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Psoriatic arthritis with Crohn's disease — SCE Rheumatology MCQ

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HardSpondyloarthropathiesPsoriatic arthritis with Crohn's diseaseSCE Rheumatology

A patient with active psoriatic arthritis has severe plaque psoriasis after TNF-inhibitor failure and recurrent mucocutaneous candidiasis. There is no uveitis or inflammatory bowel disease. Which targeted option is most appropriate to discuss?

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

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Correct answer: D — Guselkumab, an interleukin-23 p19 inhibitor

The severe skin domain favours an effective psoriasis mechanism, while recurrent candidiasis makes IL-17 blockade less attractive. An IL-23 inhibitor such as guselkumab is a rational option after TNF-inhibitor failure, subject to NICE eligibility and shared assessment of infection risk.

Reference: 2022 BSR guideline for psoriatic arthritis with biologic and targeted synthetic DMARDs (Published May 2022; corrected January 2023): https://academic.oup.com/rheumatology/article/61/9/e255/6594139; NICE TA711: guselkumab for active psoriatic arthritis (Published June 2021): https://www.nice.org.uk/guidance/ta711/chapter/1-Recommendations