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Psoriatic arthritis — SCE Rheumatology MCQ

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EasySpondyloarthropathiesPsoriatic arthritisSCE Rheumatology

A 63-year-old man has inflammatory joint pain with heel pain and a scaly rash behind the ears. Examination shows dactylitis of one toe and nail pitting. Investigations show rheumatoid factor is negative and radiographs show juxta-articular new bone formation. The diagnosis is established and symptoms remain clinically important despite initial supportive measures. There is no contraindication to disease-modifying or anti-inflammatory escalation. What is the most appropriate management?

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

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Correct answer: B — Methotrexate

Methotrexate is the best answer because methotrexate is the most appropriate next step for psoriatic arthritis in this clinical setting. Urgent antibiotics is a plausible distractor, but it does not account for the key discriminator in the stem. Local corticosteroid injection and Secukinumab would be more appropriate in a different clinical pattern or at another point in the pathway, while Increase NSAID therapy is suboptimal for this presentation. Clinical pearl: rheumatology management is generally treat-to-target, but infection risk, pregnancy plans and shared-care monitoring often determine the safest answer.

Reference: NICE NG65; EULAR/ASAS axial spondyloarthritis recommendations; BNF