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IBD-Associated SpA — SCE Rheumatology MCQ

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HardSpondyloarthropathyIBD-Associated SpASCE Rheumatology

A 30-year-old man with ulcerative colitis has inflammatory back pain and MRI-confirmed bilateral sacroiliitis. HLA-B27 is negative. Which diagnosis best accounts for this presentation?

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Correct answer: C — Enteropathic axial spondyloarthritis, after specialist assessment, with clinical reassessment

The best answer is “Enteropathic axial spondyloarthritis, after specialist assessment, with clinical reassessment”. Inflammatory back pain with objective sacroiliitis in a person with inflammatory bowel disease supports enteropathic axial spondyloarthritis; a negative HLA-B27 result does not exclude the diagnosis. The remaining choices—“Mechanical low-back pain, with clinical reassessment, after specialist assessment, within a rheumatology pathway”, “Septic sacroiliitis, within a rheumatology pathway, with clinical reassessment, after safety review”, “Crystal-associated sacroiliitis, after safety review, within a rheumatology pathway”, “Lumbar disc prolapse, after specialist assessment, after safety review, with clinical reassessment”—are credible in related rheumatology presentations, but each addresses a different diagnosis, investigation, treatment sequence or complication and does not fit the decisive findings in this stem.

Reference: NICE NG65 spondyloarthritis: https://www.nice.org.uk/guidance/ng65/chapter/Recommendations