skip to main content

Axial PsA Treatment — SCE Rheumatology MCQ

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

ModerateSpondyloarthropathyAxial PsA TreatmentSCE Rheumatology

A 48-year-old woman with PsA has been on Methotrexate 25 mg weekly for 6 months without achieving MDA. She has significant axial disease alongside peripheral arthritis. What is the most appropriate treatment escalation?

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

Reveal the answer and explanation

Correct answer: B — Biologic therapy (TNF inhibitor or IL-17 inhibitor) as conventional csDMARDs including Methotrexate have NO proven efficacy for axial SpA

A critical principle in axSpA (including axial PsA) is that conventional csDMARDs (Methotrexate Sulfasalazine Leflunomide Hydroxychloroquine) have NO proven efficacy for axial disease. BSR 2022 PsA and 2025 axSpA guidelines recommend targeted therapy (TNF inhibitors IL-17 inhibitors or JAK inhibitors) for axial disease that has failed NSAIDs. The choice between biologics should consider the domain-based approach: TNF inhibitors are effective across most PsA domains; IL-17 inhibitors are particularly effective for axial disease and skin but should be avoided with IBD. csDMARD failure for peripheral disease typically precedes biologic escalation but for axial disease csDMARD trial is not required.

Reference: BSR 2025 axSpA; BSR 2022 PsA guidelines