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Psoriatic arthritis — SCE Rheumatology MCQ

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ModerateSpondyloarthropathiesPsoriatic arthritisSCE Rheumatology

A 50-year-old man with psoriatic arthritis has swollen MCP joints and worsening plaques despite methotrexate. Examination shows dactylitis and nail pitting are present. Investigations show liver tests are stable and DAS-style joint activity remains high. What is the most appropriate management?

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Correct answer: B — Escalate to biologic or targeted synthetic therapy according to phenotype

Active psoriatic arthritis despite a conventional DMARD should be escalated to targeted therapy chosen by joint, skin, enthesitis and comorbidity phenotype. Long-term steroid monotherapy is not disease-modifying and can worsen psoriasis on withdrawal. Good psoriatic arthritis care integrates dermatology and rheumatology outcomes.

Reference: NICE NG65; BSR axial spondyloarthritis guideline; BNF