Psoriatic arthritis biologic therapy — SCE Rheumatology MCQ

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ModerateSpondyloarthropathiesPsoriatic arthritis biologic therapySCE Rheumatology

A 52-year-old man has active psoriatic arthritis with five swollen joints and severe plaque psoriasis. He has failed methotrexate and sulfasalazine. There is no inflammatory bowel disease and TB screening is negative. Dermatology notes extensive skin disease despite topical therapy. What is the most appropriate biologic?

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Correct answer: B — Secukinumab

Explanation lettering: C = shown as A · D = shown as B · B = shown as C · E = shown as D · A = shown as E

Secukinumab is best because an IL-17 inhibitor such as secukinumab is a NICE-approved option for active psoriatic arthritis and can also improve significant psoriasis. A is less suitable because belimumab treats SLE; B is less suitable because cyclophosphamide is not routine PsA treatment; C is less suitable because rituximab is not a PsA biologic pathway; E is less suitable because mepolizumab treats eosinophilic disease such as EGPA. Clinical pearl: skin severity can steer biologic choice in PsA when joint eligibility is met.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/musculoskeletal-conditions