene I, Hoffman IE, et al. Rheumatoid factor and anticitrullinated protein antibodies in rheumatoid arthritis: diagnostic value, associations with radiological progression rate, and extra-articular manifestations. Ann Rheum Dis. 2004 Dec;63(12):1587-93. [CrossRef] [PubMed]
3. Spagnolo P, Lee JS, Sverzellati N, Rossi G, Cottin V. The Lung in Rheumatoid Arthritis: Focus on Interstitial Lung Disease. Arthritis Rheumatol. 2018 Oct;70(10):1544-1554. [CrossRef] [PubMed]
4. Butt YM, Smith ML, Tazelaar HD, Roden AC, Mengoli MC, Larsen BT. Surgical Pathology of Diffuse Parenchymal Lung Disease in Patients With Psoriasis or Psoriatic Arthritis. Arch Pathol Lab Med. 2022 May 1;147(5):525-533. [CrossRef] [PubMed]

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