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Ankylosing Spondylitis — SCE Rheumatology MCQ

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HardSpondyloarthropathyAnkylosing SpondylitisSCE Rheumatology

A 40-year-old man has radiographic axial spondyloarthritis with persistently active axial symptoms despite adequate trials of two NSAIDs. During the previous 12 months he has had three ophthalmologist-confirmed episodes of acute anterior uveitis. He has no inflammatory bowel disease or clinically significant psoriasis and has not previously received a biologic or targeted synthetic DMARD. According to current BSR guidance, which advanced therapy is the best choice from the options below if prevention of further uveitis recurrence is a major treatment objective?

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Correct answer: A — Adalimumab

Adalimumab is the best answer. Recurrent acute anterior uveitis is an extra-musculoskeletal manifestation for which monoclonal TNF inhibitors are preferred in axial spondyloarthritis. Among the listed agents, adalimumab is a monoclonal TNF inhibitor and has supportive comparative evidence for reducing recurrent uveitis. Etanercept is a soluble TNF-receptor fusion protein and is less reliable for this objective; comparative data show more recurrent uveitis than with adalimumab. Secukinumab and ixekizumab are IL-17A inhibitors: they are effective for axial disease but are not preferred where recurrent uveitis drives treatment selection. Tofacitinib is a targeted synthetic JAK inhibitor rather than a biologic and lacks comparable evidence for prevention of recurrent anterior uveitis in axSpA. If uveitis developed despite confirmed adherence to adalimumab, reassessment and consideration of switching to another monoclonal TNF inhibitor would be appropriate.

Reference: British Society for Rheumatology. The 2025 British Society for Rheumatology guideline for the treatment of axial spondyloarthritis with biologic and targeted synthetic DMARDs. 2025. https://pubmed.ncbi.nlm.nih.gov/40199504/