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PsA Skin-Predominant Treatment — SCE Rheumatology MCQ

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HardSpondyloarthropathyPsA Skin-Predominant TreatmentSCE Rheumatology

A patient with psoriatic arthritis has excellent joint control on a TNF inhibitor but develops a new sharply demarcated palmoplantar pustular eruption. There was no psoriasis at these sites before treatment. What is the best interpretation?

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Correct answer: A — Paradoxical palmoplantar psoriasiform eruption emerging during TNF-inhibitor therapy

TNF inhibitors can paradoxically induce new psoriasiform disease, often with a palmoplantar pustular pattern despite control of the underlying arthritis. Dermatology–rheumatology review should confirm the phenotype and decide whether topical treatment, continuation or a mechanism switch is appropriate.

Reference: 2022 BSR guideline for psoriatic arthritis with biologic and targeted synthetic DMARDs (Published May 2022; corrected January 2023): https://academic.oup.com/rheumatology/article/61/9/e255/6594139; BSR biologic DMARD safety guideline in inflammatory arthritis — executive summary (Published 2019; update in development): https://academic.oup.com/rheumatology/article/58/2/220/5076445