How would you manage a patient with Takayasu arteritis controlled on TNFi who develops erythema nodosum that is only partially responsive to NSAIDs?

Erythema nodosum and pyoderma gangrenosum (as well as erythema induratum) are well recognized as cutaneous manifestations of TAK. Unfortunately, we do not know how often cutaneous and the vascular disease are decoupled from each other due to a lack of available data. Most case series document association of cutaneous disease and TAK but do not correlate cutaneous to systemic disease activity.

Active skin disease should make you suspicious that there is systemic disease activity, but if labs, ima...