Diagnosis: Psoriasis and Psoriatic Arthropathy Treated With Methotrexate Administered Intravenously. Presented by Drs. R. Auerbach, N. Orentreich, and R. Berger.
A 55-year-old white male has been disabled with pain and swelling of the right wrist and fingers since April, 1963. Shortly after that date he developed extensive psoriasis with severe involvement of the nails.When first seen in August, 1963, the right wrist was swollen to approximately twice its normal size. The interphalangeal and metacarpophalangeal joints were similarly affected, as was the interphalangeal joint of the first left toe. There were welldemarcated, erythematous plaques covered by adherent, white scales on his palms and back.He had been treated with several salves, including a tar cream, and with triamcinolone by mouth (4 mg t.i.d.). Under this regimen the condition continued to worsen.Laboratory studies of the blood and for kidney and liver function revealed normal values.Present treatment was started with