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Psoriatic arthritis — SCE Rheumatology MCQ

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ModerateSpondyloarthropathiesPsoriatic arthritisSCE Rheumatology

A 74-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. 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: C — Ixekizumab

Ixekizumab is the best answer because ixekizumab best matches the disease domain and escalation pathway for psoriatic arthritis. Mepolizumab is a plausible distractor, but it does not account for the key discriminator in the stem. Adalimumab and Anakinra would be more appropriate in a different clinical pattern or at another point in the pathway, while Infliximab 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