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Psoriatic Arthritis — SCE Dermatology MCQ

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ModerateInflammatory DermatosesPsoriatic ArthritisSCE Dermatology

A 28-year-old man has psoriatic arthritis with dactylitis ('sausage digit') of his right 3rd toe and enthesitis at the Achilles insertion. His skin psoriasis is mild (PASI 3). He is being considered for a biologic that treats both skin and joint disease. Which biologic class has the broadest musculoskeletal evidence across peripheral arthritis, axial disease, dactylitis, and enthesitis?

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Correct answer: D — TNF-alpha inhibitor (Adalimumab/Infliximab)

TNF-alpha inhibitors (Adalimumab, Infliximab, Certolizumab, Golimumab, Etanercept) have the broadest and longest evidence base across ALL musculoskeletal domains of PsA: peripheral arthritis, axial disease, dactylitis, enthesitis, and structural progression. IL-17 inhibitors (Secukinumab, Ixekizumab) also have good musculoskeletal evidence including axial disease. IL-23 inhibitors show efficacy in peripheral arthritis, dactylitis, and enthesitis but have limited axial disease data. Ustekinumab has more modest musculoskeletal efficacy. The choice depends on the dominant clinical domain, comorbidities, and skin severity. GRAPPA guidelines recommend domain-based treatment selection.

Reference: NICE PsA Pathway; GRAPPA 2021; BAD 2020