Psoriatic Arthritis — SCE Rheumatology MCQ

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ModerateSpondyloarthropathyPsoriatic ArthritisSCE Rheumatology

A 45-year-old man has active peripheral psoriatic arthritis requiring a biologic or targeted synthetic DMARD. He also has active Crohn disease. Which therapeutic class should be avoided because of the risk of worsening his bowel disease?

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Correct answer: B — IL-17 inhibitors

The correct answer is B, IL-17 inhibitors. In UK prescribing information, secukinumab is not recommended in patients with inflammatory bowel disease because new or exacerbated Crohn disease and ulcerative colitis have been reported. This is particularly relevant when Crohn disease is active. TNF inhibitors can be appropriate for both peripheral PsA and Crohn disease, although etanercept is not used to treat Crohn disease. IL-12/23 inhibition with ustekinumab is an established option across both diseases. JAK inhibitors include agents with indications in both PsA and Crohn disease, subject to their individual safety restrictions. IL-23 inhibition is also not intrinsically unsuitable: risankizumab has a UK indication for moderately to severely active Crohn disease. Choice should be coordinated with gastroenterology.

Reference: Electronic Medicines Compendium. Cosentyx (secukinumab) Summary of Product Characteristics, section 4.4: inflammatory bowel disease. Current UK SmPC. https://www.medicines.org.uk/emc/product/12953/smpc