Psoriatic arthritis with severe skin disease — SCE Rheumatology MCQ

Instant feedback + full explanation. One question, done properly.

HardSpondyloarthropathiesPsoriatic arthritis with severe skin diseaseSCE Rheumatology

A 53-year-old woman has active peripheral psoriatic arthritis despite methotrexate and extensive plaque psoriasis without inflammatory bowel disease. What is the most appropriate management?

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

Reveal the answer and explanation

Correct answer: E — Escalate to a biologic targeting TNF or IL-17 pathways

Escalate to a biologic targeting TNF or IL-17 pathways is the single best answer because dominant skin and joint disease after csDMARD failure favours biologic escalation. The stem is testing management choice, not isolated recall, so the relevant clinical pattern and risk context determine the answer. Mechanical back pain is less suitable because it fits a different clinical pattern or a different treatment threshold; Rheumatoid arthritis, Methotrexate for isolated axial symptoms and Rituximab do not address the key discriminator in this vignette. Clinical pearl: in SCE-style rheumatology questions, autoantibodies, imaging and synovial fluid findings should be interpreted with the whole phenotype.

Reference: NICE NG65; BSR psoriatic arthritis and axial spondyloarthritis guidance