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Psoriatic arthritis — SCE Rheumatology MCQ

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EasySpondyloarthropathiesPsoriatic arthritisSCE Rheumatology

A 29-year-old woman 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: A — Local corticosteroid injection

Local corticosteroid injection is the best answer because local corticosteroid injection is the most appropriate next step for psoriatic arthritis in this clinical setting. Increase NSAID therapy is a plausible distractor, but it does not account for the key discriminator in the stem. Urgent antibiotics and Treat underlying infection would be more appropriate in a different clinical pattern or at another point in the pathway, while Mycophenolate mofetil 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