skip to main content

Mild Paradoxical Psoriasis Management — SCE Rheumatology MCQ

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

EasyRheumatology PharmacologyMild Paradoxical Psoriasis ManagementSCE Rheumatology

A 50-year-old man with RA on Adalimumab and Methotrexate develops new-onset psoriasis on his scalp confirmed by dermatology. The psoriasis is mild and responds to topical treatment. His RA is well controlled. Should the Adalimumab be changed?

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

Reveal the answer and explanation

Correct answer: A — Continue adalimumab with topical psoriasis treatment

BSR biologic safety guidelines recommend a pragmatic approach: mild paradoxical psoriasis that responds to topical therapy does not mandate biologic change if the underlying inflammatory condition is well controlled. Potent topical steroids vitamin D analogues and emollients can manage mild-moderate psoriasis. If psoriasis is severe refractory to topical therapy or significantly impacts quality of life then switching biologic class should be considered. The balance between RA disease control and psoriasis management should guide the decision through rheumatology-dermatology collaboration.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/musculoskeletal-conditions