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SAPHO syndrome — SCE Rheumatology MCQ

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ModerateSpondyloarthropathiesSAPHO syndromeSCE Rheumatology

A 42-year-old woman has anterior chest wall pain and pustular skin lesions. Examination shows sternoclavicular tenderness is present. Investigations show bone scan shows uptake at the sternoclavicular region. 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: B — Adalimumab

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

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