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Ankylosing Spondylitis — SCE Rheumatology MCQ

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EasySpondyloarthropathyAnkylosing SpondylitisSCE Rheumatology

A 25-year-old man has axial spondyloarthritis causing inflammatory back pain and stiffness, with no peripheral arthritis. He asks whether treatment with a conventional synthetic disease-modifying antirheumatic drug would improve his axial symptoms. Which statement best reflects the current evidence?

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Correct answer: D — No conventional synthetic DMARD has established efficacy for purely axial symptoms

Conventional synthetic DMARDs, including methotrexate, sulfasalazine and leflunomide, have no established efficacy for purely axial manifestations of axial spondyloarthritis and should not be used to treat inflammatory back pain or stiffness. Sulfasalazine may be considered when clinically important peripheral arthritis is present, but that exception is excluded in this stem. Methotrexate and leflunomide do not provide an effective alternative for axial disease, and hydroxychloroquine has no therapeutic role in axial inflammation. Management should instead include exercise and physiotherapy plus NSAIDs where appropriate. If disease remains active despite conventional management, eligibility for a biologic or targeted synthetic DMARD should be assessed according to NICE and BSR criteria; failure of a csDMARD is not required.

Reference: Ramiro S et al. ASAS-EULAR recommendations for the management of axial spondyloarthritis: 2022 update, Recommendation 8. Ann Rheum Dis. 2023;82:19-34. https://pubmed.ncbi.nlm.nih.gov/36270658/