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Psoriatic Arthritis — RACP Adult Medicine MCQ

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ModerateRheumatologyPsoriatic ArthritisRACP Adult Medicine

A 30-year-old man with psoriatic arthritis develops dactylitis of the third right toe and enthesitis at the Achilles tendon insertion. He has failed methotrexate after 4 months at 25 mg weekly. According to Australian guidelines, what is the next-line treatment?

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Correct answer: E — TNF inhibitor (e.g. adalimumab)

For psoriatic arthritis with dactylitis and enthesitis that has failed methotrexate, biologic therapy is indicated. TNF inhibitors are typically first-line biologics for PsA in Australia (PBS-listed). Both TNF inhibitors and IL-17 inhibitors (secukinumab, ixekizumab) are effective for PsA with dactylitis and enthesitis. The choice depends on comorbidities (IL-17i preferred for skin-predominant disease; TNFi preferred for concomitant IBD).

Reference: eTG – 2025 – Rheumatology; GRAPPA – 2024 – PsA Treatment Recommendations; PBS – 2025