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Systemic juvenile idiopathic arthritis — SCE Rheumatology MCQ

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HardPaediatric rheumatologySystemic juvenile idiopathic arthritisSCE Rheumatology

A 74-year-old man has quotidian fever, salmon-pink rash and arthritis. Examination shows there is hepatosplenomegaly and knee synovitis. Investigations show ferritin and CRP are markedly raised. 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 — Anakinra

The best answer is “Anakinra”. Anakinra is the most appropriate next step after the disease phenotype, previous treatment and safety constraints in the stem are considered. The remaining choices—“Mepolizumab, after specialist assessment”, “Tocilizumab, with clinical reassessment”, “Canakinumab, within a rheumatology pathway”, “Ustekinumab, after safety review”—are credible in related rheumatology presentations, but each addresses a different diagnosis, investigation, treatment sequence or complication and does not fit the decisive findings in this stem.

Reference: NICE NG226 osteoarthritis: https://www.nice.org.uk/guidance/ng226/chapter/Recommendations