American Board of Internal Medicine (ABIM) Certification Practice Exam

What condition should raise suspicion when a patient with psoriatic arthritis experiences a severe flare?

1. Rheumatoid arthritis

2. HIV infection

3. Gout

4. Multiple sclerosis

The correct answer is: HIV infection

When a patient with psoriatic arthritis experiences a severe flare, suspicion for HIV infection is warranted due to the associated immune system compromise and increased susceptibility to opportunistic infections and inflammatory conditions in patients living with HIV. Psoriatic arthritis is primarily an autoimmune condition, and individuals with autoimmune diseases often have a higher risk of various infections. HIV can lead to a significant change in the immune response, which may exacerbate underlying conditions like psoriatic arthritis, leading to more severe symptoms or flares. Therefore, noticing an unexpected change in a patient’s condition should prompt consideration of underlying factors such as opportunistic infections or other HIV-related complications, emphasizing the importance of screening and testing in these situations. While other conditions like rheumatoid arthritis, gout, and multiple sclerosis can also involve arthritis symptoms, they do not directly relate to the sudden and severe exacerbation of symptoms in this context as closely as HIV does.