How would you treat a patient with Ig A nephropathy and diabetic glomerulosclerosis on biopsy who also has psoriatic arthritis treated with Humira and Cr already above 2 mg/dl.
Is there any other therapy option other than ACE inhibitors/ARB and fish oil. If this patient had a serum creatinine 2mg/dl on presentation, would steroids and /or immunosuppresion have been an option? How would either of these therpy options (steroids or immunosuppression) interact with treatment for psoriatic arthritis with drugs like Humira or Remicade?