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Psoriasis — SCE Dermatology MCQ

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ModerateDermatopharmacologyPsoriasisSCE Dermatology

A 52-year-old woman with chronic plaque psoriasis is started on Methotrexate 15 mg once weekly. According to BAD/NICE guidelines, which blood test is recommended for serial monitoring of hepatic fibrosis risk?

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Correct answer: C — Procollagen III N-terminal peptide (PIIINP) every 3 months

The BAD and Manchester guidelines recommend serial PIIINP measurement (baseline then every 2-3 months) for monitoring hepatic fibrosis in patients on long-term Methotrexate for psoriasis. Liver biopsy is indicated when PIIINP is persistently elevated (>4.2 mcg/L on three occasions in 12 months or any value >8.0 mcg/L on two consecutive samples). This approach significantly reduces the need for liver biopsy compared to the older American approach of routine biopsy at cumulative doses.

Reference: BAD 2016 Methotrexate for Skin Disease Guidelines