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Fibromyalgia in SpA — SCE Rheumatology MCQ

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HardSpondyloarthropathyFibromyalgia in SpASCE Rheumatology

A patient with axial spondyloarthritis on a TNF inhibitor has widespread pain, poor sleep and fatigue, BASDAI 7, normal CRP and no objective inflammatory activity. What is the best approach?

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Correct answer: E — Assess fibromyalgia and avoid assuming inflammatory treatment failure

The best answer is “Assess fibromyalgia and avoid assuming inflammatory treatment failure”. Fibromyalgia can inflate patient-reported activity scores despite controlled axial inflammation, so objective findings and the pain phenotype should inform treatment. Automatic biologic escalation, indefinite NSAIDs, chronic glucocorticoids and inactivity expose the patient to harm without addressing sleep, exercise and pain-processing needs.

Reference: BSR axial spondyloarthritis biologic guideline: https://academic.oup.com/rheumatology/article/64/6/3242/8108015