American Board of Internal Medicine (ABIM) Certification Practice Exam

Which monoclonal antibody can be used for patients with refractory peripheral psoriatic arthritis?

1. Ustekinumab

2. Secukinumab

3. Adalimumab

4. Etanercept

The correct answer is: Secukinumab

Secukinumab is a monoclonal antibody that targets interleukin-17A (IL-17A), which plays a significant role in the inflammatory processes associated with psoriasis and psoriatic arthritis. In cases of refractory peripheral psoriatic arthritis, secukinumab has been shown to provide effective relief and improvements in both joint symptoms and skin lesions. It is specifically indicated for psoriatic arthritis and has demonstrated strong efficacy in clinical trials, making it a suitable choice for patients who have not responded adequately to other treatments. The other options also target various pathways involved in psoriasis and psoriatic arthritis but are generally considered after secukinumab or may not have as strong evidence for use in refractory cases. Ustekinumab targets interleukin-12 and interleukin-23 and is effective for psoriasis but may not be as specifically beneficial in refractory psoriatic arthritis. Adalimumab and etanercept are both tumor necrosis factor (TNF) inhibitors and are widely used for psoriatic arthritis, yet some patients may not respond sufficiently to these agents, particularly in more complex, refractory cases. Hence, secukinumab is a preferred option in this context due to its unique mechanism of action and demonstrated effectiveness