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Psoriatic Arthritis — SCE Dermatology MCQ

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ModerateInflammatory DermatosesPsoriatic ArthritisSCE Dermatology

A 55-year-old woman with psoriasis and psoriatic arthritis has joint erosions visible on X-ray. She is being started on a biologic. What is the evidence that biologics can inhibit radiographic progression of joint erosions in psoriatic arthritis?

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Correct answer: B — Anti-TNF and IL-17 inhibitors have demonstrated inhibition of radiographic structural progression in PsA clinical trials

TNF-alpha inhibitors (Adalimumab, Infliximab, Golimumab, Certolizumab) and IL-17 inhibitors (Secukinumab, Ixekizumab) have demonstrated inhibition of radiographic structural progression (joint space narrowing and erosion development) in randomised controlled trials for PsA. This disease-modifying property is a key distinction between biologics and conventional DMARDs (Methotrexate has NOT convincingly demonstrated radiographic progression inhibition in PsA). IL-23 inhibitors (Guselkumab) and IL-12/23 inhibitors (Ustekinumab) also show structural benefit but with less robust data. Early initiation of effective therapy is critical to prevent irreversible joint damage in PsA.

Reference: NICE PsA Pathway; GRAPPA 2021; BAD 2020