Psoriatic arthritis — SCE Rheumatology MCQ

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ModerateSpondyloarthropathiesPsoriatic arthritisSCE Rheumatology

A 39-year-old woman with psoriatic arthritis has persistent swollen wrists, MCPs and knees despite NSAIDs and local steroid injections. She has mild plaque psoriasis and no axial symptoms. Baseline blood tests are normal and pregnancy is not planned. What is the most appropriate management?

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Correct answer: D — Start methotrexate

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

Start methotrexate is best because peripheral psoriatic arthritis with polyarthritis should be treated with a conventional DMARD such as methotrexate. A is less suitable because waiting for erosions risks preventable damage; C is less suitable because alendronic acid treats osteoporosis and not synovitis; D is less suitable because long-term antibiotics are not treatment for established PsA; E is less suitable because colchicine treats crystal inflammation and not PsA as DMARD. Clinical pearl: peripheral PsA treatment differs from axial SpA because csDMARDs have a role.

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