A 35-year-old woman presents to clinic with the skin lesions (shown) and joint pain. She was previously well controlled on guselkumab, but has flared since her dog was diagnosed with cancer. She has previously failed various treatments including topical steroids, methotrexate, narrow-band UVB, adalimumab, ixekizumab, and etanercept. She developed transaminitis and hepatic steatosis in response to adalimumab, and the other biologics lost efficacy after a few months of treatment. She also notably developed nephrotic-range proteinuria after her last pregnancy, which required treatment with Rituxan.

Which of the following is the next best step in management?

A. Stop guselkumab; trial narrow-band UVB

B. Stop guselkumab, restart topical steroids

C. Continue guselkumab, start topical steroids and low-dose methotrexate

D. Stop guselkumab, start secukinumab

E. Stop guselkumab, start cyclosporine

To find out the correct answer and read the explanation, click here.

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