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Behçet disease — SCE Rheumatology MCQ

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HardVasculitisBehçet diseaseSCE Rheumatology

A 38-year-old man has recurrent oral ulcers, genital ulcers and painful red eyes. Examination shows papulopustular lesions and a positive pathergy test are present. Investigations show HLA-B51 is positive. Conventional therapy has been optimised and a biologic or targeted agent is being considered according to UK specialist practice. Infection screening has been completed and shared-care monitoring is in place. What is the most appropriate biologic?

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Correct answer: A — Infliximab

Infliximab is the best answer because infliximab best matches the disease domain and escalation pathway for behçet disease. Anakinra is a plausible distractor, but it does not account for the key discriminator in the stem. Rituximab and Etanercept would be more appropriate in a different clinical pattern or at another point in the pathway, while Secukinumab is suboptimal for this presentation. Clinical pearl: biologic choice depends on disease domain, previous biologic exposure, comorbidity, infection screening and commissioning criteria.

Reference: BSR GCA guideline; EULAR ANCA-associated vasculitis recommendations; BNF