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PsA Enthesitis Treatment — SCE Rheumatology MCQ

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HardSpondyloarthropathyPsA Enthesitis TreatmentSCE Rheumatology

A 45-year-old woman with PsA has enthesitis of the Achilles tendon confirmed on ultrasound showing thickening hypoechogenicity and power Doppler signal at the insertion. She has failed NSAIDs. According to GRAPPA recommendations what is the next treatment step for persistent enthesitis?

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Correct answer: C — Biologic therapy (TNF inhibitor or IL-17 inhibitor)

The best answer is “Biologic therapy (TNF inhibitor or IL-17 inhibitor)”. Biologic therapy (TNF inhibitor or IL-17 inhibitor) is supported by the cited UK or directly applicable specialist authority and best matches the tested threshold, complication or monitoring principle. The remaining choices—“Sulfasalazine, after specialist assessment, after specialist assessment”, “Methotrexate, with clinical reassessment, with clinical reassessment”, “Intra-tendinous corticosteroid injection, within a rheumatology pathway”, “Hydroxychloroquine, after specialist assessment, after safety review”—are credible in related rheumatology presentations, but each addresses a different diagnosis, investigation, treatment sequence or complication and does not fit the decisive findings in this stem.

Reference: NICE NG65 spondyloarthritis: https://www.nice.org.uk/guidance/ng65/chapter/Recommendations