A 42-year-old woman has psoriatic arthritis with persistent active peripheral synovitis of the hands and wrists despite 6 months of methotrexate 25

Question

A 42-year-old woman has psoriatic arthritis with persistent active peripheral synovitis of the hands and wrists despite 6 months of methotrexate 25 mg weekly. She also has clinically significant plaque psoriasis affecting the scalp and elbows, and Crohn disease that is currently quiescent on azathioprine. A biologic or targeted synthetic DMARD is now being considered. According to British Society for Rheumatology guidance, which approach should determine the choice of advanced therapy?

Accepted Answer

Select by integrating the active disease domains, associated conditions and comorbidities, prior therapy, and the patient's goals and preferences

Answer

Select the lowest-cost commissioned therapy, since disease phenotype does not materially affect class choice

Answer

Select the therapy with the greatest cutaneous efficacy, since psoriasis severity should determine the class chosen

Answer

Select on the basis of peripheral synovitis alone, managing the bowel and skin disease separately

Answer

Select any licensed advanced therapy, since efficacy is equivalent across the psoriatic arthritis domains

PsA Domain-Based Treatment — SCE Rheumatology MCQ