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Psoriatic Arthritis — SCE Dermatology MCQ

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HardInflammatory DermatosesPsoriatic ArthritisSCE Dermatology

A man with plaque psoriasis reports inflammatory back pain and alternating buttock pain. His PEST score is 1, examination shows no peripheral synovitis and plain radiographs are normal. What is the most appropriate next step?

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

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Correct answer: A — Rheumatology assessment for inflammatory axial symptoms in a patient with psoriasis

Explanation lettering: E = shown as A · D = shown as B · A = shown as C · C = shown as D · B = shown as E

E is correct. NICE recommends prompt rheumatology referral whenever psoriatic arthritis is suspected and specifically warns that PEST does not detect axial arthritis or inflammatory back pain. A low PEST score therefore cannot exclude the phenotype described. Repeating PEST delays assessment; nail mycology does not address inflammatory spinal disease; rheumatoid factor neither rules in nor rules out axial PsA; and topical skin treatment will not prevent structural axial damage. Normal plain films also do not exclude early axial spondyloarthritis, so the clinical pattern should drive referral.

Reference: NICE CG153 psoriasis recommendations: https://www.nice.org.uk/guidance/cg153/chapter/Recommendations