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Psoriatic arthritis biologic selection — SCE Rheumatology MCQ

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HardSpondyloarthropathiesPsoriatic arthritis biologic selectionSCE Rheumatology

A 32-year-old has newly diagnosed adult-onset Still disease with quotidian fever, evanescent rash, inflammatory polyarthritis and ferritin 18,000 micrograms/L. Infection and malignancy have been reasonably excluded; there is no macrophage activation syndrome. Which disease-modifying strategy best reflects current EULAR/PReS recommendations?

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Correct answer: D — Introduce IL-1 or IL-6 inhibition early with a short glucocorticoid course

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

B is correct. Modern Still-disease management seeks rapid control and glucocorticoid withdrawal through early IL-1 or IL-6 inhibition rather than a prolonged steroid-only course or mandatory conventional-DMARD ladder. A embeds cumulative glucocorticoid harm. C delays effective treatment by imposing three unsupported sequential failures. D assigns first-line priority to a less consistently effective mechanism and wrongly separates adult from paediatric biology. E confuses a disease-activity and macrophage-activation marker with a contraindication. The diagnosis still requires careful exclusion of infection and malignancy, and emerging macrophage activation syndrome would alter urgency and combination treatment, but neither issue justifies a year of glucocorticoid monotherapy in the stated case.

Reference: EULAR/PReS recommendations for Still disease across children and adults: https://pmc.ncbi.nlm.nih.gov/articles/PMC11672000/