Psoriatic Arthritis — SCE Rheumatology MCQ

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ModerateSpondyloarthropathyPsoriatic ArthritisSCE Rheumatology

A 32-year-old woman with psoriatic arthritis has active peripheral polyarthritis dactylitis and extensive skin psoriasis unresponsive to Methotrexate 25 mg weekly for 3 months. According to NICE guidance, which biologic would address all three disease domains?

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Correct answer: E — Adalimumab

Adalimumab (TNF inhibitor) has demonstrated efficacy across all three domains: peripheral arthritis, dactylitis, and skin psoriasis. Secukinumab and Ustekinumab are also effective but Adalimumab has the broadest established evidence base and is typically first-line. Etanercept is effective for joints but less effective for skin. Apremilast is a PDE4 inhibitor with more modest efficacy. BSR 2022 PsA guidelines recommend considering the predominant disease domain when selecting therapy.

Reference: BSR 2022 - Guideline for treatment of psoriatic arthritis with biologic and targeted synthetic DMARDs; NICE TA199 TA340 TA445