skip to main content

PsA Nail Disease Treatment — SCE Rheumatology MCQ

Instant feedback + full explanation. One question, done properly.

ModerateSpondyloarthropathyPsA Nail Disease TreatmentSCE Rheumatology

A 45-year-old woman with psoriatic arthritis has functionally troublesome nail psoriasis affecting eight fingernails, with pitting, onycholysis and subungual hyperkeratosis. Her peripheral synovitis is controlled with methotrexate, but appropriate topical nail treatment has been ineffective. Following multidisciplinary assessment, systemic targeted treatment is considered appropriate. Among the listed biologics, which has the highest probability of achieving complete nail psoriasis resolution at approximately 24–26 weeks according to comparative network meta-analysis?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: C — Ixekizumab

Ixekizumab is correct. Nail psoriasis should be assessed as a distinct psoriatic disease domain when treatment is selected. Comparative network meta-analyses using complete nail clearance at approximately weeks 24–26 ranked ixekizumab highest among the evaluated biologics. One analysis estimated a 46.5% probability of complete resolution and a SUCRA ranking of 97%; a later analysis again found ixekizumab most likely to be the best treatment. Infliximab, adalimumab, ustekinumab and guselkumab can all improve nail psoriasis, so they are plausible alternatives, but they ranked lower for complete clearance. The evidence supports an agent-specific conclusion rather than claiming that every IL-17 inhibitor is necessarily superior to every other biologic. In UK practice, initiation must also satisfy the relevant NICE pathway and account for other PsA domains and comorbidities.

Reference: Husein-ElAhmed H, Husein-ElAhmed S. Bayesian network meta-analysis of head-to-head trials for complete resolution of nail psoriasis. Clinical and Experimental Dermatology. 2023;48:895–902. https://pubmed.ncbi.nlm.nih.gov/37052062/